PVCs stop after Stroke

[Val]

My history is a Bovine aortic valve and aneurysm repair in 2005 and a Onx aortic valve and pacer in 2013.

This past March I started to have a lot of PVCs whenever I began to exercise ( or even walk fast) and when I sleep. My heart valve sounds became much louder. I started having angina and breathlessness with exercise when PVCs were bad.

Could not get an appointment with my cardiologist but office said that they would schedule and echo. They never scheduled the echo, but finally got my primary care doc to do it.

Cardiologist read the echo and said that all is fine and not to worry. Still hadn't had an office visit and I wasn't feeling fine Complained to my primary care who sent complaint up the line.

Ended up with a new cardiologist who examined me and my charts and said that all looked fine and that he can put me on meds for PVCs and that a loud mechanical valve was a healthy mechanical valve. Declined the med and have a follow up appointment in end of November.

PVCs had subsided some what but come back at the start of intense exercise .

Last week, on a trip, I has a minor stroke. Tingling in left side of lips, tip of tongue and left hand finger tips. Went to the ER in Zagreb and got a CT scan. My INR level was in the therapeutic range 2.6, my BP was high. Was told to follow up with my own doc, which I did yesterday, 7 days later, when I got home. I'll have a follow up CT scan, waiting for scheduling.

Now here's the weird part and the reason for this post. My heart valve sounds have gone back to Normal. I still hear the click but it doesn't keep me up at night. Also, PVCS are gone and I can exercise again. I'm still having some minor numbness in tongue and fingers but it gets better every day. BP is returning to normal. So what happened? Any guesses?

 

[pellicle]

Very interesting. Something changed that's for sure.

Any aspirin in the mix?

Ahh, checked your about and found

Medications asprin


There could be something to explain it that's missing, perhaps something apparently trivial. But it sounds like something like a thrombosis was forming on a leaflet that detached.

What's your normal INR and how frequently do you test?

Glad it's improving

Best Wishes

 

[Protimenow]

Oddly, I had a TIA with the same presentation - numbness on left side of tongue, left side of face, and left fingertips. It felt like I had a shot of novocaine, and the novocaine was wearing off. Symptoms resolved in about 2-3 days.

My INR was good before and after this. I keep it in range. My cardiologist thought it may have been a cholesterol plaque that dislodged. Who knows?

My PVCs haven't abated since my TIA. I've still got them.

You've confused me a bit -- you said you have a Bovine valve, then you mentioned mechanical valve. They're two different animals (well, one animal, and one carbon fiber) - I'm assuming that you meant mechanical.

I had a TIA (they called it a 'mini-stroke at the time' in 2011) and still have residual symptoms - but this actually had a cause -- my meter was saying 2.6, and the hospital tests said 1.7. I may have had a low INR for weeks before the TIA.

I'm glad to see that you're doing better and that, somehow, your PVCs have resolved. (Just a wild thought -- is it possible that you had some kind of plaque on one of your heart's electrical nodes, causing the PVCs, and it broke off and went to your brain? This may explain the PVC and its disappearance. But, of course, this is just random speculation).

 

[Val]

Very interesting. Something changed that's for sure.

Any aspirin in the mix?

Ahh, checked your about and found

Medications asprin


There could be something to explain it that's missing, perhaps something apparently trivial. But it sounds like something like a thrombosis was forming on a leaflet that detached.

What's your normal INR and how frequently do you test?

Glad it's improving

Best Wishes

Oddly, I had a TIA with the same presentation - numbness on left side of tongue, left side of face, and left fingertips. It felt like I had a shot of novocaine, and the novocaine was wearing off. Symptoms resolved in about 2-3 days.

My INR was good before and after this. I keep it in range. My cardiologist thought it may have been a cholesterol plaque that dislodged. Who knows?

My PVCs haven't abated since my TIA. I've still got them.

You've confused me a bit -- you said you have a Bovine valve, then you mentioned mechanical valve. They're two different animals (well, one animal, and one carbon fiber) - I'm assuming that you meant mechanical.

I had a TIA (they called it a 'mini-stroke at the time' in 2011) and still have residual symptoms - but this actually had a cause -- my meter was saying 2.6, and the hospital tests said 1.7. I may have had a low INR for weeks before the TIA.

I'm glad to see that you're doing better and that, somehow, your PVCs have resolved. (Just a wild thought -- is it possible that you had some kind of plaque on one of your heart's electrical nodes, causing the PVCs, and it broke off and went to your brain? This may explain the PVC and its disappearance. But, of course, this is just random speculation).

Very interesting. Something changed that's for sure.

Any aspirin in the mix?

Ahh, checked your about and found

Medications asprin


There could be something to explain it that's missing, perhaps something apparently trivial. But it sounds like something like a thrombosis was forming on a leaflet that detached.

What's your normal INR and how frequently do you test?

Glad it's improving

Best Wishes

 

[Val]

Very interesting. Something changed that's for sure.

Any aspirin in the mix?

Ahh, checked your about and found

Medications asprin


There could be something to explain it that's missing, perhaps something apparently trivial. But it sounds like something like a thrombosis was forming on a leaflet that detached.

What's your normal INR and how frequently do you test?

Glad it's improving

Best Wishes

My normal INR is 1.5 to 2.0 and I test once a week. My new cardiologist suggested that he would like to see me target a higher INR.

A thrombosis on the leaflet actually makes sense. That would explain the increase valve noise and problems with PVCS during exercise.

Thanks for the reply

 

[pellicle]

My normal INR is 1.5 to 2.0 and I test once a week.

this is too low, and despite the small scale and inadequate experiment conducted On-X there are substantial criticisms of that process. Not least is the duration

I wrote and published this small essay on my Google drive (saves finding where I've posted it here and reposting). It asks questions which I think are valid questions and leverages off another analysis of the same On-X funded study.

A thrombosis on the leaflet actually makes sense. That would explain the increase valve noise and problems with PVCS during exercise.

as I often, if the key turns the lock its a sufficient copy, even if its not 100% perfect.

Best Wishes

 

[Val]

Oddly, I had a TIA with the same presentation - numbness on left side of tongue, left side of face, and left fingertips. It felt like I had a shot of novocaine, and the novocaine was wearing off. Symptoms resolved in about 2-3 days.

My INR was good before and after this. I keep it in range. My cardiologist thought it may have been a cholesterol plaque that dislodged. Who knows?

My PVCs haven't abated since my TIA. I've still got them.

You've confused me a bit -- you said you have a Bovine valve, then you mentioned mechanical valve. They're two different animals (well, one animal, and one carbon fiber) - I'm assuming that you meant mechanical.

I had a TIA (they called it a 'mini-stroke at the time' in 2011) and still have residual symptoms - but this actually had a cause -- my meter was saying 2.6, and the hospital tests said 1.7. I may have had a low INR for weeks before the TIA.

I'm glad to see that you're doing better and that, somehow, your PVCs have resolved. (Just a wild thought -- is it possible that you had some kind of plaque on one of your heart's electrical nodes, causing the PVCs, and it broke off and went to your brain? This may explain the PVC and its disappearance. But, of course, this is just random speculation).

Sorry for the confusion. I started off with the bovine valve, it lasted 8 years. Then it was replaced the Onx.

My PVCs were really bad before the stroke and afterwards they were gone. My valve sound went back to normal and I feel much better heart wise. Lingering numbness is no fun..

The PVCs got worse the more intense the exercise. My PVCs show up when something bad heart related is going on. I get so tired of trying to convince doctors that I know when something is wrong with my heart.

 

[Val]

this is too low, and despite the small scale and inadequate experiment conducted On-X there are substantial criticisms of that process. Not least is the duration

I wrote and published this small essay on my Google drive (saves finding where I've posted it here and reposting). It asks questions which I think are valid questions and leverages off another analysis of the same On-X funded study.



as I often, if the key turns the lock its a sufficient copy, even if its not 100% perfect.

Best Wishes

I know that now, one stroke later. My INR value is something my new cardiologist wants to talk to me about during my next visit.

Thanks, I'll read your essay.

 

[pellicle]

I know that now, one stroke later. My INR value is something my new cardiologist wants to talk to me about during my next visit.

Thanks, I'll read your essay.

you may also wish to consider this:

the coloured annotations are mine, as are the arrows; the URL for study
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415179
I recommend you bring up that study (well, and at least read the abstract) and discuss it with your new cardiologist.

Best Wishes

 

[Protimenow]

I have a Sr. Jude Aortic valve, 'My target is 3.0 - especially after I had my TIA.

Raising your INR to 2.0+ really isn't going to change your life - things are pretty much the same, whether your INR is 1.5 (plus aspirin) or 2.5 (with aspirin). I don't see much difference until my INR climbs near 4 or above. A 2.0 or higher won't change your life much - if at all - but it may save it.

(When OnX was marketing the new valve, one of the benefits they claimed was that people with the valves will be able to maintain a slightly lower INR than those with other mechanical valves. The real difference was pretty much irrelevant - but it was good marketing-speak, and convinced a lot of surgeons who didn't really understand anticoagulation enough to realize that the 'benefits' were not realy benefits at all, and who didn't do the research that they really needed to make the best decision).

 

[pellicle]

especially after I had my TIA.

BTW @Val this is an important point. The guidance for INR with an Aortic valve and no stroke history starts at target 2.5 (range 2~3) but goes up with any stroke history.

Eg
https://www.ajconline.org/article/S0002-9149(21)00782-7/fulltext

Current guidelines recommend targeting an international normalized ratio (INR) of 2.5 to 3.5 for patients with mechanical aortic valve replacement (AVR) and additional risk factors for thromboembolic events. Available literature supporting the higher intensity (INR) goal is lacking. ​

note "targeting", not the range. I read this as once you've got additional risk factors they are suggesting moving to targeting 3.5

Personally (especially since PVC's have stopped) I'd be inclined to move to the target of 2.5 not the target of 1..89 or even 2 as perhaps what was happening has stopped?

¯\_(ツ)_/¯

I understand PVC to mean: Premature ventricular contractions (PVCs) are extra heartbeats that begin in one of the heart's two lower pumping chambers (ventricles). These extra beats disrupt the regular heart rhythm, sometimes causing a sensation of a fluttering or a skipped beat in the chest.

 

[Val]

My history is a Bovine aortic valve and aneurysm repair in 2005 and a Onx aortic valve and pacer in 2013.

This past March I started to have a lot of PVCs whenever I began to exercise ( or even walk fast) and when I sleep. My heart valve sounds became much louder. I started having angina and breathlessness with exercise when PVCs were bad.

Could not get an appointment with my cardiologist but office said that they would schedule and echo. They never scheduled the echo, but finally got my primary care doc to do it.

Cardiologist read the echo and said that all is fine and not to worry. Still hadn't had an office visit and I wasn't feeling fine Complained to my primary care who sent complaint up the line.

Ended up with a new cardiologist who examined me and my charts and said that all looked fine and that he can put me on meds for PVCs and that a loud mechanical valve was a healthy mechanical valve. Declined the med and have a follow up appointment in end of November.

PVCs had subsided some what but come back at the start of intense exercise .

Last week, on a trip, I has a minor stroke. Tingling in left side of lips, tip of tongue and left hand finger tips. Went to the ER in Zagreb and got a CT scan. My INR level was in the therapeutic range 2.6, my BP was high. Was told to follow up with my own doc, which I did yesterday, 7 days later, when I got home. I'll have a follow up CT scan, waiting for scheduling.

Now here's the weird part and the reason for this post. My heart valve sounds have gone back to Normal. I still hear the click but it doesn't keep me up at night. Also, PVCS are gone and I can exercise again. I'm still having some minor numbness in tongue and fingers but it gets better every day. BP is returning to normal. So what happened? Any guesses?

I do have an update, a CT scan shows that I might have Fibromuscular Dysplasia. Feels like out of the frying pan into the fire.