received echo report

[South Sound Sailor]

I received a copy of my ECG today. The ECG was done on 11/7/2007. No previous ECGs for comparison. I met with a cardiologist on 12/5. I did not review the ECG report line by line with him. Now I'm wishing I had done that to gain a better understanding. I ABSOLUTELY understand I need to meet with another cardiologist if I want another medical opinion and I will do that. The report has a lot of readings/measurements (including AoV Area: .82 cm) but here is the plain-language info at the end of the report:

"1. Normal left ventricular size. There are no regional wall motion abnormalities with an estimated ejection fraction of 65-70%. All thicknesses normal. Parameters of diastolic function are normal.
2. Normal right ventricular size and function.
3. The aortic valve is probably trileaflet. There is marked sclerosis and restricted leaflet mobility. There is moderately severe stenosis with trace central insufficiency.
4. Trace mitral insufficiency through a structurally normal valve.
5. Trace tricuspid insufficiency with normal pulmonary pressures.
6. Normal pulmonic valve.
7. Normal biatrial size without ASD by color-flow Doppler.
8. Normal aortic dimensions, the ascending aorta was not well visualized.
9. Normal sized IVC.
10. Normal pericardium with no effusion.
Conclusion:
1. Normal biventricular size and function.
2. Moderately severe aortic stenosis.
Comment:
Consider cardiology consultation. The patient will require close monitoring of his aortic valve and likely will ultimately require valve replacement."

The cardiologist advised me, solely based on the above ECG and one slightly abnormal EKG, to discontinue running and any other strenuous activity. I have done so but my blood pressure is starting to creep up (averaging 135/89) without the daily running. I'm now thinking I have a lot to be thankful for and maybe I shouldn't rush into having surgery. But the inactive lifestyle is taking a toll on both my mental and physical health.

Anyone care to comment on any of the above info?? (and I'll again restate the disclaimer that I KNOW I need to consult with another cardiologist to get a better understanding of the ECG report... I've requested a copy of the actual ECG film that I plan to hand-deliver to the next doctor I meet with.)

 

[MikeHeim]

There are others who are really good at reading echo reports, and I'm sure they will be along with their interpretation. I would like to comment on the inactivity issue. My advice would be to ask your doctor in what range you should keep your heart rate. It's very easy for a doctor to give a statement like "no running", but it would make it easier on you if you could have some more specific guidelines. I pressed my Cardio prior to my surgery, and was told that I was OK as long as I kept my HR under 130. That certainly eliminated running for me, but I was still able to use an eliptical machine, swim, hike, etc. to try to stay in shape for the time being.

 

[DebbyA]

I agree that you could try to get more information from the first cardiologist. The runners will respond soon, I'm sure.

This is merely a comment: I'm older than you, a walker not a runner, but I was classed "moderately severe" last year. I told my cardio I wanted to try to get more aerobically fit, and she just said I might find it harder. I asked if there were any activity restrictions (she knows I hike), and she told me not to lift 100 pounds over my head, otherwise do what I felt like.

 

[ALCapshaw2]

MY Cardiologist uses 0.8 sq cm of Effective Aortic Valve Area as his 'trigger' for referal to surgery. I've seen reports of anything from 0.7 to 1.0 sq cm resulting in referal to a surgeon.

We have a saying on VR.com that goes:
"The Worse Things Get, The Faster They Get Worse"

MY AVR came 2 months after referal (with 0.8 sq cm AV Area) and I believe I got there "just in time". I was put on a Ballon Pump 6 hours after admission... NOT a Good Sign.

There has been quite a bit of discussion of Ejection Fraction but I've forgotten the exact range of 'normal EF'. (I'm thinking 55 to 65%, maybe 70%). There are a few Links to articles about EF in the Reference Forum.

HIGH EF (75%?) is a sign of the Heart pumping against a Stenotic (partially closed) Valve.

With your numbers, I would be interviewing Surgeons to get their assessment of WHEN (not IF) you should proceed to surgery. Most surgeons like to operate before there is permanent damage done to the Heart Muscles and Walls, thus providing a Better Surgical Outcome.

I see NO Benefit to Waiting given the High Success Rate of First (and even Second) Surgeries in patients under age 60. Waiting carries the risk of permanent muscle damage and possibly sudden death.

Forgive me if I'm repeating myself.

'AL Capshaw'

 

[Phyllis]

I agree with Al- why not meet with a surgeon instead of with another cardiologist. Meeting with a surgeon does not mean immediate surgery, he may determine that you are in the waiting room for a while, but since surgery is most likely in your future, this is a good opportunity to start your search for the perfect "match". Not sure if you are considering another cardio because you are unhappy with this one???

 

[Ross]

My vote is to see and discuss this with a surgeon. Let him be the one to say when, not the cardiologists.

 

[bvdr]

My vote is to see and discuss this with a surgeon. Let him be the one to say when, not the cardiologists.

Amen, Amen, Amen!

 

[South Sound Sailor]

Thanks!

Thanks!

First... words cannot express enough thanks for the support that I am receiving on this site!

To clarify, my intentions are to meet with a cardio-thoracic surgeon, not another cardiologist. I have been corresponding with a local surgeon and this afternoon, I sent the above ECG information to him along with a request to schedule a meeting as soon as possible. I did that before I read everyone's comments so it's wonderful to see I'm on the right track.

The surgeon (actually, it's his research director/RN) I am in communication with is participating in the On-X clinical trial studies for reduced ACT. Just a few days ago, I was seriously considering traveling to Houston (Methodist DeBakey or St. Luke's) for the AVR. I am now back to square one, where I originally was a couple of weeks ago with renewed conviction to pursue participation in the clinical trial.

It's not a matter of insurance, money or inconvenience, in fact I have parents, sisters and a brother who live in or very close to Houston for family support. My family also has had (unfortunately) AVR experience with doctors in Houston (Dr. Coselli being one). I just keep coming back to the possibility of being able to participate in the On-X clinical trial study (I've received the trial brochure and paperwork so I'm aware there's a strict screening process and that we're not talking zero ACT).

The participating research hospital is a 40 minute drive from my home. Ultimately, as with any big decision in life, it's up to the individual and that's the point I'm at in my life right now. I'm not writing this to generate controversy. I know there are mixed feelings about the On-X clinical trial. I saw in another thread a majority response appeared to be opposed to the idea of participating in this trial. But I do value the opinions that are stated in this site so if anyone has a comment, I'll take it to heart (sorry!).

Thanks again to everyone for showing so much interest in my situation!


SSS

ps: how do you get a graphic in your signature line???

 

[Phyllis]

Great- I'm glad you are getting right on it- keep us informed after your consultation- you know we care!

 

[harleygirl528]

Hi there...I just wanted to chime in with my "two cents worth"...since we are neighbors and all. I found out about my heart condition on October 19 and started immediately interviewing surgeons. I agree with what everyone else has basically said, which is there really is no benefit to waiting for a surgery that is inevitable, and there is much to gain, like regaining your physicial vigor and your mental health.

I was told be two surgeons here locally that I would be fine to "watch and wait" with a 5 cm aneurysm...that just didn't set well with me as I was getting a lot of feedback from folks on this forum to the contrary...ultimately I did consult with 2 physicians from out of state and even sent my records for review and, as you know from my posts, I am having surgery in about a month. I don't know about you, but I would rather just get it done with and get on with healing and getting better. My activities are so retricted right now and my way of life is so compromised that it "gets me down" and rather that continue with this quality of life I would rather move forward toward healing.

You have already said that your lifestyle restrictions are not to your liking...and I can tell you are a proactive person like me...so take the bull by the horns...find a doctor you totally trust and get it taken care of and get on with your life! When you think about it, there really isn't any benefit to waiting and there are lots of advantages to getting it done before you have any damage to your heart!

Take care and best of luck to you!

 

[dtread]

I think you should get a Cardiac Catheterization prior to surgery. That can provide more info on your valve functionality as well as whether you need to have any bypasses (don't presume just because you are a runner that you wouldn't need bypasses), and other heart related information. It is surprising that the Echo did not clearly indicate whether you had bicuspid or tricuspid aortic valve. You could clearly see the outline as bicuspid on my Echo. Lastly, I agree with the others that you should try to accelerate the date for your surgery. Since you're now on a "no exercise" routine (i.e., you are directed to be a couch potato) you're going to get atrophied, flabby, and out of shape. This will only make recovery that much more difficult. Plus, you'll have the surgery hanging over your head that much longer. Good luck!

 

[tobagotwo]

I have to agree with Rachel. The results are somewhat ambiguous for a dedicated runner. It's made more difficult to gauge by the fact that you have no prior echoes to go against. We can't see progressions within the normal range.

While I'm not a medical professional, here are some thoughts...

First, I would point out that "normal" is quite a range, and you may well be (probably are, based on the severity of your stenosis) out of your own normal size range, whether you have crept past the official enlarged marker or not. 65%-70% is quite aggressive. 65% might be a high normal reading for a dedicated runner, but 70% is definitely high, indicating that your heart would be somewhere in the late beginning stages of the left ventricular hypertrophic cycle that people with aortic valve problems almost always go partway through. (Believe me...you don't want to finish this particular cycle.)

Did you see anything that looked like AO or AA (Aortic Opening or Aortic Annulus) or similar? That would be the effective valve opening area.

Ignore the "trace" insufficiencies. Trace values are transient, and they have an unnoticeable effect on the heart's operation. They often disappear by the next echo or after surgery. They are real, but not individually significant to your heart.

At this point in time, there are several factors that are degrading your heart's ability to perform. The valve opening is restricted by apatite crystals (calcification), so the left ventrical is having to push harder to force the blood through the smaller hole. There is sufficient apatitic buildup that it is in the way of your valve leaflets when they try to open, placing further backpressure on the ventricle. The leaflets themselves are also likely coated by this time, making them inflexible.

It doesn't form the type of crystals that you would want on your mantlepiece. The apatite buildup on the valve looks not unlike the calcium-laced crud that grows around the holes in showerheads or around pipes. It varies in color from white to brownish, and is actually hard and brittle like rock (bones and teeth are formed from variations of apatite). It's so ingrained into the flesh, that surgeons sometimes mention that the valve literally crumbled in their hand as it was removed. Apatite contains calcium and phosphorus (in the form of a phosphate). The third member can be fluorine, hydroxyl (one oxygen and one hydrogen, other wise known as OH, or a hydroxide) or chlorine. There are usually a number of impurities in the mix as well.

The prohibition is for sudden or intense physical exertion. It can cause sudden death in people with severe aortic stenosis. Running is verboten, but walking isn't. Shoveling snow is absolutely out, but using a snowblower is okay. You should not carry objects heavy enough to make you grunt (like multiple bags of water softener salt or birdseed, or cases of canned goods), but one bag of groceries at a time (or a couple of light bags) is all right. Exercise stress tests are out.

The concern is that under sudden load, the stenotic heart can work so hard that it basically "locks," unable to respond to the electrical current that makes it beat. A defibrillator can usually fix this, but there's rarely one available in the driveway where you're shovelling snow. If this happens, lack of a defibrillator or a very fast response from a trained resuscitation technician results in sudden death. A fair number of heart-related snow shovelling deaths may be related to undiagnosed aortic stenosis, rather than the assumed blocked arteries. As well, strenuous exercise on a heart served by a stenotic valve can cause other arrhythmias, and some of them can be fatal.

You will likely experience some palpitations (non-harmful arrhythmias) over time, as well as some shortness of breath. You may be experiencing angina already, but only as a tightness in your throat or other unexpected manifestation. It's important that you do recognize symptoms in yourself, as your cardiologist is downplaying the immediacy based on lack of symptoms and the fact that your heart hasn't exceeded the upper range of normal size. Symptoms raise the stakes, and bring the cardiologist more in line with the surgical option.

A consultation with a surgeon or an unaffiliated second cardiologist would be a wise move. Most cardiologists like to push off the surgery for as long as possible, as they tend to see it as risk avoidance. However, that doesn't necesarily work in your best interest. You don't want to wait until there is permanent damage to your heart before having this fixed.

Best wishes,

 

[tobagotwo]

Thank you, Rachel. I've found that post now. I had missed it.

Then you should absolutely be getting a second opinion and choosing a surgeon now, in my nonmedicalprofessional opinion. Anything below 1 cm is valid for surgery, and you're well below that, enlarged or not. There is nothing "moderate" about .82 cm. Please don't wait before getting another opinion. At this point you're only waiting for damage to your heart or sudden death, neither of which is to your survival or recovery advantage.

Best wishes,

 

[South Sound Sailor]

To Bob H. and a question about working...

To Bob H. and a question about working...

(Rachel is correct... my echo report reads AoV .82 cm)

Thank you Bob for taking the time to provide such a detailed response. I had a 15 minute visit with him 2 weeks ago and he hit the high points: stop running, think about a 1 to 2 year time frame in which you'll need to have your AV replaced, sudden death is a possibility.

Bob, your comments help flesh out the high points the cardio covered with me. I have been taking my situation seriously but it's only been in the past week that I have started to develop a growing urgency to aggressively address my problem by seeking a surgical solution. I am counting hours until Monday morning. I'll try again to make contact with the cardio-thoracic surgeon in Tacoma, Dr. Dennis Nichols. I've been in contact with his research director and RN but I understand I need to commit to resolving this problem ASAP.

I focus on the fact that both my sister (46 years old) and my mom (75) had AVR surgery earlier this year. My mom received a porcine valve, my sister a St. Jude valve. My sister also had an aortic aneurysm. My mom spent several days in ICU. That was several months ago but less than 10 months for both of them. Both my mom and sister have stories to tell that mirror so many that you read on VR.com. They both talk about feeling better than they've felt in years. Renewed levels of energy and for my mom, she can handle a full day of shopping and cooking whereas in the past few years, she would tire out in a just an hour or 2.

When i read Bob's information, I can't help but feel the anxiety level rise. I recognize that all I can do is be cautious with my activity. Eat healthy meals. Stay focused on the here and now and hug my kids a lot (best therapy that I can find).

I have had tightness in my throat... particularly on the left side. I now have a sensation of having a nerve pinched at the back of my neck when I swallow. Very minor sensations but definitely things that are catching my attention.

Does anyone have any comments about going to work given the status I'm in? I sit at a desk but I've got to tell you that kind of work is a killer... I know my BP can spike up even though I'm sedentary for several hours during the work day. I have to drive about 20 miles to work, most of it on the interstate. Some evenings when I drive home I can clearly tell I'm feeling "fuzzy." I wonder... should I be talking to my cardio or the surgeon about making changes to my work situation? I can do my work from home and that would cut out the driving. Working from home presents it's own share of stress but at least I won't be flying on the interstate twice a day.

OK, that's probably enough for now. I appreciate the comments everyone has offered me and again, to Bob, thanks for the detailed response.

SSS

 

[Superbob]

Sailor,

Prior to my surgery, I had a killer commute to work, 25 miles through DC area traffic. In the last few months before my surgery, I worked a great deal from home. (I did the type of work that made that possible.) If you are able to telecommute, I would recommend it.

 

[tobagotwo]

Well, I don't want to raise your anxiety level, but I do want to see you get moving. I thought of you fleetingly as I shovelled snow off the back steps this morning, to be able to feed the birds.

One thing to bear in mind is that the heart not only feeds the rest of the body with blood, it also feeds itself. When it falters, it also has to deal with the deficit of oxyen to itself as it tries to recover.

The tight feeling you have in your throat is almost certainly angina. I had it show in that way also. I didn't think it had anything to do with my heart for a year or more, until I read about it in an obscure article that was associated with a valve life study I was looking at. This is vitally important, because cardiologists consider symptoms to be a key factor in determining a go-ahead. If they go unrecognized, proper treatment may be unnecessarily delayed.

I had been telling my doctor that I wasn't having angina, because I had no chest, back, or left arm pain. Now I know that less than half of angina presents in those "classic" ways. They're probably best known because they play well in movies, where the audience can see the actor clutching his chest as he keels over, and realize it's his heart without someone having to say it.

A similar angina manifestation is described as the feeling you get at the top of your throat when you're breathing very cold air. For women, angina can often be felt as jaw pain. Better hope their dentists know to refer them to their cardiologists.

So my thought would be to treat it like a fire alarm in a theater: don't panic, but move quickly toward the exit.

Best wishes,

 

[tobagotwo]

To clarify, as I see I didn't include this disclaimer: the sudden death risk is small. However, it is real, and can be avoided, so it absolutely makes sense to do so.

The other thing that time can bring from calcifications is tiny pieces of the apatite breaking off into the bloodstream and causing TIAs, or even strokes. Again, the risk is not large, but there are several on the site who've experienced this problem.

Best wishes,