Short of Breath ?

[BAV]

Does the mechanism in which aortic regurgitation and stenosis causes shortness of breath also lower blood oxygen levels ?

I was recently told by my cardiologist that im getting close to surgery and he's monitoring me with echos every three months now .

My numbers show that I am both moderate severe for both stenosis and regurgitation. I definitely have been dealing with some overall tiredness but I'm busy as a single dad , with work , home , and I try to exercise 4 times a week .

Ever since I've been told that we're almost to the point of surgery and he asked if I had symptoms I've felt like I need to breathe deeper than I used to and that I'm not getting enough air. This mostly started after my last consultation a month ago and I'm trying to figure out if it's in my head or real .

Could I measure this with blood o2 levels because mine are always 98-100? Even on my trip to Peru recently anywhere between 7500 ft and 14000 ft had my levels mostly between 97-99 . I think I saw 96 once on the trip . Would the mechanisms of stenosis and regurgitation cause your blood oxygen levels to be less or does it work a different way?

 

[Protimenow]

Thinking back 30+ years, I remember when, after minor exertion, my legs would turn white. I DID get short of breath.

After significant exertion, I felt what seemed like cold tingling in my legs. Surgery got rid of the symptom.

Back then, there were no cheap blood oxygen testers.

Blood oxygen levels, AFAIK, may not necessarily reflect regurgitation -- your heart just works harder to move the blood through your lungs than it would if you didn't have your issues.

Check the color of your legs. Press on a fingernail and see how long it takes to pink back up. Having to breathe harder may be head and real at the same time.

 

[Zoltania]

Anxiety can cause a surprising number of physical symptoms. Even if the source is "in your head" it's real to you.

I once took a class on coping with anxiety/panic, and one thing we learned is how to calm down the sympathetic nervous system (which fires up when we feel threatened) and activate the parasympathetic nervous system (which counteracts it) by doing diaphragmatic breathing. Nothing fancy, just a slow deep breath in and a longer exhale. I use 3 counts for the inhale and 6 or 7 for the exhale.

 

[pellicle]

Good morning

Does the mechanism in which aortic regurgitation and stenosis causes shortness of breath also lower blood oxygen levels ?

short answer yes, but as do other things.

I was recently told by my cardiologist that im getting close to surgery

could be that you're exactly (as he said) close ... I would begin acting accordingly. Keep in mind that exersize is for health (not vanity) and so if you need to dial back you need to dial back.

ONLY YOU can be sure of what's happening in your body, so if you rule out anxiety (as was mentioned) then the deduction is you're closer than monitoring. You need to make the next step and get a recommendation to visit a surgeon.

Myself I see no reason to be deferring a few months each time because you think you may be able to. IF there is a reason for such a deferment (as I gave to my surgeon in 1992) then give that, but it needs to be better than "I'm not ready for facing this yet"

My numbers show that I am both moderate severe for both stenosis and regurgitation. I definitely have been dealing with some overall tiredness but I'm busy as a single dad , with work , home , and I try to exercise 4 times a week .

the tiredness may exactly be symptoms.

Could I measure this with blood o2 levels because mine are always 98-100? Even on my trip to Peru recently anywhere between 7500 ft and 14000 ft had my levels mostly between 97-99 .

The body is an excellent mechanism at protecting the brain and this means the oxygenation levels and core temperature from harming the brain. It will force you to slow down (recall your feeling tired?) to prevent you from doing irreversible damage to your brain by denying it oxygen.

If I were you I'd either seek a second opinion or contact your cardiologist and tell them clearly about your symptoms.

Its often said its easier to be a vet than a doctor, because the animals don't put spins on their condition.

Be honest, be frank and look after yourself; if you're a single dad and you die who'll look after you child? Don't panic but equally don't dither.

Best Wishes

 

[pellicle]

@BAV

further to my above answer (I knew it was there, just had to search it), I strongly recommend you review this thread:

https://www.valvereplacement.org/th...re-vs-waiting-for-symptoms.888781/post-920179
and don't miss this post either
https://www.valvereplacement.org/th...re-vs-waiting-for-symptoms.888781/post-920191
Both of those contributors are high value contributors.

 

[70sdiver]

I know once I got to feeling the shortness of breath or having to take deep breaths I started looking at which surgeon to use. I tried to ask myself if it was in my head also, it wasn't If I have to do a do over I'm going in for surgery right away. I feel like I'm ten years younger . I'm one year post avr. Had surgery august 18th and was fishing steelhead in late october from my friends boat.

 

[Zara0006]

I also experience pretty much the same symptoms at the thought of having open heart surgery, so I’m finding extremely difficult to determine whether they really are ‘symptoms’. I work in the medical field myself and often see patients who have had these procedures, but nothing prepares you for having to face the reality of it yourself. I’ve found this forum to be considerably more helpful in making decisions, and also for my anxiety rather than speaking to other healthcare professionals so thank you all. I hope your surgery goes well

 

[RickAUS]

Hi mate,

I am in the same vote as you! Moderate severe regurgitation (however no stenosis), I never noticed anything until I had a strange feeling in my chest and went for a check up. After I had been told of the BAV I started noticing that I was out of breath and felt tired etc. I have two businesses, 3 kids and a pretty active lifestyle, I never stop really! Up at 5am most days and bed by 10-11pm (I sleep hard). Definitely think once you are made aware of it you notice it more, however if I think back a couple of years I can recall being puffed walking up stairs and definitely when I was trail running or riding I noticed I was breathing super heavy. At the time I blamed this on being over weight and unfit!

I am having surgery in December, probably a little early however I am 40 and will be getting a mech valve so no point in waiting! Looking forward to being able to run around my garden with the kids going nuts : )

All the best with it, keep checking in on the forum there is some great people with great advice on here. : )

 

[Varago33]

Does the mechanism in which aortic regurgitation and stenosis causes shortness of breath also lower blood oxygen levels ?

I was recently told by my cardiologist that im getting close to surgery and he's monitoring me with echos every three months now .

My numbers show that I am both moderate severe for both stenosis and regurgitation. I definitely have been dealing with some overall tiredness but I'm busy as a single dad , with work , home , and I try to exercise 4 times a week .

Ever since I've been told that we're almost to the point of surgery and he asked if I had symptoms I've felt like I need to breathe deeper than I used to and that I'm not getting enough air. This mostly started after my last consultation a month ago and I'm trying to figure out if it's in my head or real .

Could I measure this with blood o2 levels because mine are always 98-100? Even on my trip to Peru recently anywhere between 7500 ft and 14000 ft had my levels mostly between 97-99 . I think I saw 96 once on the trip . Would the mechanisms of stenosis and regurgitation cause your blood oxygen levels to be less or does it work a different way?

 

[Varago33]

I was told this same BS some time ago and the ONLY time it comes to mind is the few times I come here My advice is enjoy life and DONT worry about it. When it was explained to me I ask can it be fixed? Their answer was NO. So here I sit at 73 and enjoy each and every day. I have two daughters and two grands kids and we all live in the same city. So I am very happy. Enjoy what you have and forget the WHAT IF's they only speed up the process. My problem is an aortic aneurysm, the docs tell when it happens it will quick and with a lot pain. My wife drives when we go out.

Dave live and enjoy every day

 

[carolinemc]

When we have problems with the heart, it will affect the lungs to where we are short of breath from exertion of walking, or other things we physically do. Even clean the house, garage, or mowing the lawn can become difficult with the heart issue and affect the lungs. You can ask your cardio-vascular doctor or surgeon. It has been a mystery for centuries.

 

[carolinemc]

Hi mate,

I am in the same vote as you! Moderate severe regurgitation (however no stenosis), I never noticed anything until I had a strange feeling in my chest and went for a check up. After I had been told of the BAV I started noticing that I was out of breath and felt tired etc. I have two businesses, 3 kids and a pretty active lifestyle, I never stop really! Up at 5am most days and bed by 10-11pm (I sleep hard). Definitely think once you are made aware of it you notice it more, however if I think back a couple of years I can recall being puffed walking up stairs and definitely when I was trail running or riding I noticed I was breathing super heavy. At the time I blamed this on being over weight and unfit!

I am having surgery in December, probably a little early however I am 40 and will be getting a mech valve so no point in waiting! Looking forward to being able to run around my garden with the kids going nuts : )

All the best with it, keep checking in on the forum there is some great people with great advice on here. : )

With the shortness of breath, you will be more tired and fatigued and want to sleep more. I had this before my last bypass. It is normal when there is a problem with the heart, the lungs are also affected. Good luck and after you are cleared for activity, you will feel much better. more energy and less shortness of breath.

 

[Joseph]

The fact that you hiked in Peru and didn't pass out is probably a positive sign regardless of your SpO2. I had a severely perforated mitral valve, which leaked like a colander, with extreme regurgitation. I was literally gasping for air after walking up two flights of stairs.

 

[BAV]

Thanks everyone for your responses and sharing your experience. I do think that the feelings of shortness of breath was mostly in my head because it started after I found out my heart was worse and surgery was getting closer , but it's went away at this point . I can still exercise with good intensity and I can tackle stairs and longer fast paced walks without feeling winded .

I am taking everyone's advice to push to have the surgery soon but I'm in a weird situation where I need a non related procedure that has high bleeding risk so it's something I'd like to tackle before I most likely end up on anti-coagulants.

Unfortunately this particular surgeon I'm working with is having a hard time getting all my records from last doctors and I'm getting concerned that I may have to have the valve replaced before I can tackle this other procedure including the 3 -4 week recovery time .

Does anyone have experience with having major surgery with high bleeding risk on warfarin ? Are you able to come off of warfarin for 3-5 days for a procedure ?

 

[pellicle]

Are you able to come off of warfarin for 3-5 days for a procedure ?

Yes
Have a read through this and the associated articles I cite.

http://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html
But things like hip replacement are more challenging

 

[Jack Julles Jackson]

Yes
Have a read through this and the associated articles I cite.

http://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html
But thinks like hip replacement are more challenging

Nice post. I read it all. But seems like is very complicated to manege INR before that procedures. And if you need a major surgery? How does it works? Can we get on the table doin INR?

 

[pellicle]

I read it all. But seems like is very complicated to manege INR before that procedures.

well describing anything sounds complicated.

If I described what I did on my motorcycle yesterday in sufficient detail you'd probably never do it.

Can we get on the table doin INR?

of course, and I've done that twice now.

the point is pretty simple you just have to understand how it works:

• we are on anticoagulation therapy to dial down how fast things clot
• there are times when you need to be off that therapy
• for surgery you absolutely need coagulation to be present normally to assist healing so you MUST BE OFF anticoagulation for that
• some time after the surgery (usually a few days) you resume anticoagulation therapy.
• some specific time is required to heal the tissues which were cut and need go grow together, coagulation is then not needed

the vast majority of my article and its linked citations was discussing the evidence for that gap in therapy.

Some people can't change a spark plug or an oil filter, so in that case those people should get someone to do that for them.

The standard practice (which was also discussed) is called Bridging therapy, there you swap out warfarin for heparin. When the warfarin wears off slowly the heparin is much more "instant on and fast off". So this can be managed by

1. cease warfarin
2. commence daily injections of heparin
3. 12 hours before the surgery cease heparin
4. 24 to 48 hours after surgery commence heparin and warfarin
5. when INR is back to therapeutic range cease the heparin injections

Measurement of INR is not interfered with by the presence of heparin.

So if all that seems overwhelming, then get your Dr to do it for you (they usually aren't that experienced in this hence the 1 to 300 advantages discussed in the blog post and the cited articles trying to get doctors to lift their game.

Many of us self manage ... so that article is to help them. Maybe that's not you.

¯\_(ツ)_/¯

HTH

PS: IF you are still in the "making a valve decision" then this is all part of the informing process of what life will be like with a mechanical valve. Every persons circumstances and capability are different, so you alone can decide what's right for your. Hit me up with specific questions if you have them.

 

[pellicle]

Can we get on the table doin INR?

another example
https://cjeastwd.blogspot.com/2020/10/another-example-small-procedure.html

 

[pellicle]

on Bridging therapy:

https://www.valvereplacement.org/th...w-molecular-weight-heparin.888104/post-907524
from that study (I encourage you to read at least the small summary provided:

Conclusions​

​

In patients with atrial fibrillation and/or mechanical heart valves who had warfarin interrupted for a procedure there was no benefit from post-procedure LMWH bridging.​

bold mine and LMWH = Low Molecular Weight Heparin (often known by the product name lovenox in the USA).

a good discussion starts here
https://www.valvereplacement.org/th...nd-other-options-severe-ar.888126/post-907919
lastly a diagram to go with my above comment here:

The standard practice (which was also discussed) is called Bridging therapy, there you swap out warfarin for heparin

 

[Joseph]

Late to the discussion but my my previous EP was a bridging guy and had me on Lovenox prior to "minor" surgeries. I overshot a few times during that period and actually passed out at one point which was attributed to the bridging. Needless to say, my SO was not happy with the entire process and said I looked ghostly during the transition on and off heparin. Obviously my dosing was too high but I just kept sticking myself because the doctor said so.

My current EP/cardiologist does not recommend bridging and prior to my pacemaker surgery this year had me (IIRC) continue on my regular dosage of Warfarin. Just an anecdote to support the excellent posts by pellicle.