Should I be worried about the decision I have to make?

[JensenJoe]

Hello Everyone,

My name is Joe, I am 64 years old, and this is my first post here on this message board. I am writing this in the hopes of getting some expert advice about a procedure my Doctor is telling me I should get.

I am also disabled due to back and leg pain, and could not use the tread mill to stress my Heart, so I had the Persantine test. I had one last year also, and my ejection fraction was about 57, this year it is about the same, (he said 50 or more & very vague) but what worries me, he also said that one of the valves was leaking more this year than last year.

The odd thing is that he seems to be more concerned about the bottom of my Heart, because he said the test showed that part of it is not getting the amount of blood it shood. He then said it could be because of the possiblity the lung may be shadowing that part of the Heart. So he wants to send me for a Cardiac Catheteaiztion of that part of the Heart. When I asked why is he so concerned about the bottom of my Heart, he said you could get a Heart attack. My concern is why isn't he more concerned for the leaking valve? Is there a reason for him to take this approach before he worries me about the leaking valve?

I am very concerned about the valve, because my Mother's Sister (my Aunt) had her's replaced because of the very same problem. She did die, but from old age and not the heart, she lived many years with that stainless steel ball that replaced the valve, and right up to the day she died it was still working.

I know I should be asking him these questions, but how do you question his motives? I thought there must be a reason for him to do it in this order, and frankly many of these questions don't come into your mind when he is examining you.

If there is someone out there who may have some answers and advice to these problems I would appreciate that very much.

Thanks,
Joe

 

[Nancy]

Hey Joe-

I recognize you from WebMd. I'm the person who gave you this link.

As I mentioned there, my husband has had 3 valve surgeries and also has had many caths. It's a test that shows a lot and is necessary for a good diagnosis of what's going on with your heart. So go ahead with the test. It's pretty pain-free, and is quite common. I'm sure lots of folks here will tell you the same thing.

Also heart valve surgeries aren't usually done until the leak is in the moderate to severe range, and the patient has some symptoms. The docs determine the right time by keeping a watch on your valves with various tests and when it is time based on the test results they will have you see a surgeon.

Along with the test results, your own symptoms play a part in the determination. So if you have some symptoms, write them all down and discuss it with your cardiologist.

Here are some very informative links from the Texas heart Institute. They will answer many of your questions, and will be from experts in the field.

Texas Heart Institute Home Page
http://www.tmc.edu/thi/index.html

Heart Anatomy
http://www.tmc.edu/thi/anatomy.html

Valve Surgery
http://www.tmc.edu/thi/vsurg.html

Valve Diseases
http://www.tmc.edu/thi/valvedis.html

Heart Valve Types
http://www.tmc.edu/thi/valvetype.html

Diagnostic Tests
http://www.tmc.edu/thi/diagtest.html

Heart Related Glossary
http://www.tmc.edu/thi/glossary.html

Frequently Asked Questions
http://www.tmc.edu/thi/question.html

 

[MelissaM]

Hi Joe,

Sounds like your cardiologist is right on target. Valve problems, while serious, can go on for years with minimal symptoms and implications. Many members had their valve problems diagnosed as children/teens and are only now having surgery in their 40s, 50s, etc. If there is more leaking, it doesn't mean that you are at a critical stage yet - it just means that you have more leaking.

Meanwhile, it sounds like you have some potentially complicated situations developing in the bottom of your heart. I am not familiar with most of what you wrote re: that, but it sounds like he is looking for ischemia (lack of blood flow to the heart?), which I believe can be responsible for heart attacks - as you most likely know, this is something that can permanently damage your heart muscle an even be fatal.

Sounds like he has the right priorities to me. . .

Welcome to the forum
Melissa

 

[Ross]

Hi Joe and welcome

I would go ahead with the catheterization, as it will give an inside look at everything and the flow pressures can be measured too. Usually you end up with the stress test, echocardiogram, catheterization, and Trans-esophageal echo for full diagnostics.

I had somewhat the same problem before my aortic valve replacement. The catheterization showed a blockage in the apex or bottom of my heart. They thought that I had already had a heart attack. When they got in there to replace the valve, it turned out that it wasn't a clot, but a cyst on the pericardial wall.

I wouldn't question the Doctor ordering the test. He's looking out for your best interest and it's in line with all the testing that can be done. Hope this helps you in some way.

 

[ALCapshaw2]

Hello Joe,

The Heart Catheterization is the standard test for blood flow to the heart. Valves can also be evaluated during a cath.

I well remember that I was scared out of my mind before my first cath. After it was over, I had one of those "is that all there is" feelings. I've lost count of the number of cath's I've had. NO BIG DEAL !

An Echogram is a good non-invasive starting place for Valve evaluation. The TransEssophageal Echogram (TEE) is the gold standard for valve evaluation where they place an ultrasonic transduced down your throat to get it right next to your heart. Don't worry, they use conscious sedation and other drugs to put you in a state of "I don't care" and you won't remember a thing.

My only caution is to go to a hospital that does these tests by the thousands. The more they do, the better they are.

'AL'

 

[JensenJoe]

Dear Nancy, Melissa, and Al,

I really appreciate your advice, and after reading them I think I will go ahead with the test. However my wife and her friend say that I should get a second opinion, but I wonder if I go to a different Doctor in the same area, I think he will most likely be hesitant to criticize a friend or Doctor? In other words I don't think that I could get a different result, so why try and waste time?

The only thing that has me concerend about this opinion is that I don't have any symptoms, no chest pain, no arm pain, or any indication that I have Heart problems. I was sent to a Heart Doctor several years ago because of varicose veins by my GP Doctor who gives me my pain medication for the Spinal Stenosis problem I have had for years. That Heart Doctor found that I had Congestive Heart Failure, and gave me several tests to prove that. I was being treated for that with Atenolol, and Lasix, but my Wife kept saying she didn't beleive that I had that.

So one day at another Doctors office (this Doctor saved my life because I had Thyroid Cancer which he operated twice, once to remove a tumor, and the second operation was to remove the Thyroid) she mentioned to him that she thought that I did not have Congestive Heart Failure, so he sent me to this Doctor. This Doctor found that I do not have Heart Failure, but has found this problem now. I like this Doctor very much, but after my experience with the other one, I can't help asking the same questions to myself, that my Wife was asking.

I know this may sound like I made it all up, or like a soap opera, and I am sorry maybe I should have explained this first, but when you go to a Doctor no matter who they are, don't you trust them to the point of putting your life in their hands?

Like I said before I think I will go through with it, and I plan now to call next week and make the appointment, I just want to talk it over with the kids ( my children) this weekend before I call.

I would like to thank you all for taking the time and such an interest in my well being, I appreciate that very much.

Joe

 

[Ross]

Hi Joe

If you want a second opinion, by all means get one, a third even. To be totally honest, I think they all will recommend the samething and that is to have it done. None the less, for your own piece of mind, do see about another opinion.

The other thing about not having symptoms--There are some people walking around this planet right now that could be in real danger and not even know it. A perfect case example, John Ritter, who we lost not long ago. These things don't always present symptoms. Just so your aware.

 

[Nancy]

Hi Joe-

My husband, Joe has had congestive heart failure for years. It's the type of thing that comes and goes, but is always there in the background, in other words, a chronic thing. Your Lasix is probably able to keep up with it, and that is why you aren't feeling to badly, but it can get out of hand and it almost cost my Joe his life last December.

So I would believe the doctor who diagnosed it, you might not be having a problem with it right now.

By the way, there is now a test that can determine if you have CHF, it's called BNP. It's a blood test. If your body is retaining fluid and you are having CHF symptoms, this test can help to make the diagnosis. It used to be confused with bronchitis or other respiratory things. Lots of people got much worse because they were being treated for the wrong thing.

Having the cath would be a good thing for you to do. You need to really find out what's going on with your heart. It will give you some of the answers you should have. There are other tests which could be done also, if needed.

It is ALWAYS better to know things than not. If there is something, it can be taken care of, and that's a very good thing for you. If it's nothing, then you will be a happy man.

It's a win-win situation.

 

[JensenJoe]

Dear Ross and Nancy,

All I can say is thanks for all the sound advice, and Nancy I believe the same thing i.e. isn't it better to know, than to know not.

I didn't know that CHF could be something that I could still have, I believed that it was wrong and if it is possible the CHF is also a possible problem with my Heart, will the cath also point that out ?

Another thing to worry about I guess, because if true my Heart has the strain of this CHF problem as well.

Thanks I will call and make the appointment, and when I find out, I will be sure to amke a post to let ya'll know.

Thanks again,
Joe

 

[Georgia]

Hello, Joe

Hello, Joe

You're in the right place to voice your concerns and confusion about your heart. Many of us thought we were asymptomatic (only to find that the little gurgle, choking, huffing and puffing, tiredness, etc., were heart-related).

I'm the original chicken about cardiac cath - my surgeon said I was the first he had who was more scared of the cath than the open heart surgery.

I'm here to tell you that it's a slam dunk. Tell the cardio that you're scared and they'll put you out rather than give you a "twilight" anesthetic.

Best of luck. This is the king of thing you're really better meeting head on, and the sooner the better. Stay with us and let us know what happens.

 

[Gail in Ca]

I wouldn't be too worried that you are not having symptoms.
Before my first AVR, I had no symptoms that pointed to heart problems. I only had weakness in my legs when picking up my daughter. I thought I might be getting a muscular disease. But, my Gp heard a murmur and I got the tests she ordered which showed an aneurism of operable size, leaking aortic valve and enlarged heart. My surgeon said that my symptoms didn't point at all to what I had wrong. My first cath went just super.
Gail

 

[Nancy]

Hi Joe-

CHF doesn't cause the heart problems, your heart causes CHF because it isn't functioning properly. That's why you need to go ahead with any tests your doctor wants to run, so you can either rule in or rule out underlying cardiac problems.

Here is a link from CHFpatients.com which talls q lot about the dynamics of CHF.

http://www.chfpatients.com/CHF.htm#intro

 

[sylviayasgur]

hi joe!
welcome to this site. as you can already see, everyone here is great!
i agree with all in that you will, at some point, need to have the cath anyway.
it really helps the docs see more about your heart and its condition.
i also think that if you are not comfortable with this decision, please seek out another opinion.
you need to feel you can trust and believe your cardio and doctors.
please let us know what you decide to do.
wishing you all the best, sylvia

 

[Bob]

Hi Joe. I am 67 and had the tests, all of them. Do it man! They are easy, little or no pain and they will tell you what is going on. I am alive today because of the tests my cardio gave me. Sure it scares the hell out of you but better scared than dead. You need facts not guesses of what might be...Only the tests can give you facts. Your cardio sounds like he/she knows what they are doing. Good luck.