Tia

[GregB]

Hi folks,

I ended up in the emergency room over the weekend with an apparent TIA ( Transient Ischaemic Attack - mini stroke?) Doctors speculate a small clot flicked off from around the valve area. ( the other possibility mentioned was a strange form of migraine?)

I was almost home from a reasonably gentle jog. Left side of my face suddenly went numb, also mouth and tongue. I was unable to speak clearly. I was able to walk home. My wife called an ambulance and went to to ER.

Symptoms cleared after about 30 -40 mins and I have felt OK since. I had a couple of similar episodes in late 2001 prior to AVR surgery but nothing since.

Had lots of tests and nothing too abnormal apart from elevated cholesterol showed up. I guess the scary bit is that the hospital booklet warns that "a TIA is an impending stroke, a powerful warning that a severe stroke might follow." Yuk!

The specialist emphasised that he cannot guarantee a stroke not will happen sometime but he told me not to panic ...and to see him in 3 months time!I guess that was comforting.

INR has remained in the 2.2 - 3.3 range for the last couple of weeks and was retested in the hospital.

I am wondering if anyone else has had similar experieces and how it was dealt with.

At present I am hanging out for the migraine scenario. Sounds better than the alternative!

Greg

 

[bvdr]

I'm sure that was scary. Have you read any of the threads here about "visual disturbances"? I personally would think migraine if your had some visual symptoms that went with the numbness and speech problems but there is no way they can really know for sure anyhow. I'm glad your INR is alright. I think when there is a possible history of even a small clot, trying to keep your INR on the high side of your range is a good idea.

 

[Sherry]

Hello, Greg,
I started a thread on the heart talk forum some time ago about visual disturbances that I have had since my surgery and have taken for emboli being thrown from the valve. In fact, another person today just mentioned some similar numbness symptoms (like those you mention) on that thread. Having had occular migraines for years before the surgery and then these "loss of vision" episodes after the surgery, I just never knew what to make of them. All the stroke literature mentions visual loss, so when that happens, the first inclination is to go to the e.r. or doc to have my blood checked only to have them shrug their shoulders and tell me they don't know what it is. It's become very frustrating to me and to some others who have written similar responses that I started reading up on some other possible avenues -- migraines being one of them. Amazingly, some of the migraine literature states that sufferers can have stroke-like symptoms, numbness in the face and mouth, along with visual problems, and of course, the tell tale headache. But, there's plenty of testimonials from people on these migraine sites who have only vision and numbness problems with no headache. Please know that you did the right thing in going to the E.R. and having that checked out. I've done the same, and I suspect others on this forum have too. I don't think we'll ever find an answer to these strange symptoms, but the best we can do is always listen to our bodies and if we sense some danger, have it checked out.

 

[Mary]

Greg,
I had a similar episode in late May that landed me in the hospital for 4 days.
I had a battery of tests that led to the conclusion that it was due to my valve. I have not had valve replacement yet. The tests run were Cat scan, MRI, MRA, echocardiogram, carotid artery ultrasound. The May event was the second one; the first occurred in March.
Having two occurences within three months led the doctor to order so many tests. I did not go to the hospital in March. However, in May I went to the Emergency Room. They immediately started the warafin and kept me on it while they ran the tests. I am now taking Plavix and aspirin daily, but no coumadin.

I'm a little concerned that they mentioned the possibility of a migraine episode. I believe that only serves to cloud the issue. My visual disturbance was in no manner consistent with a migraine. My episode was momentary tunnel vision along with left side weakness and temporary loss of speech. The tunnel vision indicates one is about to lose consciousness. If you ever experience tunnel vision, you will never confuse it with any other type of visual disturbance. They are in no way similar. I also had the jaw and face tingling sensation in March. That was the chief sympton at that time.

Although I have not had my valve replaced, the day that this occurred I knew that I had over exerted myself. I remember thinking two different times, I'm doing too much. I'm going to have to sit down when I get a chance. It makes sense to me that if I was working my heart harder than usual, the increased pressure of blood flow trying to get through the valve might have dislodged a particle of calcium.

I would keep after this since my second experience was more severe than the first.

Mary

 

[Nancy]

My husband has had about 16 of them (TIAs). Many of them came on with visual problems, with one or both eyes having impaired or no vision, one caused garbled speech, another caused confusion, another stabbing head pain, several causing vertigo, and he fell out of bed with another. He went to the ER with each one and had immediate testing for any possible full-blown stroke, no evidence was found, and the symptoms cleared in an hour or so.

He was referred to a neurologist who put him on Plavix for a while.

These occurred prior to his mitral surgery in 1999. He hasn't had any more of them since. They were considered to be micro-emboli spinning off his valve/s.
What he has found is that having his INR in the low range is when these happened the most. So his doctor keeps it at the middle to the top of his range. Joe's INR range is 2.5-3.5. So keeping it between 3 and 3.5 seems to work best for him, so far.

 

[ALCapshaw2]

My cardiologist also recommends keeping INR on the high side (3.0 to 3.5) for people who experience TIA's.

During one trip to the ER for a possible TIA, I was told to chew a regular aspirin which is an anti-platelet.

The best clarification of the difference between anti-platelets and anti-coagulents came from a Pharmacy Resident at my Coumadin Clinic. She said that anti-platelets (such as aspirin) prevent already formed platelets from 'sticking' together. She said that anti-coagulents prevent platelets from being formed. This is consistent with another explanation I have heard that both prevent clotting but through different mechanisms.

Bottom Line: It may be wise to chew a single aspirin upon the advent of TIA symptoms. BE SURE TO GET CONCENT from your DOCTOR, preferably your Cardiologist or whoever is monitoring your Coumadin / INR.

'AL'

 

[GregB]

Tia

Thanks for the re-direct to the Heart Talk forum on visual disturbances. Much of that makes a great deal of sense to me. I have had some aura type visual disturbances every now and then since surgery which may add to the migraine possibility. I will continue to follow that thread as it develops.Clearly with so many posts it is an issue that impacts on a large number of us at some time or other.

I had pretty much the same tests as those reported by Mary. I do however relate to her comment on over exertion and stress. When I think back over the past weeks I have been pushing it pretty hard with work, gym and running and a couple of bouts of chest infection. I think now I might have pushed a bit too hard.

One of the senior nurses gave me a stern lecture on balance in life and how I needed to see this event as a timely warning. Not everyone gets the privelage of such a warning, so I need to be more sensible about the demands I have been placing on myself.

Despite the speculation about possible migraine the most likely explanation is micro-emboli spinning off from the valve (or dacron sleeve in the aorta) as was described by Nancy. It makes sense then to try to keep the INR on the high side of 3.0. I am already taking 100 mg of aspirin along with 9mg of Warfarin.

Right now I feel as I imagine a resident of San Francisco might feel...waiting for the big one.

But life goes on there as it does for me now.

Clearly I have to take this as a warning as my nursing friend said and to refocus on the disciplines imposed by a life with warfarin: regular activity, good rest, sensible diet,restricted alcohol intake and careful dosing and testing. Should be doable.

Thank you all for your help.

Greg