Ventricular Impairment

[mrmean]

Hi,

I posted my first intro a few weeks ago after attending my 6 month post op, I have today received a further letter and would like someone to possibly explain what it means... because I can't find out any info, anywhere.

"Dear Anthony,

I recently saw you in clinic with your mother as follow uo to your aortic valve replacement. I have reviewed the echocardiogram in person and as indicated in the clinic the valve replacement is working fine. There is some very mild indication of some ongoing left ventricular impairment. (This is the main pumping chamber). This is unlikely to cause you any problem but we will obvisously have to monitor this in the future with annual clinical reviews and echocardiograms at that time. It is medical practice to introduce a medication of an ACE inhibitor to maintain an efficient heart in the context of any signs of left ventricular impairment. Therefore I would advise you to obtain a prescription of this medication (I have suggested a tablet called Ramipril 2.5mg od) to take once a day. It can have marginal affects of lowering your blood pressure. This would need to be an ongoing medication. If you have any queries regarding this, to discuss it with your GP.

To summarize everything is satisfactory and you appear to have done very well following your operation.

Your Sincerely,
***"

There was also a much more detailed/technical letter spreading over 2 whole a4 sheets, but its too much to type. If further detail is necessary I am happy to upload them so people can take a look.

 

[JeffM]

That other documentation you mentioned will probably help answer your questions in more detail. I'm a Realtor, not a medical professional so take this for what it's worth. Often, by the time an aortic valve replacement is performed, as in my case, the left ventricle (LV) has been abnormally dilated for some period of time, either due to the resistance from a calcified (stenotic) valve or, as in my case, from a valve that leaks (regurgitates) badly and allows excessive blood flow back into and effectively flooding the LV. Once the muscle tissue that forms the walls of the LV get stretched out beyond a certain point, the LV loses some of its ability to efficiently pump blood. End diastolic diameter and ejection fraction measurements are common indicators of the efficiency of your heart. ACE inhibitors slightly lower blood pressure to take as much pressure as possible off the heart so it has the best chance of remodelling itself after surgery. Your Dr feels you would benefit from taking this medication indefinitely. Be curious to know your 6 mth ejection fraction (EF) and end diastolic diameter (EDD) measurements if you can identify them on that report.

 

[mrmean]

That other documentation you mentioned will probably help answer your questions in more detail. I'm a Realtor, not a medical professional so take this for what it's worth. Often, by the time an aortic valve replacement is performed, as in my case, the left ventricle (LV) has been abnormally dilated for some period of time, either due to the resistance from a calcified (stenotic) valve or, as in my case, from a valve that leaks (regurgitates) badly and allows excessive blood flow back into and effectively flooding the LV. Once the muscle tissue that forms the walls of the LV get stretched out beyond a certain point, the LV loses some of its ability to efficiently pump blood. End diastolic diameter and ejection fraction measurements are common indicators of the efficiency of your heart. ACE inhibitors slightly lower blood pressure to take as much pressure as possible off the heart so it has the best chance of remodelling itself after surgery. Your Dr feels you would benefit from taking this medication indefinitely. Be curious to know your 6 mth ejection fraction (EF) and end diastolic diameter (EDD) measurements if you can identify them on that report.

Hi JeffM,

Thanks for replying.. I have uploaded the more detailed letter, you can view the first page:
http://www.anthonyshapley.co.uk/wp-content/2.jpg
and second page:
http://www.anthonyshapley.co.uk/wp-content/3.jpg

Many thanks,
Anthony

 

[Adrienne]

He doesn't seem to put the percentage of ejection fraction (I didn't see it anyway), but writes of mild hypokinesis. To me that means that the LV just doesn't move quite as well as it should.

 

[mrmean]

Doesn't sound too bad then?

 

[JeffM]

Don't you love doctors sometimes? So, does improvement over "mild to moderate" pre op ventricular impairment mean it's now just mild? I'd say not too bad. You definitely want to ask your GP to interpret for you though. I would want to know what you can do as far as exercise intensity. How hard can you go? What, if anything, should you not do? How are you feeling, by the way?

 

[mrmean]

Don't you love doctors sometimes? So, does improvement over "mild to moderate" pre op ventricular impairment mean it's now just mild? I'd say not too bad. You definitely want to ask your GP to interpret for you though. I would want to know what you can do as far as exercise intensity. How hard can you go? What, if anything, should you not do? How are you feeling, by the way?

Hi JeffM,

Thanks for coming back to me. I've never felt better, which is why this comes as bit of a surprise to me! It just sounds like they're being extra careful to me.

I am talking to my GP on Thursday and will follow up this thread when I know a little more. Hopefully I won't experience any major side effects of this drug they are recommending.

Cheers,
Ant

 

[Eva]

2.5 mg is a very low dose and you may benefit from it and they may stop it after a while, hoping your muscle will remodel itself and start functioning well on its own again.

I look forward to your update after you see the doctor...I am curious to know his interpretation. Good luck

 

[mrmean]

Good Evening,

Just thought I'd do a brief update on this... presently the new drug still hasn't been prescribed.

After meeting the doctor and discussing the side effects which include a dry cough and decreased kidney function... I raised concerns (my mum has just had a kidney transplant because of her diabetes). Not that I'm diabetic.

However I am now going to have a check for diabetes and a look at my kidney function at present. Which I hope / assume should be fine.

Regardless I've pretty much made up my mind that I do not want to take it, if its going to damage something else. I can't imagine indefinitely prescribing a drug to a 21 year old which is going to consistently cause more damage to me, is a good idea. Since all this drug does is lowers blood pressure I will discuss how this can be improved first, as an alternative to taking additional medication as I'm dead against it.

I'll update next week after meeting the doctor again.

Cheers,
Anthony


... thoughts welcomed