Visual problems following cardiac surgery

[epstns]

Add me to the list -- I've had occasional episodes of the "sparklies" and the "tunnel vision" with gray around the outside. I've also had several episodes in which both eyes still "work" but I cannot bring the two images into convergence, so I see double. Fortunately, none of these episodes has lasted more than seconds, but from what I've read here over the years, all of these are fairly common, and they become more common after heart surgeries. At one time the theory was that being on the heart-lung machine caused microscopic debris to be in the bloodstream, and when any of this got into the circulatory system of the eyes, disturbances would result. I'm not sure if this is true, but maybe.

At least be comforted that you are not nearly alone in this, and it seems to be benign as far as I can remember reading.

 

[Dan Zulu]

I'll pass on any information I receive at my next appointment. My cardiologist wasn't concerned at all, but surgeon wanted me to get a specialty exam.

 

[Southrnshooter]

Add me to the list. 2 weeks post op. Had migraines since I was 7, but these a different. Getting them since a day or 2 after surgery.

 

[Owenall]

I'm now 18 months after AVR (mechanical), I always suffered migraine before operation since my teens, but have had lots of visual disturbances since, I have the zig zag aura on average about twice a week (without headache), also like Steve I have the occasional double vision, not lasting long, just for a few seconds and about twice had the tunnel vision which is a bit scary when it happens.
Seems like something some of us have to put up with after surgery.

 

[Dan Zulu]

The neuro opthamologist suspects some minor spasms in my blood vessels, which should go away with time. If my symptoms arose suddenly and only lasted a couple seconds then he would suspect some particles in the blood stream caused by the heart lung machine. So at least as long as my symptoms are long (10 minutes average duration) then my chances are good it's nothing serious or permanent.

 

[Paleowoman]

The neuro opthamologist suspects some minor spasms in my blood vessels, which should go away with time. If my symptoms arose suddenly and only lasted a couple seconds then he would suspect some particles in the blood stream caused by the heart lung machine. So at least as long as my symptoms are long (10 minutes average duration) then my chances are good it's nothing serious or permanent.

Thanks for the report Dan.

I wonder what your neuro opthamologist would do if he suspected particles in the blood stream caused by the heart lung machine ? I get the migraine aura which lasts 15-20 mins every couple of weeks, but also sparkles of light crossing my vision for a few seconds most days, and double vision with dizzyness which lasts half a minute or so once every couple of weeks.

 

[ajc1991]

Ugh, I already have these and REALLY hope they don't happen more often after I have my surgery. They're really irritating. I first get the zig zag and then get the headache, and a little bit of nausea. Really annoying and not fun.

 

[workmonkey]

I'm comforted to know I'm in good company. Visual auras have probably been the most prominent side-effect from my February, 2014 valve/aorta repair. Sometimes I have the auras 7 - 8 times a day (even waking up to them). Other times, I just get an intense pressure behind my eyes that eases with time. Still other times, it just feels like seeing "hurts" - just the act of using my eyes, even when I see fine. They all usually come with a side-serving of mental fog and vertigo. They always pass within an hour or so.

The interesting thing is I experienced auras for many years before the surgery - usually about three to four times a year (usually under periods of high-stress or exhaustion or caffine overdose). So they definitely weren't caused by the surgery itself - just intensified and made more frequent. So this makes me feel it doesn't have to do with the heart-lung machine.

My arm-chair diagnoses, from the reading I've done, is that it has to do with blood pressure. The veins behind your eyes are some of the smallest and most delicate, and more prone to changes in blood pressure than any other. Many vision problems are caused by blood disorders (like diabetes as example). Obviously, there are some blood pressure disturbances from the surgery. And if you are on betablockers, you usually get daily swings in blood pressure (from when you are sleeping to going about your day) that can impact the veins/nerves, and the aura is them working back into balance. I do know sleep is when your blood pressure is lowest, so maybe this is why they come during sleep or earlier morning (which is usually when I get them).

While annoying, they seem harmless. I have found that baby aspirin helps for some reason. And I'm guessing that as your blood pressure normalizes in the coming year or two, it'll start to subside. Just a guess - let's all keep each other updated to see if we can find any tricks or solutions!

P.S. As a side-note, I seem to be tracing a lot of random side-effects like these to betablockers, not the actual surgery ... I have learned to hate them. I take them after exercise in the mornings, and can literally feel them letting the air out of my balloon ... The worst part is the mental fog. It's like putting a bag over your head. My cardiologist insists I take them for one full year after the surgery, but when I stop next February I'll report back to see if some of these symptoms have resolved.

 

[Paleowoman]

Hi workmonkey - I started to get these visual problems the day after surgery. A doc at the hospital said they were to do with the heart lung machine, and a study I found on the internet says that visual problems are a 'neurological' side effect of being on a heart lung machine. At first I thought they were also to do with the betablockers I was on, but I've been off them now for 7 months - hurray - I hated being on them and was able to stop them three months after my AVR. My blood pressure is fine. This morning I woke up with an aura which lasted about ten minutes. Lots of those sparkling blobs of light crossing my vision on and off today, something that happens often.

It's so interesting that so many of us have this post surgery.....reassuring too in a way.

 

[epstns]

Workmonkey - I hear you about the beta blockers. After my surgery, I was taking metoprolol extended release, 100 mg/day. I felt like I was dragging a sled full of boulders behind me all the time. I tolerated this for the first 6 months (IIRC), as my recovery was slowed by some complications. At about the 6 month mark, I had a discussion with my cardio and negotiated a reduction in BB dosage to half of the original amount. We said that if my heart rate and rhythm behaved, I could remain at the lower dosage, if not, back up it would go. I felt much better, and had no problems.

Fast forward another few months, and I repeated the discussion with my cardio, again negotiating a reduction in dosage to half again. Now I'm down to 25 mg/day, with no rate or rhythm issues noted. I'm feeling much better at this dosage, so I've "agreed" to keep this level of meds for a while.

My point in mentioning this? Have the discussion with your cardio. Maybe he/she feels you're ready to reduce your dosage. If so, you may find a point at which you feel good but still have some of the "protection" of the meds.

 

[workmonkey]

Thanks for the suggestion epstns - I have an appointment for early December and my first order of business is to ask about the beta-bockers. I appreciate that they are trying to be protective, and will follow their recommendations to a point ... but I feel like I won't be able to fully feel like normal again until I get the dosage/medication right. I'm glad to hear that lowering the dose has had such a positive effect.

Paleogirl - interesting that the aura cause may be the heart/lung machine ... I guess I had hoped that wasn't the case, as I don't know that much can be done to fix that other than just wait it out. But it makes sense that something like that would have residual effects.

 

[Elmo]

I too have had visual disturbances since my AVR 4 years ago. I've also had "ordinary" migraines since I was 17 & these continue too.
I find that certain shades of white light - especially cold white lights make me feel really ill.

Workmonkey - with regard to your beta blockers, why not ask your cardiologist about trying a different one. Metroprolol caused me no end of problems, but I discussed it with my surgeon & he was only to happy for me to try something else. After trying a couple more we found that bisoprolol suited me & i don't get any of the side effects I did with the other types.

 

[Mooney]

Hi everyone,

Just checking in and I hope you all are doing well. I wanted to update this thread, I am still getting those ocular migraines, migraines with aura, whatever you call them. The longest I went without one is about six weeks, the shortest about 48 hours. In general I seem to get them every two weeks or so. But in between I am often dizzy and kind of spaced out, It takes great effort at it times just to focus and concentrate.

I switched from taking toprol XL to bisoprolol but no real difference.

I really don't know what to do, just live with it I guess, but it is very difficult at times.

Keep well,
Richard

 

[cldlhd]

When I was on beta blockers I was originally put on metoprolol but I started getting migraines every week instead of a couple a year. My cardiologist said it there was no way the metoprolol was at fault,she said it was stress , but once I convinced her to try a different beta blocker ( verapimil ) they went away altogether.

 

[ottagal]

When I was on beta blockers I was originally put on metoprolol but I started getting migraines every week instead of a couple a year. My cardiologist said it there was no way the metoprolol was at fault,she said it was stress , but once I convinced her to try a different beta blocker ( verapimil ) they went away altogether.

Interesting as to how we all react.

I am a migraine sufferer and one of the recommendation for treatment from my neurologist was to stay on my beta blocker.
Here is information on how it is used for migraine sufferers.

http://www.nbneuro.com/betablockers.shtml

 

[cldlhd]

Yes I was told metoprolol should help with migraines but it didn't for me. I did find verapimil was fine for me though. I think it's possible lifelong use of verapimil could prevent migraines for me, possibly, but since I normally ( pre beta blockers ) only got a couple migraines a year I don't want to stay in them just for that purpose if I don't need them from a cardiac standpoint. Verapimil is a calcium channel blocker which is supposed to be better for migraine prevention.
I'm just going to eat some pumpkin seeds as a daily snack in order to get some magnesium, natures beta blocker and also supposedly a migraine preventative.

 

[Paleowoman]

Some years ago, several years prior to heart surgery, I was prescribed propanolol for migraines - these were the regular type of migraine of aura followed by headache. I don't think the auras and other visual problems we are getting post AVR are caused by the same thing as regular migraines which is why, perhaps, beta blockers don't work with them. I was told and have read, that these occular auras, mostly without headache, plus double vision and flashing lights across vision are to do with being on the heart lung machine. With my regular migraines there were definite trigers, there are no triggers for these post AVR migraines - I've even woken up in the middle of the night with one of them halfway through the sequence - you know the prism of circling light which gets bigger and bigger.

 

[cldlhd]

I was wondering the same. Are these post surgery auras without headache a totally different beast or ,hopefully, is there something about the improved hemodynamics that eliminated the headache and nausea part.

 

[Paleowoman]

is there something about the improved hemodynamics that eliminated the headache and nausea part.

If that were true then there wouldn't be people on here post AVR getting these migraine auras who never, ever had migraines before surgery. Nice thought though.

 

[cldlhd]

A little positive thought can't hurt