A lot of people are curious (and reasonably so), so here's a rather long-winded, tedious thread about the series of events around my recent valve surgery...
I got my latest echo results two months after the echo. In between, I had been contacted by the cardio's office and told that the echo said my heart was "normal."
Except the echo was very different. In this new echo, I suddenly had mild regurgitation in both my tricuspid and mitral valves, which had not been affected before. And it indicated calcification beginning on my mitral valve. My valve opening was listed as .74 cm². Plus, I now had AFib and "pauses" in my heart rhythm.
The cardio wasn't even going to discuss possible surgery. He didn't even consider my aortic stenosis severe. He said that the pressure gradient was 39 mmhg, and 40 mmhg was the demarcation for severe. I pointed out that the mitral and tricuspid valves were now leaking, and the pressure was lower because it was now going out both ends of the ventricle: the aorta, and also back into the atrium. Rather than showing that my heart was dealing with the issues (his view), it said to me that my heart was unravelling like a wet, cardboard box. He felt the mild regurgitations were not particularly harmful, and I should go to his Coumadin clinic for the AFib, and to to an electrophysiologist to determine what to do about the rhythm issues (read: pacemaker).
I saw those misrhythms as precisely what they were the last time: a cry for help from my heart. Ginger Baker playing nightly on the stage of my heart. (He was the drummer for Cream.) The cardio felt I wasn't particularly symptomatic, and I am at a loss there, having described my increasing angina and SOB with him at each visit.
Also, if the AFib is related to the valve issue, and the valve is replaced (which always includes a cardio conversion) within a few months of onset, there is an 80% chance it will dissipate. Later, it's less than 20%. He was entirely willing to trade me having permanent AFib and possibly getting a pacemaker for - what? To control my case another six months? I don't for a moment think he meant ill, but that is not a decision you make for someone without discussion.
He had already sat on the report for almost two months, and had apparently brushed up that morning and saw that I had AFib, and it was suddenly an emergency to get me into his Coumadin clinic.
By that point in the visit, I already knew what my plan was going to be: find my surgeon and get that thing replaced ASAP. At that point, there was no reason to get into anybody’s Coumadin clinic, as I knew I would likely be having the surgery in the next few weeks. (They wouldn’t be likely to have my INR even stabilized by then, and the bridging would add new dimensions to the surgery, and likely even raise the prospects of a post-surgical stroke – all over an arrhythmia that had an 80% chance of going away after surgery.) As far as the other rhythm problem (“pauses”): after the replacement and cardio conversion, your rhythm may get worse, or it may get better, but there is an enormous likelihood that it will not be the same. No point in treating a temporary phenomenon with some permanent fix that would also likely delay the resolution of the base, obvious causation: aortic stenosis.
I allowed him to prescribe Plavix for the AFib, and reminded him that I am not 85 years old (barely 57), and thus it wasn’t appropriate to simply manage my heart condition until I died of something else. This is the thing I’m most likely to die of, at this point. Everything else works.
Everything at that point became a whirlwind of trying to get visits set up, deal with turnover at work (now, mind you, at this point no cardiologist has agreed with me yet), get information from the third party company who handles company leaves, try to figure out what dates might work, and try to take the week in Maine that I would miss earlier. I had trouble getting files sent from one office to another. They sent none. Then only part. Obviously, no one had immediate time to talk to me, although I give great credit to both my cardiac interventionalist (Cath Man) and my surgeon for making time for me much earlier than I really could have expected.
I had to present my case to each of them, as I had no cardiologist’s agreeing opinion in my pocket. The surgeon was very careful that he was not putting the idea of surgery into my head, nor making it too easy for me to get the surgery. However, he was persuaded by the arguments (they make sense) and the aperture size, along with my symptoms. The Interventionalist was a bit more skeptical, but in the end, determined that along with my symptoms, it was one reasonable path to pursue.
They each provided “maybe” dates. At one point, a PA told me the dates were “casual.” I explained that when you’re working (which I still was), all kinds of people want firm dates, and it isn’t so casual. Both doctors wanted to push it forward because ot the AF ib liability. They agreed to hash out a schedule while Pat and I went to Maine for the last week. (I have no PC or connectivity in Maine.)
The Thursday before we returned home, I was finally able to confirm the dates. I particularly have to mention my Interventionalist, because he drove all the way into Newark on a day he wouldn’t normally be there, in order to allow me to have the catheterization in the destination hospital and stay there overnight.
It was a fairly wretched, frustrating time, and the trip to Maine was a great blessing, if a bit eery (you can’t help but wonder a bit, after all).
There’s more, but I’m out of steam for the moment…
Best wishes,
My symptoms. Al. They were worse than they were the first time. As I had pointed out for some time and in many posts, my valve was not right from the get-go, so I knew there had to be a reckoning with it eventually. But my cardio's office was telling me I had a 1.1 cm² valve opening, which wouldn't get me anywhere with a surgeon unless I were bedridden. (Generally, with symptoms, any thing below 1 cm² can be a green lght.)Al Capshaw said:
I got my latest echo results two months after the echo. In between, I had been contacted by the cardio's office and told that the echo said my heart was "normal."
Except the echo was very different. In this new echo, I suddenly had mild regurgitation in both my tricuspid and mitral valves, which had not been affected before. And it indicated calcification beginning on my mitral valve. My valve opening was listed as .74 cm². Plus, I now had AFib and "pauses" in my heart rhythm.
The cardio wasn't even going to discuss possible surgery. He didn't even consider my aortic stenosis severe. He said that the pressure gradient was 39 mmhg, and 40 mmhg was the demarcation for severe. I pointed out that the mitral and tricuspid valves were now leaking, and the pressure was lower because it was now going out both ends of the ventricle: the aorta, and also back into the atrium. Rather than showing that my heart was dealing with the issues (his view), it said to me that my heart was unravelling like a wet, cardboard box. He felt the mild regurgitations were not particularly harmful, and I should go to his Coumadin clinic for the AFib, and to to an electrophysiologist to determine what to do about the rhythm issues (read: pacemaker).
I saw those misrhythms as precisely what they were the last time: a cry for help from my heart. Ginger Baker playing nightly on the stage of my heart. (He was the drummer for Cream.) The cardio felt I wasn't particularly symptomatic, and I am at a loss there, having described my increasing angina and SOB with him at each visit.
Also, if the AFib is related to the valve issue, and the valve is replaced (which always includes a cardio conversion) within a few months of onset, there is an 80% chance it will dissipate. Later, it's less than 20%. He was entirely willing to trade me having permanent AFib and possibly getting a pacemaker for - what? To control my case another six months? I don't for a moment think he meant ill, but that is not a decision you make for someone without discussion.
He had already sat on the report for almost two months, and had apparently brushed up that morning and saw that I had AFib, and it was suddenly an emergency to get me into his Coumadin clinic.
By that point in the visit, I already knew what my plan was going to be: find my surgeon and get that thing replaced ASAP. At that point, there was no reason to get into anybody’s Coumadin clinic, as I knew I would likely be having the surgery in the next few weeks. (They wouldn’t be likely to have my INR even stabilized by then, and the bridging would add new dimensions to the surgery, and likely even raise the prospects of a post-surgical stroke – all over an arrhythmia that had an 80% chance of going away after surgery.) As far as the other rhythm problem (“pauses”): after the replacement and cardio conversion, your rhythm may get worse, or it may get better, but there is an enormous likelihood that it will not be the same. No point in treating a temporary phenomenon with some permanent fix that would also likely delay the resolution of the base, obvious causation: aortic stenosis.
I allowed him to prescribe Plavix for the AFib, and reminded him that I am not 85 years old (barely 57), and thus it wasn’t appropriate to simply manage my heart condition until I died of something else. This is the thing I’m most likely to die of, at this point. Everything else works.
Everything at that point became a whirlwind of trying to get visits set up, deal with turnover at work (now, mind you, at this point no cardiologist has agreed with me yet), get information from the third party company who handles company leaves, try to figure out what dates might work, and try to take the week in Maine that I would miss earlier. I had trouble getting files sent from one office to another. They sent none. Then only part. Obviously, no one had immediate time to talk to me, although I give great credit to both my cardiac interventionalist (Cath Man) and my surgeon for making time for me much earlier than I really could have expected.
I had to present my case to each of them, as I had no cardiologist’s agreeing opinion in my pocket. The surgeon was very careful that he was not putting the idea of surgery into my head, nor making it too easy for me to get the surgery. However, he was persuaded by the arguments (they make sense) and the aperture size, along with my symptoms. The Interventionalist was a bit more skeptical, but in the end, determined that along with my symptoms, it was one reasonable path to pursue.
They each provided “maybe” dates. At one point, a PA told me the dates were “casual.” I explained that when you’re working (which I still was), all kinds of people want firm dates, and it isn’t so casual. Both doctors wanted to push it forward because ot the AF ib liability. They agreed to hash out a schedule while Pat and I went to Maine for the last week. (I have no PC or connectivity in Maine.)
The Thursday before we returned home, I was finally able to confirm the dates. I particularly have to mention my Interventionalist, because he drove all the way into Newark on a day he wouldn’t normally be there, in order to allow me to have the catheterization in the destination hospital and stay there overnight.
It was a fairly wretched, frustrating time, and the trip to Maine was a great blessing, if a bit eery (you can’t help but wonder a bit, after all).
There’s more, but I’m out of steam for the moment…
Best wishes,
