Heavy weight lifting and stenosis

[jimbo]

Hello all. This is an excellent forum. I was diagnosed with a bicuspid aortic valve at the age of 43 (2years ago). Right after I got the diagnosis, I climbed Mt. Whitney with no problems. Recently, I have had no cardio stamina and my heart has gone into A-fib a couple times. I have met with two docs and they say it's about time to get the valve replaced. The valve opening is about .08-1.0 cm in diameter. I have been very active since about 18 years old. I used to lift real heavy weights up until recently (over 400 lbs bench). Does anyone know if lifting heavy over a long period of time increases stenosis? Thanks

[tobagotwo]

The lifting itself would not increase the stenosis, although it would contribute to ventricular hypertrophy (heart enlargement) in someone who has it.

However, stenosis does greatly increase the danger of lifting heavy weights. Your heart can choke on the backpressure, and you can die on the spot.

There is some evidence that many snow-shoveling deaths are related to aortic stenosis, and the AHA (American Heart Association) recommends that exercise stress testing not be done on patients with symptomatic aortic stenosis, because it is deemed excessively dangerous for the patient.

Best wishes,

[jimbo]

Thanks for the information. The doctor told me to stop the weight lifting but my mind says other things. I'll probably be going in the next couple months for the surgery so I thought I should keep my body in shape. Now I know what the doctors mean. This whole thing is new to me. I have been active my whole life, now I've got to slow down for a little bit. I'm learning from all of you.

[epstns]

As a 59-year-old patient with aortic stenosis and a "probable" bicuspid valve, I will tell you that my cardio gave me the same instructions that Bob H just passed along. He said that it was best to limit the weight I lift to 40-50 lbs but that I could do as many reps as I want. I wasn't lifting the massive iron that you've been toting, but I was bench pressing my own weight in sets. For the past couple of years, I've had to limit the weights and continue to focus on cardio-vascular conditioning, jogging my usual 4 miles/day.

Be careful out there -- at least until your doc gets everything fixed and clears you for more.

[MrP]

BAV patients have a larger aorta than the normal population due to a known association between BAV and aortic medial degeneration, and as a result, sometimes develop ascending aortic aneurysms. Weight lifting, as well as lifestyle choices such as smoking, increase risks of developing aortic aneursyms in BAV patients. The following excerpt is taken from an article by
John A. Elefteriades, MD, FACC, Section of Cardiothoracic Surgery, Yale University.


It is well known that serious weight lifters, at peaksof exertion, can elevate systolic arterial pressure to300 mm Hg. This type of instantaneous hypertension is, of course, not prudent for aneurysm patients. We recommend continuing any and all aerobic activities,including running, swimming and bicycling. Regarding weight lifting, we recommend one half the body weight as a limit.

[dick0236]

I am finding va.come very, very interesting althouge y'all use a lot of abbreviations, words and numbers that I'm not very familar with. This phrase "aortic stenosis" rang a bell since that was my diagnosis. Before my surgery, I too was very active and (as I remember) had few outward symptons. I had known for years that I had a "heart murmur" but when the U of KY docs told me I had a "one in four chance of dropping dead without warning" did it get my attention. I have remained as active after the surgery as I was before the surgery. I only use a little better judgement now. I started "lifting" at the YMCA about 5 years ago, I lift about 28000 lbs per week on the strength machines. I probably could do more but my spine, not my heart, doesn't like it.

When I "post", it is from MY EXPERIENCE ONLY. I truly believe that if I hadn't had the surgery before I had problems, I wouldn't be here today.

[jimbo]

Thanks all for all the advise. This site is great. It answers many of the unknown questions that a "future valve recipient" like myself might wonder about. Since many people encourage walking on this site, what about backpacking? Are there any backpackers out there who are on cumadin?

[MrP]

jimbo, I backpack in the Sierra Nevada mountains and have no problems climbing with a pack on my back. Coumadin is a non-issue as far as climbing...don't fall on my head.

dick0236, BAV is an acronym for bicuspid aortic valve disease which is more than just a valve disease...see

www.bicuspidfoundation.com

for more info.

[Jims]

MrP.

Thanks for the link : www.bicuspidfoundation.com
It was very informative.

Jim

[jimbo]

thanks Mr.P

I too love to backpack the Sierras. After the surgery Ii plan to hike the John Muir trail, all 212 miles of it! After that, Were going to cross country ski Yosemite, then... I guesss I'm getting ahead of myself. I First got to get this valve fixed. Thanks Again.

[MSG Morrissey]

I am so happy I read this. I have / had BAV now have St Jude and have Stenosis. I livt VERY heavy and regular. I will reevaluate starting today

[METAL VIPER]

Hello all,

I'm new here, 22, just got replacement surgery on Thursday after having congenital aortic stenosis. I went with the mechanical replacement valve. Well after surgery, the doctor told me that I would have to limit my weight lifting significantly. This was a big problem, since I am a typical stubborn kid and I'm a powerlifter and aim to get the big three (squat, bench, deadlift) as high as possible. Strength training is what I live for and I'm not willing to give it up.

My question is, since I lifted fine with the stenosis (I had surgery pre-emptively and was asymptomatic), how big of a danger am I putting myself in? Are we talking about dropping dead on the spot or my heart slowly deteriorating?

[Cooker]

I don?t lift at all anymore but when I did I never lifted more than 12 oz at a time:rolleyes::D

[Lynlw]

MV, Welcome, (My son is 20) Can I suggest you start a new thread? you might get more replies that way instead of using a 2 year old thread

[SumoRunner]

It doesn't matter how old the thread is. As soon as someone posts a new note it rises to the top again.

As far as heavy wts, it's more than just a matter of waiting for the chest bones to heal. That itself will take a long time, months or even years to return to full strength. The tensing of all the chest and back muscles causes huge pressure increases in the thoracic cavity. So the old lifters mantra of start low and go slow has to be your guide.

Go over to here:
http://www.cardiacathletes.org.uk/forums/index.php
and you'll find other people who can tell you all you need to know.

[METAL VIPER]

MV, Welcome, (My son is 20) Can I suggest you start a new thread? you might get more replies that way instead of using a 2 year old thread
Thanks for the reply. I just don't know how it is on this messageboard. Others that I'm on prefer if you just bump on older thread rather than start a new one on a similar subject.

It doesn't matter how old the thread is. As soon as someone posts a new note it rises to the top again.

As far as heavy wts, it's more than just a matter of waiting for the chest bones to heal. That itself will take a long time, months or even years to return to full strength. The tensing of all the chest and back muscles causes huge pressure increases in the thoracic cavity. So the old lifters mantra of start low and go slow has to be your guide.

Go over to here:
http://www.cardiacathletes.org.uk/forums/index.php
and you'll find other people who can tell you all you need to know.
Thanks a lot for the link; I'll check it out.

[JeffM]

I'm no cardiologist but I'd bet you were doing damage when you were powerlifting even without symptoms. I had the same attitude as you for years because I felt fine. Finally, I opened my eyes and paid attention to what every single cardiologist told me: "stay off the heavy weights". So I read as much as I could about it. It increases, dramatically, the pressure in your heart. Think of a water pump in your car. Now think of a weak or repaired component in that system responding to dramatically increased pressure. Whatever issue you have will be made worse. You're working against it instead of helping it. Don't take my word for it...but ask every expert you know. If they tell you power lifting is neutral or good for you heart, go for it. Until they do though, maybe start thinking about what's more important: competing with the guys to power lift the most weight for what, another 5 years, or living a nice long life and finding another athletic outlet that perhaps develops your respiratory and circulatory system in a way that helps your heart work better. I'm just sayin' bro.

[METAL VIPER]

It's just hard for me to accept that something that I love is damaging

[Duff Man]

Dude, this is just something you just can't fudge on or you risk sudden cardiac death. I'm 25 with an aortic aneurysm and I can tell you that although it's hard to stomach, I've modified the way I lift everything. I work smarter, not harder by using a hand truck. I'm also selling my olympic weight bench and dumbbells over 35 pounds. And, god forbid, I now ask for help when something's heavier than say 40 or 50 pounds. It helps to have a wife that will kick my ass if I lift something heavy though.

Someone here made a post about lifting in high rep amounts with ridiculously low weight and still bulking up. You might want to try that.. cause it works. I know you think it can't, but it does.

[METAL VIPER]

I'm just trying to understand what can happen and how. Is the problem from the pressure going to affect the valve itself or how it is anchored in?

[Duff Man]

from what I understand the potential is there for both because of extraordinarily high intra-aortic pressure from valsalva maneuvers. If you do a search for Arnold Schwarzenegger you'll see quite a few people mention his valve failure as a didactic on weight lifting.

Ultimately it's something you should seriously make an appointment with your surgeon about. Maybe he/she is comfortable with you lifting, or maybe he can give you guidelines...

[METAL VIPER]

If you do a search for Arnold Schwarzenegger you'll see quite a few people mention his valve failure as a didactic on weight lifting.

Did Arnold have a mechanical valve or was it a Ross procedure? I have a post-op with my surgeon on Monday; I'll be sure to ask plenty of questions

[tobagotwo]

Arnold may have had issues with steroids in the years before his valve problem showed up, which can also damage heart valves.

He wound up having the surgery twice in quick succession, due (I may recall this incorrectly) to starting up again too soon, too hard.

Valve issues at a young age are usually congenital, as you've said yours is. The earlier it needs to be corrected, the more likely it is that there will be other tissue involved as well. That means a greatly increased chance of weakened bonding between the three layers of the arterial wall of your aorta, as that's a frequent, unhappy companion of early-onset, congenital valve disorders. Under pressure, the layers can separate like a cheap garden hose in a sudden freeze.

Ross can tell you what the upshot of sudden aortic dissection is like - for someone who manages to live through it. Most don't.

Find out from your surgeon if there was myxomatous tissue involved in your valve problem. If there was, just be done with the heavy weights. Instead, take up chasing women as a hobby.

Best wishes,

[METAL VIPER]

Ross can tell you what the upshot of sudden aortic dissection is like - for someone who manages to live through it. Most don't.
Thanks for the reply. So what I would essentially be looking at is near sudden death? I'd basically bleed out internally?

[tobagotwo]

Unfortunately, it's not that elegant or quasi-heroic.

It might be sudden. It might be a prolonged, extremely painful emergency room saga, involving emergency repair surgery, with an extended and uncertain recovery. If you lived through the repair surgery, you might well still suffer paralysis or other life-long, debilitating health woes.

I'm not saying this to scare you, which I'm pretty sure it does not. This is just pointing out that the outcomes are not what you really want.

There are other things you can conquer and excell at in life.

Best wishes,

[Sean L]

I have read up on this a lot and there are different opinions on it. Some feel there is no issue with heavy weights and others feel one should be careful and keep light weights with high reps. It seems to me that the majority side with the latter. To be careful I try and keep my bench press with at least 15 reps. The dumbell, like wiht curls, I will try and keep them above 10 reps. I feel I can go a little heavier on those since it is not as much of a strenous lift.

[tobagotwo]

Plainly, it should depend to an extent on individual circumstances. For a person who doesn't indicate any myxomatous tissue problems, who has no indications at all of aortic enlargement, it would not reasonably seem as critical. My personal bent is that in those circumstances, it's probably not as dangerous as the current wisdom would imply.

But those are probably not be the majority of cases. Most weight lifters are younger, and younger people who are far enough along to have been diagnosed have a greater likelihood of a larger myxomatous involvement and risk.

Unfortunately, fibrous or infiltrated tissue is not always as easily spotted during OHS as it might seem. You can search on the site for a number of postings by people who have had to have follow-up surgeries a few months or a few years later because of aortic dilations or aneurysms, even partial dissections that seem to result from or have been activated by the valve surgery or the changes in pressure and stresses it causes. As the surgeon was right there, it was plainly not obvious at the time he was sewing it. And surgeons don't routinely risk collateral damage by opening up other parts of the heart just to look.

In short, you may not have any way to know if you have an area of tissue in your circulatory system that simply can't stand up to the intense pressures that your skeletal muscles have been trained to bear.

What is that risk worth, in the context of things? There's so much in the world to see and do, and each of us only has time to get to such a small fragment of it, even in the best of circumstances. If less heavy weights that still keep you sculpted and powerful can also give you the chance to see Hawaii, to build your own business (maybe a gym) from scratch, to dance at your granddaughter's wedding...

Best wishes,

[METAL VIPER]

Well I finally had my post-op yesterday. The doctor was totally fine about me lifting weights; he placed no explicit limitations, but told me that power movements in the 1-5 range (80-100% of 1RM) weren't optimal and that could induce hypertrophy.

[METAL VIPER]

For curiosity's sake, what would be the repercussions of hypertrophy of the heart? What's the prognosis?

[Lynlw]

For curiosity's sake, what would be the repercussions of hypertrophy of the heart? What's the prognosis?


The entire heart like Hypertrophic cardiomyopathy? or a ventricle?

[METAL VIPER]

The entire heart like Hypertrophic cardiomyopathy? or a ventricle?
Hmm, I'm not explicitly sure. I believe the entire heart. What does it look like for each?

[Lynlw]

Well it depends on WHY it is enlarged, If a ventricle is enlarged because of backed up blood from a bad valve after the repair it should go to normal size or close to it. IF something else is causing the entire heart to be hypertrophic the cause determines everything else and sometimes the heart is just enlarged in athletes but that is considerred healthy hypertrophy, or athletes heart.
I'm assuming you are asking about your heart? if so what did the doc say?

[METAL VIPER]

Well it depends on WHY it is enlarged, If a ventricle is enlarged because of backed up blood from a bad valve after the repair it should go to normal size or close to it. IF something else is causing the entire heart to be hypertrophic the cause determines everything else and sometimes the heart is just enlarged in athletes but that is considerred healthy hypertrophy, or athletes heart.
I'm assuming you are asking about your heart? if so what did the doc say?
I'm incurring about enlargement via anaerobic exercise with near maximal weights. He said that powerlifting rep ranges (1-5) can enlarge the heart as a whole, but said nothing I could do would damage my mechanical valve, but he didn't go into what can/might happen if I continued with powerlifting. Just looking for some information.

[BackDoc]

two things:
1. you can enlarge the volume of the left ventricle via aerobic exercise.

2. activities such as heavy weight lifting, wrestling, or other activities that involve straining or valsalva type manuevers result in an enlargement of the left ventricle via a thickening of the ventricular wall. There are no "cardio-protective" benefits of this type of ventricular enlargement. Those with pre-existing valve disorders or aortic disorders need to be careful regarding these types of activities.

I have no idea how it effects mechanical valves. That is between you are your doctors.

[METAL VIPER]

I have no idea how it effects mechanical valves. That is between you are your doctors.
Definitely interesting. I'll have to bring it up the next time I see my cardiologist, as it is something I want to know about

[David R Robbins]

Hello all. This is an excellent forum. I was diagnosed with a bicuspid aortic valve at the age of 43 (2years ago). Right after I got the diagnosis, I climbed Mt. Whitney with no problems. Recently, I have had no cardio stamina and my heart has gone into A-fib a couple times. I have met with two docs and they say it's about time to get the valve replaced. The valve opening is about .08-1.0 cm in diameter. I have been very active since about 18 years old. I used to lift real heavy weights up until recently (over 400 lbs bench). Does anyone know if lifting heavy over a long period of time increases stenosis? Thanks

I have had (2) AVR in 2008; 1st after sepsis from Bacterial Endocarditis and 2nd after 1st failed in July. Ihave been a 3x week speed intensive runner for 25 years and 3x week weight intense lifter for 35 years. The cardiologists suggested lighter weights and higher repetitions(8-12 reps), but gave no other limitations. I am in Atrio Fib and scheduled to get an ablation in 1 month. Returning to Sinus Rhythym may cure some "low energy" , lightheadedness and dizziness. I have listened intently to my body and doctor visits have shown an improvement in ejection faction, since the 2nd surgery(35% to 50%). I don't run anymore, as my first attempt resulted in "passing out", a result most likely a cause of the Atrio Fib. I will reurn to running after I can achieve Sinus Rhythm. For the time being, I walk, use elypticals and treadmills in the gym. I have acquired more muscle mass without running, due to the retained glycogen stores. I weigh 195 versus 180 prior to surgery in March 2008'
I don't know about heavy lifting and Stenosis, but have read about the dangers of a sternum break, if the chest is used to bounce the weight bar for rep completion. Apparently, Arnold had an incident such as this after his AVR surgery and when bench-pressing. I am trying to get a more scientific explanation for the limitations on weight lifting and its effect on the heart organ over time, other then a "safe answer" that many cardiologists are free to give and afraid to address, due to the fear of mal-practice lawsuits.
I intend to "push the bar" to the limit until I pass this earth or die trying, but not without some testamonials from athletes who underwent similar ailments and heart surgery. I think we have to live life on our terms and if we all played safe, we would have more obesity, diabetic, and lifestyle issues in our population. This may not help, but it sure felt good telling the story. I am glad 2008 is behind me!

[METAL VIPER]

I am trying to get a more scientific explanation for the limitations on weight lifting and its effect on the heart organ over time, other then a "safe answer" that many cardiologists are free to give and afraid to address, due to the fear of mal-practice lawsuits.
I intend to "push the bar" to the limit until I pass this earth or die trying, but not without some testamonials from athletes who underwent similar ailments and heart surgery. I think we have to live life on our terms and if we all played safe, we would have more obesity, diabetic, and lifestyle issues in our population.
Got to agree. I'm a powerlifter and since this is such a lowly populated niche of athletes, I question how many my doctors have treated and if what they are telling me is fact or anecdotal, since the popular stigma is that heavy weights are bad, thus we should stay away from them.

[Lynlw]

Got to agree. I'm a powerlifter and since this is such a lowly populated niche of athletes, I question how many my doctors have treated and if what they are telling me is fact or anecdotal, since the popular stigma is that heavy weights are bad, thus we should stay away from them.

From what I've been told the problem can happen right on the seam where the valve was stitched, if the pressure gets too great when you bear down

ps welcome David

[METAL VIPER]

From what I've been told the problem can happen right on the seam where the valve was stitched, if the pressure gets too great when you bear down

ps welcome David
Interesting, because I raised that proposed outcome, the doctor shook his head and told me that my own tissue grows over where it was stitched and that the valve issue wasn't the problem, rather the effect on the whole heart

[gustaf]

What is the general recommendation for weight lifting after a procedure? I have, or had, BAV and have now since a year a reconstructed aorta valve and a graft as well after an emergency aortic dissection and starting rupture (yeah, a *very* close call).

My doctor still recommends me not to do any heavy lifting (or perhaps even worse to scuba dive), but the aneuyrism should now be fixed, shouldn't it?

What's the recommendation others have received post-surgery?

::g