Confused

[Peg63]

Just had my yearly echo and do not know how to proceed. Last year the Dr. said moderate aortic stenosis with moderate left atrial enlargement and normal left ventricular wall thickness now this year he said severe aortic stenosis with a valve area of 0.8 cm2 but by visualization of the valve it appears to be moderate AS and severe left atrial enlargement with left ventricular wall thickness increase consistent with left ventricular hypertrophy. I have had severe stress the last year with the death of two close family members and my bp has been over the moon for a while. Trying to get it under control now. Can atrial enlargement be reversed with bp control? My point is the Dr did not seem concerned at all and said see you next year. I don't want to let this progress to where heart damage is permanent but am I overreacting because I am scared of these test results?
I am 65 and was diagnosed in 2014. Thank you for any input. I feel very confused and scared.

 

[Nocturne]

Docs are never concerned, not really. They aren't the ones who are sick, and they know that so long as they follow the AHA guidelines, they won't get sued.

It is my understanding that atrial enlargement is part and parcel to aortic valve stenosis, and that it often (if not always) reverses at least partially after AVR surgery. Basically, your heart is having to work harder to kick open the "stuck door" that is your stenotic valve, and as a result of the workout it gets stronger and larger. When the bad valve is replaced, the heart does not have to work as hard anymore, and the muscle atrophies (at least partly) down to normal size -- which is a good thing.

In general, docs are pretty good today about making sure that things do not progress too far before recommending surgery. If you are especially worried you could always get a second opinion.

One fun fact I like to share -- after the age of 65 or so, the relative survival rate after aortic valve replacement surgery is about 100%, which means that you can expect to live about as long as you would have lived if you had never needed the surgery. So there is no need for you to fear it at this point. Hope this brightens your day.

 

[mikeccolella]

Do you have symptoms like shortness of breath, lihghtheadedness? I was diagnosed with severe AS but was asymptomatic. Once I started developing symptoms it was time to get surgery As far as my doctors were concerned.

http://www.acc.org/latest-in-cardio...perate-in-asymptomatic-severe-aortic-stenosis

http://www.medicinenet.com/aortic_stenosis/page5.htm

 

[Peg63]

Actually the over sixty five fact did brighten my day. I am going to make another appointment with my cardio and have him go over the test results with me and my areas of concern. Also the info about atrial enlargement helped too. Thanks.

 

[Peg63]

Actually the over sixty five fact did brighten my day. I am going to make another appointment with my cardio and have him go over the test results with me and my areas of concern. Also the info about atrial enlargement helped too. Thanks.

 

[dornole]

I have mitral issues, but also find that they don't really care about atrial enlargement. It's the ventricle they monitor.

 

[Nocturne]

Actually the over sixty five fact did brighten my day. I am going to make another appointment with my cardio and have him go over the test results with me and my areas of concern. Also the info about atrial enlargement helped too. Thanks.

You're welcome. If you'd like, I can show you the links to the studies that reveal what I said about AVR after 65.

As as for atrial enlargement, probably most people here know a lot more about it than I do, so I'd listen to them more than me. :^)

 

[ashadds]

Docs are never concerned, not really. They aren't the ones who are sick, and they know that so long as they follow the AHA guidelines, they won't get sued.

It is my understanding that atrial enlargement is part and parcel to aortic valve stenosis, and that it often (if not always) reverses at least partially after AVR surgery. Basically, your heart is having to work harder to kick open the "stuck door" that is your stenotic valve, and as a result of the workout it gets stronger and larger. When the bad valve is replaced, the heart does not have to work as hard anymore, and the muscle atrophies (at least partly) down to normal size -- which is a good thing.

In general, docs are pretty good today about making sure that things do not progress too far before recommending surgery. If you are especially worried you could always get a second opinion.

One fun fact I like to share -- after the age of 65 or so, the relative survival rate after aortic valve replacement surgery is about 100%, which means that you can expect to live about as long as you would have lived if you had never needed the surgery. So there is no need for you to fear it at this point. Hope this brightens your day.

For a person younger than 50 ....the relative survival is less but the overall absolute survival is more....most of the statistics about cumulative mortality are skewered because of more people > 60 years who are not expected to survive as long as a person less than 60....ultimately it is not uncommon for a 25 year old to have a 50 year old life expectancy in the general population and 25 year old with AVR will still have a reasonably high probability of living for atleast 20 years ~88-90% probability excluding timely reinterventions.....but it might be possible to have that 50 year life span but with more risks of dying that doesn't mean death still ..its the possibility of dying that increases not an absolute certainity....

 

[dick0236]

..its the possibility of dying that increases not an absolute certainity....

......and "the older you get, the older you're gonna get".

In 17 days, Aug 16, 2017, I will hit that 50 year mark.......surgery Aug 16, 1967. I was one of those who was sure of a life expectancy of no more than 20 years following surgery. Now I am beginning to outlive many of my "normal" friends.....goes to show how much I really know.

BTW, the guy who got the very first valve in 1960, Philip Admundson, died after 10 years.......he fell off a roof and broke his neck.