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Paleowoman

Paleowoman

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Joined
Jun 13, 2010
Messages
2,985
Location
Surrey, UK
I saw the cardiac surgeon at the Royal Brompton this morning. Had the trans-oesophageal echo day before yesterday which shows the replacement 19mm Magna Ease valve is small, about 1 sq cm, and I have that left ventricular hypertrophy caused by that, but the valve is not degenerating. Surgeon doesn't feel that at the moment I should have major interventional surgery to put in a bigger valve - phew ! He’s going to arrange for an MRI to see/measure the heart muscle (MRI more accurate than echo for that) and then do another one in a year’s time to see if there is any increase in the thickening. He also said to continue with six monthly echoes. He suggested my cardiologist might prescribe beta-blockers or an ACE inhibitor so my heart works less hard, but as my blood pressure is normal and sometimes quite low I would not be keen, especially as I get up four or five times during the night, I wouldn’t want to keel over then. I am so relieved to not be facing heart surgery again so soon :)

Thanks for everyone's support !
 
That is great news, Anne! Nice to know you have some time on your side. Hopefully, you can put all this aside for now and "enjoy yourself."
I also had a cardiac MRI used to more accurately measure what they thought was a aneurysm.
 
Thnaks everyone - you can't believe how absolutley mega super relieved I am ! On Monday I spent most of the day at the Royal Brompton Hospital on one of their cardiac wards (the whole hospital is just for heart and lung) as the trans-oesophageal echo was done under general anaesthetic (apparently they always do them that way there, the cardilogist who did mine explained why), and because I was there so long, got there 7.30am but didn't get to theatre till 2.30pm and I wasn't allowed to leave till 8pm, it brought it all back to me even more vividly seeing other patients slowly shuffling/walking along the corridor like you do after surgery. My room was right opposite the nurses station and my door open to try and keep the temperature down as it was the hottest day in London (33C which is 92F) and there is no air con at the Royal Brompton, except in the operating theatres. The hospital is the most up to date techie wise but no air con would you believe - apparenty it is too expensive to put in, and, I suppose generally we don't get such hot weather here. The doctors and nurses were wonderful though and I was very impressed and felt very safe, they did all the tests and procedures that are done on any patient who is admitted, just in case I had to stay overnight or whatever, definitley an excellent cardiac hospital (as long as you don't go there during a heatwave).
 
Just seeing this thread now, Anne, and I'm so relieved to hear that they don't want to rush right to the OR yet. If things can be stabilized, you can re-define "normal" again.

I've never taken an ACE inhibitor, but I do take a beta blocker. If I didn't need the BB to try to avoid AFIB, I wouldn't take it. It limits my max heart rate, and has probably contributed to reducing my maximum exercise intensity. I don't feel that it affects lifting, as my heart rate doesn't accelerate that much with light weights. It does affect jogging, treadmill, bicycle, elliptical machine, etc., which makes getting a good cardio workout more difficult. I've negotiated my dosage from 100 mg/day down to 50 and now (for several years) 25 mg/day, but doc won't go any lower. He says I get the BB "for life."
 
Very pleased to hear this, and that you were happy with the Brompton. I hope things stay stable.
 
Thats great news Anne - you must be relieved! I'm on Ramipril which is an ACE inhibitor ... apparantly keeps the heart strong too . I was originally on Bisoprolol a beta-blocker but reacted badly to it. I've been fine on Ramipril. Well, thats good news and hope the scans are equally good news :)
 
Anne - the BB is "supposed" to reduce blood pressure. I can't say for sure if mine does, as I take the BB along with a diuretic (25 mg HCTZ daily). The combination of the two keeps my blood pressure on the high side of normal, which is where my cardio wants to keep it. He feels that the prosthetic valve is slightly stiffer than a native valve, so I need "high-normal" blood pressure to ensure it opens fully. My early morning pressure, before meds, is usually around 135/88. By mid-afternoon, it is often down to around 128/78 - so he's happy keeping it there.

I've thought about asking for a different med for BP management, but haven't asked because I'm pretty sure he will want to keep the BB to help avoid AFIB, and I probably need the diuretic. About the only other thing I could think to substitute might be something like Avalide, which is an angiotensin receptor blocker, and includes a dose of HCTZ.
 
epstns;n877455 said:
Anne - the BB is "supposed" to reduce blood pressure. I can't say for sure if mine does, as I take the BB along with a diuretic (25 mg HCTZ daily). The combination of the two keeps my blood pressure on the high side of normal, which is where my cardio wants to keep it. He feels that the prosthetic valve is slightly stiffer than a native valve, so I need "high-normal" blood pressure to ensure it opens fully. My early morning pressure, before meds, is usually around 135/88. By mid-afternoon, it is often down to around 128/78 - so he's happy keeping it there.
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That is really, really interesting Steve. You are confiming something I have been thinking about today and concluding logically about. Thing is my blood pressure is normal to low. I understand that the rational for giving an antihypertensive is to allow the heart to work less hard and so reduce left ventricular hypertrophy BUT that is when LVH is due to having high blood pressure which I don't have ! My LVH is due to having a small valve, which is essentially therefore stenotic, and so if my blood pressure were reduced that would mean that my small valve would open even less which would surely entail risk of syncope which could certainly be dangerous (I get up to go to the loo several times a night for example) and it would not neccessrily reduce the LVH which isn't being caused by high blood pressure. I doubt any of that would matter if I were very old and sitting around most of the day but I'm really very active and not about to reduce that - in fact surgeon said "no restrictions". I need to exercise as in long walks and the regular weight lifting I do for my overall health, ie my osteoporosis to strengthen my bones to avoid fractures, and diabetes to help control my blood glucose, and also for my sheer enjoyment and well being.

I can see that probably continued frequent surveillance will be what's needed until the point is reached that the risk of not doing surgery is greater than doing it. When I do eventually have surgery the surgeon said I would have to have either root enlargement or root replacement so that a bigger valve can be put in.
 
Anne such great news! I have been away for a few days and am catching up here. I, like you, have fairly low blood pressure and was on BB for a time between my first and second valve replacements. They switched it a coupe times to find one that did not make me as tired. I also had some breathing problems when taking them so finally expressed my concerns and weaned off them completely. I am sensitive to drugs and careful taking them. I now take 3 mg warfarin two days a week and 4 mg the other five days. Oh and an iron tablet. Nothing else and seem to have fewer problems.

Best of luck to you now and enjoy your great news!
 
Hi jwinter - I can’'t imagine being on a BB with fairly low blood pressure ! I'’ve been reading up quite a bit these past few days about blood pressure medications and they'’re definitely something that I would seriously question the wisdom of for me.
 
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