Passed out.

[greg]

I had an aortic valve replacement in Nov of 2003. All has gone very well after learning to live with blood thinner and the mechanical click at night.

Now my problem. About 2 months ago I got up for work as usual but I passed out or something like that. I stumbled from the living room to the bedroom and started hugging my pillow (security thing from post-op).
My wife could tell I was not coherent and she called 911 then got up to unlock the door. I followed her back to the living room, fought the parimedics and eventually the police had to handcuff me to get me to the hospital.
I started regaining some memory of events at the hospital but it took several hours for the fog to completly clear up.

I was tested for any and all drugs (none), tested for diabetes (none), CAT scan of my head read by two different neurologists (no problem found), INR was 2.9 (perfect), echocardiogram showed everything was great, cartaroid arteries were still very clean, no one found a problem anywhere.
My family doctor finally suggested that it was possibly a virus.
Nobody knows why I lost 20/30 Mins. completly and several hours all together.
Question:
Has anyone ever had anything like this happen????


greg

 

[Arlyss]

Re. Your Experience

Re. Your Experience

Dear Greg,

So sorry to read what happened to you.....so frightening for both you and your wife. I want to share my husband's experience in case it might help you or others.

My husband's mechanical aortic valve had been there for over 15 years when he had a stroke last fall. Like you, his INR was perfect, carotids fine.....testing done locally could not explain why he had a stroke. There was no doubt he had one - it was major, and the evidence showed clearly on both CT and MRI of the brain.

He also has had a TIA - a "mini stroke", which generally leaves no lasting effect. This was later, after surgery to remove the mechanical valve. It was likely caused by microemboli of some sort due to still raw/rough surfaces after surgery. What you describe reminds me of that. Like you, he was disoriented, and I knew something was wrong. With each hour that passed I saw that he was improving, and this time the CT, MRI, and EEG's done on his brain did not show anything additional. So "mini strokes" may not show up on tests. But they are very real and very frightening.

We learned that there is a subset of people with prosthetic valves that have strokes, even though their INR is in proper range. My husband was one of them. If we had stopped with the local testing, we would not have found the cause. It took a transesophageal echo (TEE) to find the culprits - he had developed fine, hair-like strands of tissue on the "heart-side" or "intake side" of his mechanical prosthesis. TEE is the only test that detects them. Presumably, some of them broke away and traveled to his brain.

There are references to this in the medical literature. If you visit the Medical Information page of the Bicuspid Aortic Foundation, http://bicuspidfoundation.com/Medical_Information.html

in the "Other Topics" section you will find two references to these valvular strands and their association with stroke.

It has been somewhat of a mystery why those whose blood is properly anticoagulated should be getting strokes. These strands are the explanation for at least some and possibly many of these strokes. They are very hard to detect - TEE is the only test that has been reported to find them. The valve may seem ok, continuing to open and close well, and still have a problem with these strands.

If we had stopped with the local testing, we would not have known that there were strands floating in the blood stream beneath my husband's prosthetic valve. Eventually, he would have been in big trouble again....

So it is well worth it to have a very good look at the valve when there has been an episode that might have been a TIA or mini stroke. They can look for other things also, such as a PFO, that might also cause a problem for the brain. When my husband's TEE was done, it included a "bubble study" to check for any holes in his heart. That was not his problem. He also had a 64 slice CT, which did not show the strands but did show some important detail that the TEE did not. Together these tests gave the surgeon additional valuable information in preparation for my husband's surgery - his third open heart procedure - he now has a tissue valve!

I hope some of this is helpful. Best wishes to you and your wife in your search for information and help.

Arlyss

 

[Mb]

Good morning:

I thought I would also post my husband's experiences. He has dual valves, and chronic a-fib. He has had a number of tia'S AND ONE SMALLER STROKE.

One TIA and the very small stroke were after his surgery. The first two were prior to the surgery, and he was not anticoagulated at the time.

The first two did show on an MRA of the brain. The second MRI showed the small nurological event (very small stroke) that left him with a weak leg, not bad just slightly weak. The TIA he had at that time, there was no evidence of on the MRI, but I am positive he had one, as I was with him when it happened.

Now neither time did he experience a "blacked out" period of time, but certainyl that could happen. Oh, his INR was IN range the third time, but he had run out of enteric aspirin, and hadn;t taken one for two or three days. The TIA he had? INR of 1.8 - Ooops.

I would not let this go. A TEE sounds like a good idea to me as well.

Something certainly happened, no doubt.
Marybeth

 

[Nancy]

Joe has had several TIAs and it sounds like that. I would call your card. or primary doc and ask about having a neurological workup done.

 

[Rush20]

Wow! Scary stuff!

As a card-carrying St. Jude Mechanical valver, reading this is quite upsetting. No doctor, cardiologist or surgeon ever mentioned this.

 

[greg]

Arlyss and Marybeth

Arlyss and Marybeth

Thanks very much for your responses.
Can you tell me more about the TIA's?
What kind of symptoms did they have before, during and after?

Once my head 'cleared up' I have had no other problems. The next day I went back to work, light exercise, and life in general without incident. I just don't know if something is waiting out there to strike again.

What I expierenced acted like what I was warned would happen if I didn't get the valve replaced. Loss of blood flow to the brain causing light headedness or passing out and, of course, eventual death.
My cardiologist didn't think there was any chance of the valve sticking or 'hanging up' in a partially open position for some lenght of time and causing whatever happened.
I had no pain at all so I suspect there was not lack of oxygen to muscles.
I will talk to him about a TEE since he wants a stress EKG and another echo in May.

Again, thanks for your responses.

greg

 

[tobagotwo]

It may have been a TIA. There's a decent case for that on face value.

However, it also sounds like TGA - Transient Global Amnesia. It's a temporary inability to create and access short-term memories, and during such an attack, the victim may be able to parrot back what is said to him immediately, but will "lose" the answers to questions he may have asked only minutes before. There may be temporary loss of less recent memories (from the last few months) as well. After the attack is over, the victim will remember much of what happened during the attack, including having felt lost or forgetful. The other memories will all return. It used to be a very uncommon happening, but is being reported with more frequency these days.

A friend of mine had an episode of it that lasted for most of a day. It was a few months after he started taking atorvastatin. Since then, I have read that it might be associated with the drug's effects on cholestrols used by the brain to do numerous tasks - including create memories.

However, TGA probably existed before such medications were developed, so there must be other ways to cause it as well. Statins are not listed as a causations on any of the mainstream literature currently extant. Perhaps long-term or overwhelming stress is the major player.

TGA has no real rules around it, no fully determined causation. Precursors are generic and unhelpful: physical or emotional stress, sexual intercourse, driving an automobile, swimming in cold water.

There have been numerous attempts to link TGA with Transient Ischemic Attack (TIA), which is sort of a fast-dissolving ministroke. However, unlike TIA, TGA is not associated with a higher risk of stroke later on.

Best wishes,

 

[Nancy]

http://www.emedicine.com/EMERG/topic604.htm

 

[Karlynn]

Greg,
Do you know what your blood pressure was at the time? My husband had an episode of passing out one morning. No tests showed anything, so they are assuming it was a low BP issue. He passed out for a few seconds the first time when rising from bed. He got up, sat down on the bed, waited a minute, then got up to go into the bathroom to get ready for work. I thought I'd better go check on him. He was peeing and just as I came in he passed out again. He was out cold for a good 5 minutes. I called 911. Once he came to he was pretty combative. Wouldn't sit down, was crabbing at me, insisted on talking to the 911 operator. (I heard her yelling at him to sit down!!!) He finally did sit down. The paramedics came and carted him away. By the time he left home he was fairly normal, so his episode wasn't nearly as long-lasting as yours. But just like you, they couldn't find any reason for it. And he is not a heart patient!!!! So their best guess was BP but I'm not convinced. He's not had an episode since.

Being a heart patient, you will want to explore more closely, but you may also want them to look outside the typical things associated with heart problems because there may be a chance it is not related.

How are you feeling now? Hopefully this was a weird incident that will not reoccur.

 

[Mary]

Greg,
You said it happened two months ago. Have you had any problems or similar incidents since then?
Tobagotwo's theory sounds very plausible; more plausible than a TIA.
Having had several TIA episodes, I can say that I did have some residual aftereffects; for several weeks, I was reluctant to have a conversation for any prolonged amount of time (That's was a first! )

 

[greg]

Karlyn,
You might be very close to the problem.
Not mentioned before is the fact that I was on BP medicine. I'm not sure of names and spelling but one was norvasc and one was lysinopryl, I think.
When family Doc. said it might be a virus I had him change me back to mycardis.... I have taken it in the past with no bad effects.
Every time they checked BP at the hospital is was in the 140/80 range.

I don't know if the BP meds are related or not. I, and everyone else first went to the AVR as the problem.

Thanks

 

[greg]

Mary,
No, no problems before or since.
That is part of my concern. Is something changing and just starting or was it a one time event.
Not knowing is most of the problem I think.

Thanks,
greg

 

[Arlyss]

Complexity of the Brain.....

Complexity of the Brain.....

Having now entered the world of those with brain injury with my husband, I can only encourage everyone to leave no stone unturned in getting to the bottom of any unusual event. The brain is very complex. It is hard to predict just what the symptoms/behavior will be when it is injured and also difficult to project what the recovery will be.

No doubt there are a number of things that neurologically might affect us. However, the heart and vascular system are highly suspect because so often particles originating there find their way to the brain.

Regarding blood pressure, having BAVD and the associated labile blood pressure, my husband takes a significant amount of medication for it. Getting a home monitor, taking it at least morning and evening, and writing it down will let you know where you are. Medication can be adjusted more easily when there is some record of the trend. If it were the case that blood pressure/pulse were that low, I would again pursue why that happened.... I would not let it go without further understanding.

Again, I would just encourage everyone to pursue every possible angle. Sometimes it is not easy to find answers. But if the answer is out there somewhere, it is so important to find it....

Best wishes,
Arlyss

 

[Ohiosweetheart16]

I had an aortic valve replacement in Nov of 2003. All has gone very well after learning to live with blood thinner and the mechanical click at night.

Now my problem. About 2 months ago I got up for work as usual but I passed out or something like that. I stumbled from the living room to the bedroom and started hugging my pillow (security thing from post-op).
My wife could tell I was not coherent and she called 911 then got up to unlock the door. I followed her back to the living room, fought the parimedics and eventually the police had to handcuff me to get me to the hospital.
I started regaining some memory of events at the hospital but it took several hours for the fog to completly clear up.

I was tested for any and all drugs (none), tested for diabetes (none), CAT scan of my head read by two different neurologists (no problem found), INR was 2.9 (perfect), echocardiogram showed everything was great, cartaroid arteries were still very clean, no one found a problem anywhere.
My family doctor finally suggested that it was possibly a virus.
Nobody knows why I lost 20/30 Mins. completly and several hours all together.
Question:
Has anyone ever had anything like this happen????


greg

hi my daughter has had this happen to her she has nms neurally medicated syncope she faints all the time and gets very dizzy maybe it is something like this have or doc order a tilt table test hope all goes well for you

 

[seand]

Transient Global Amnesia

Transient Global Amnesia

Hi all -

Just two days ago I had an event involving sudden, extreme disorientation and amnesia, lasting about 10 minutes (I guess - I was alone at the time). When I described it to an M.D. friend later, he immediately said it was almost certainly TGA. Very frightening while it's happening, but at least in my case, very minor and short in duration.

I am 10 months past aortic root replacement (T David procedure w/ dacron graft, retaining my own valve). I am a bicycle racer and ride *extremely* hard, pushing my body to 110% of max, which my cardiologist is allowing as I actually can't reach true max, being on Toprol for a couple more months anyway. I've been back racing since about 6 months post-op (I was back on the bike - indoors on a trainer, going easy - at about 3 weeks after surgery, and back on the road at 6 weeks). All my tests have been good, most recently an echo at 9 months post-op.

But after this TGA event, I'm theorizing that pushing my heart to pump blood as vigorously as I do is increasing the amount of debris that gets washed off of my graft into my bloodstream. I take a daily aspirin of course, but maybe that's not sufficient in my case to keep the bloodstream clear?

Does this make sense? Any thoughts? As I said, this just happened two days ago and I haven't yet spoken to my cardiologist. Just how dangerous is the debris that we might have flaking off of our repairs?

Thanks -
seand

 

[hensylee]

orthostatic hypotension? Did they check you for that?

 

[Christina L]

I tend to side with Karlynn and some

I tend to side with Karlynn and some

others here - low blood pressure and dehydration - that is my guess. Of course, I want to think that it was "only" this - something that is very fixable and easy to wrap your mind around.

I know you'll be okay and this was a fluke thing.

Christina L

 

[joanne6]

I had 2 episodes 2 1/2 months apart. Probably unrelated but both landed me back in the hospital. The first was 10 days after surgery and I was dehydrated. Had low BP, passed out cold. Felt terrible for a while and was told to go back to the hospital. The second episode was probably positional a week after I had cataract surgery. Ended up back in the hospital. Had ECHO, monitored, tilt table, etc. All negative. I now have a Loop Recorder implanted for a year in case of another episode. Thankfully, so far no further problem.
Hopefully, in your case it was also a blood pressure drop or some other benign form of syncope.
Let us know if you get an answer.