Interesting Sunday; TIA? Migraine?

[musician2k]

Like Deb, I just missed the hospital so much I decided to visit the local ER yesterday afternoon. *sighs*

How do you know when it is really appropriate to go to the ER? I was having some symptoms yes, but I suspected I knew what was going on. I was sitting at the PC, typing, when suddenly it felt like my right leg was going to sleep. You know, that pins & needles feeling, no biggie. So I shifted but then noticed the muscles were somewhat weak in my right leg and my right arm. I noticed I could not type well with my right hand (problem still persists this a.m.) and I just began to feel 'unwell' overall. I had been feeling great - cardia rehab has been going well, and my migraines have been less frequent. Well of course you assume the worst - TIA or stroke - and I told my poor wife immediately and she had to pack up her papers (she was doing some marathon grading for school - she's a teacher) and quickly off we went. They did a cardiac work-up and took at CT of the brain & found no infarct. Some of you might recall I've already done this once, about a week after I got home from the hospital after my OHS in July. That, I now think after reading information here, was transient global amnesia. This time, I'm just not sure. They released me because I have generally returned to normal. I'll have an appointment with my neuro about this one ASAP but just curious if you all think it was appropriate that I went to the ER for this, when I do have complicated migraine? I'd never had hemiplegic migraine but it is certainly possible that's what this was. In any event I'm becoming more concerned about my future and feel strongly that a major CV event is looming - if not now, then some year.

For those of you who've suffered strokes, what can I do NOW to prevent them, if anything? Should I get a home monitoring device, since I'm home alone a lot? Any suggestions welcomed....

Chris

 

[PJmomrunner]

Hi Chris! I just got back from fitting choir uniforms at the high school (thought you'd want to know ) and I saw your post. I'm sorry you had that scary experience. Your feeling of impending doom is understandable but can't be fun either. Perhaps if you could rule out some risk factors you'd feel less apprehensive.

Maybe it makes sense to assess your risk for stroke a little further. We all know that BAV's often come with ascending aortic aneurysms and Arlyss has mentioned before (and recently posted a study supporting this) that people with BAV's often have brain aneurysms as well. Your profile doesn't actually state BAV, but does sort of suggest it. Maybe you can talk with the neurologist about checking out the vasculature north of the aortic arch.

What about arrythmia--was your heart rate normal during this episode? Has this been an issue for you at all? Has it been checked out since surgery?

Have you been walking/exercising? That's a good way to reduce risk--kinda like keeping the water flowing through those pipes helps to keep the sludge from building up or the water from freezing.

Is your INR on track? Do you feel confident in your monitoring? You might want to keep it in the high end of your range--can't hurt, might help.

Just a few thoughts. If you can cross these off your list, your risk of stroke should be minimal.

 

[Marguerite53]

PJ. That seemed to me like a great list of suggestions!

Hi Chris. Sorry you're experiencing these events and that they are frightening for you. Undoubtedly, we all have peculiar responses to this very serious surgery. I'm sure I'd have high-tailed it to the ER, too. Once that weakness and tingling became pronounced, I think you were totally wise.

I worry that you are left in a state of mild but nagging paranoia about it. I hope that you can investigate and get enough answers so that your day to day living will not be taxed by worry. That won't accomplish anything.

You have been given a new lease on life. You have. It may have come with some new peculiarities. Try to think of this first year out as a learning time. If you went out and bought a new musical instrument, would it be responding to your touch the exact same way as your old ones? I think not. Each piece has it's own personality. Your heart's personality has been altered. As it works hard to get back to what it thinks is normal, it may be making some bizarre adjustments. Try to be patient and kind to it, as you would to a promising instrument.

But don't hesitate to get things checked out. That is why we buy insurance every month, and what keeps doctors learning.

Take care!

Marguerite

 

[Mary]

Chris,
I would want to know what my INR was.
It sounds like you suffered a TIA; many times they won't registered on a CAT even if they are of a fairly long and severe duration.
How was your speech during the episode?
I've had several major ones, and many small ones, but none since my valve replacement.
I think you did exactly the right thing by going to the ER.

 

[musician2k]

thanks

thanks

thanks to you all for your responses.

PJmomrunner:

Fitting uniforms eh? Yep, that sure does bring back memories. Some of them very similiar to the sensation of a stroke, so it's apropos that you mentioned it .

I had an aortic aneurysm and had that repaired when the surgeon "fixed" me with a St. Jude's. And yep, I did have BAV disease; I'll update my profile here. I have a Medtronics pacemaker and it keeps my HR very steady, around 85 and it was slightly elevated but not much. My blood pressure was all over the place - probably some anxiety there - but it was odd that it fell to the 90/50 range at one point and I was NOT given any kind of sedative. I was not having arrhythmia as far as I could tell; I had episodes of this that were so noticable (despite what everyone said here...) that my Cardio went ahead & put me on a monitor for 48 hours during which I felt arrhythmias constantly but they say they were not the troublesome kind. I've certainly gotten plenty of walking/exercise at cardiac rehab three times a week, and exercising on the 'off' days is becoming more common, too. My INR tested a week ago was 3.4; and they tested it again yesterday saying it was in normal range.

I would agree that the risk of stroke should be minimal given all of the above. I'm not stressing *too* much about it, just more concerned and trying to prevent my better half from having to be burdened if it's not necessary. In other words learning what symptoms require immediate attention, and which ones we can adopt a wait-and-see attitude towards.

I agree with you as well Margeurite. I did in fact buy a new musical instrument - a Roland digital synth - and I'm still learning how IT works and functions so yes, these things DO take time. I'm more than happy to be patient but at the same time, if I can prevent small problems from becoming large ones then I think it's wise to attempt to do it....

Since I get pretty severe migraines, some of which are complicated (meaning out of the norm) I think that's likely what it was. A new form of that. Yipee! But at least those are fairly benign. My brain tissue - vascular system - may need these months to get used to the new equipment and circulation from my new valve.

Chris

 

[MSG Morrissey]

I hope you are well, re: PJ MOM's initial response...

I hope you are well, re: PJ MOM's initial response...

Thanks PJ for the thoughtful and insightful response (question?why are you ?former runner?? I appreciate the note about BAV folks having aortic aneurysm and other vascular issues. I have not been Dx?d with the AA but had a TAI while driving several years ago. Movement and speech were affected. Went to the Doc, MRI etc etc, they found that I had a vascular structure (Dx escapes me) that occurred as I developed in the womb. One side of my brain had been vascular stunted and the other side fully and completely took over and created blood flow that more than compensates. Has anyone heard of such a thing? Interesting, MD keeps me in a very hi INR range now. No more TIAs.

 

[musician2k]

Very interesting point. Something I might mention to the neuro. They just called and want me to have my carotid artery checked out via ultrasound. I'm having that done this Weds, so we'll see how it goes. Anyone else had this done? Would there be any correlation between a carotid artery problem and BAV?

Thanks PJ for the thoughtful and insightful response (question?why are you ?former runner?? I appreciate the note about BAV folks having aortic aneurysm and other vascular issues. I have not been Dx?d with the AA but had a TAI while driving several years ago. Movement and speech were affected. Went to the Doc, MRI etc etc, they found that I had a vascular structure (Dx escapes me) that occurred as I developed in the womb. One side of my brain had been vascular stunted and the other side fully and completely took over and created blood flow that more than compensates. Has anyone heard of such a thing? Interesting, MD keeps me in a very hi INR range now. No more TIAs.

 

[Nancy]

Joe's had many, many TIAs (16 or so). We always went to the ER. You never know about those. Of course, once he got there, there was no evidence of the TIA, but I always felt it was better to be told that than to find out he had had a stroke.

A few times, he went by ambulance.

By the way, he also had a stroke recently, but it was a hemorraghic stroke, (off Coumadin, but on Heparin at the time). And he has also has a retinal artery occlusion and splenic infarctions which were caused by emboli. His INR was within range for both situations.

So, that's why I say to be safe is best. You cannot predict what might be going on. Let the experts sort it out.

Always err on the side of caution.

 

[PJmomrunner]

The article Arlyss refers to states, "Patients with BAVs also had greater dilation than those with MS at the level of the annulus and the ascending aorta, with dilation often extending cranially beyond the region of measurement." (You can access the abstract in its entirety at: http://www.ncbi.nlm.nih.gov/entrez/..._uids=17027578&query_hl=1&itool=pubmed_docsum

I took the article to mean that the arteries that head to the head (pun intended ) are often dilated too. If my understanding is correct (and it very well may not be) it seems like the arteries between the aorta and the cranium (left and right common carotids?) would often be dilated too. So, cool that they're checking those out, Chris.

MSG, I hate to go borrowing trouble (which is why I haven't had a head-check ), but having had a BAV replaced and known funky brain vasculature, I do hope they are monitoring your aorta and all. The correlation between BAV's and ascending aneurysms is well-established and very high--some studies say up to 52%. Among those on this website my sense is that it is pretty high as well. (Hmmm...a poll question perhaps...)

 

[debster913]

Can't really identify with having had a stroke, though I do have a weak right side from my "heart attack" at birth... but do hope you're feeling better. Going to the ER is fun, huh?

Must be grading season. Like your wife, I'm planning on doing marathon grading tomorrow after my echo. Not exactly exciting stuff.

I would suggest that you have something close at hand if you find yourself having a TIA/stroke. It's always a good idea.

Best to you and keep us posted!

Debi (the other ER-visitor! )

 

[Mama2Rylan]

Hello Chris!

I just read your post and wanted to send you a little message. I don't know much about strokes but being on coumadin, I worry about them all the time. But I just wanted to comment on your question reguarding if it was appropriate to go to the ER, and I would say YES!!! I have delt with heart problems and know all to well that if I'm not feeling good, I need to get it checked out. I'm sure my doctors think I'm a little whacko but I don't care. Dealing with the heart and all my previous surgeries, I'd rather be safe then sorry. I remember that when I was pregnant and having problems with my heart, I felt completely fine, even though the doctors were telling me that my heart wasn't doing well at all and I had over a 50% chance of just keeling over on the spot. Listen to your body, and when in doubt go check it out! Good luck to you and I hope all goes well. Take care
(Sorry, didn't mean to get so dramatic )

 

[MSG Morrissey]

PJ, I have the "regular" echos...

PJ, I have the "regular" echos...

Just had another of the annual variety, assuming they are looking at my aortia when they do it. I am now on a 6 month schedule as there was some "minor" leakage (valve) and increased gradient. (doc's secretary said this was "normal" for my tenth year...) I will ask when I am in for my next echo for a special look. You are very helpful, thanks.

 

[marky]

Chris..
I think I would have done the same.. a visit to the dreaded ER..
I am hoping that the Neuro can offer some more concrete answers.

 

[PJmomrunner]

MSG, you are very kind. In the spirit of being helpful, please see/listen to the following presentation given by Eric Isselbacher, MD during a symposium on diseases of the aorta at the American Association for Thoracic Surgery's annual meeting last spring. It is an extremely informative presentation both because of its content and because of its strong implication that surgeons are still learning this stuff. One must presume that cardiologists are also still learning it. The whole thing is worth perusal, but if you are short on time, go directly to slide 24 to learn why "regular echo" may not be enough.

http://www.conferencearchives.com/aats2006/sessions/1500.PGAC.10/session.html

The new 2006 Guidelines for the Treatment of Valvular Heart Disease reinforce some of the same concepts:

http://content.onlinejacc.org/cgi/content/full/48/3/e1?ct

These and many more links to informative medical literature can be found at the Bicuspid Aortic Foundation website:

http://bicuspidfoundation.com/

In my own case, my aneurysm was not found by regular echo (and I'm easy to image too--reasonably thin). It was found by TEE (transesophageal echo), which was done not for the purpose of visualizing the ascending aorta, but to look for a hole between the atria of my heart. If my cardio hadn't suspected that hole's existence (PFO-patent foramen ovale), I would still have an undiagnosed aneurysm. Since being under the care of a surgeon for yearly checks, I have had regular echos to look at the root and valve and CT's to look at the aorta.

 

[musician2k]

Thanks for all the info, folks. I appreciate it. I'm on dial-up so it'll take some TIME, but I'll look at those presentations....

I already know I had the aneurysm. I guess the question remains now - is there another one? OR are we talking about plaque having formed inside the carotic arteries? Truly, the plaque issue is possible (I've not exactly been on a low-cholesterol diet, ha ha) but, during my OHS my surgeon mentioned my heart looked GOOD - no plaque build-up, etc. so I would assume (I know, 'assume') that the remainder of my arteries would be relatively open. I guess we'll see.

It's very frustrating now, because my progress seems to be peppered with these setbacks. Small setbacks are tolerable - but the looming idea of a large one is a bit depressing.

Chris..
I think I would have done the same.. a visit to the dreaded ER..
I am hoping that the Neuro can offer some more concrete answers.

 

[denobobeno]

Reply...better late than never!

Reply...better late than never!

Chris,
I just read your post...since I haven't been on in a looooong time! I just wanted to add my two cents.
Remember I had a stroke....I just don't think you can be too careful. Mine began with confusion or weakness. My husband thought maybe I needed to eat a snack..I had said that I felt weird, weak, confused...similar to when I get low blood sugar from skipping meals. I even ate a snack bar thinking he was right.
As we drove down the DFW freeway I noticed the cars going by and thought "where in the world am I"??? Where have I been? Where am I going? and what am I doing driving naked in the middle of Fort Worth? (kidding about the last one)!! You have to laugh sometimes!
My husband rushed me to the nearest hospital! Most important decision in everything!!!!
After we got there I went down hill pretty fast and don't remember anything much, except my head was splitting down the middle and I thought I would explode...
Have you had an EEG lately? They found that I was having seizures while I was in the hospital and now I'm on Triliptol. I don't even know what a seizure feels like..or when I'm having one...they just found it on the EEG (they did several while I was in the hospital).. so, I take my medicine so I don't find out! My Neurologist told me to continue taking it for at least a year, then we will reevaluate.
I hope you NEVER have a stroke...but, remember...we can get through it..I did!
Take Care and go to the emergency room and NEVER apologize for going!
xxooDeana
Not responsible for any misspelling or content of the above.

 

[musician2k]

thanks

thanks

Deana: Thanks so much for your reply. I was thinking about messaging you actually because I remembered you had recently been through this. Of course I think what you had was a stroke - because the effects have lasted. Is that correct? Have you had to have physical therapy to recover from the weakness or has it resolved with time?

I had the situation you described happen to me twice in the same day, a week after I got home. I was just sitting here at home, watching TV & the next minute I didn't know where I was, or what a TV was, and I was naked running through the neighborhood! Ok, that last one isn't true, thank goodness, but hey it could happen next time & nobody wants THAT. So after that my neuro put me on one baby aspirin per day. This most recent time was a bit scarier for me because I felt the BODY weakness....but, it did resolve & now I don't notice a thing. That's the definition of a TIA I guess, it resolves whereas a stroke's effects continue.

They did do an EEG and EKG while I was in the ER. It must've showed nothing - and a CT scan revealed nothing but I'm told that's pretty normal in these cases. I am wondering why they don't just put me on an anti-platelet drug NOW. I will ask my cardio that question when I see him next.

Again thanks for the words, Deana. Glad to hear you're doing better -

Chris