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YoungSauce

Member
Joined
May 9, 2023
Messages
7
Location
Australia
Hello,

I have just been diagnosed with a Bicuspid Aorta, with mild regurgitation. I am an avid bodybuilder and into combat sports. Aged 23. I occasionally use anabolic steroids however I have stopped a while ago and don't think this is something in the future I will use. Just being open and honest to receive the best advice from people with a lot more knowledge than myself on this condition.

My cardiologist was rather brief, diagnosed me with BAV, level 1 heart block as well, and basically explained what the condition is, how it happens and that my thing isn't stenosis, but regurgitation, which is mild- and likely won't need surgery for a while, but I really am stressed and want some clarification.

Firstly, i'd like to ask- in my follow up (I booked to clarify some things I don't understand) what should I ask about?

I didn't get much info as I was quite shocked.

I am reading about left ventricle size, aorta size/swelling, ejection fraction, RL and RNC types, stenosis and regurgitation- and what the issue with regurgitation and risk is- and i'm completely unfamiliar with these, but obviously I should know the values here to monitor and see how 'bad' my heart condition is.

Now, since I lift heavy and hard regularly, I was told that very light weights and cardio is usually the best, which has been extremely upsetting, as it's basically my entire lifestyle, and has honestly shattered me a bit- but I want to ask you guys a few questions and I hope you can help me.

If I do lift heavy and hard, will it simply bring forward the surgery date?
Or will it cause me huge issues?
Also, will regurgitation effect my athletic performance- meaning I won't have the strength or power as a normal person would?

Additionally- when I have the valve replaced, will I be as good as a normal person regarding athletic endurance/exertion, since the valve is now sealing and functioning as normal? Or is it still not the same, meaning I am always at a greater risk when pushing weights, and will always have lowered power output?

And finally, the question i'm quite sure I know the answer too- how detrimental are things like anabolic steroids to this condition? I know Arnold Schwarzenegger had this condition, and I'm also very well aware AAS can contribute to LVH, but if I have the valve replaced, would it be non- problematic relating to this condition (aside from the obvious unrelated cardiac side effects associated with usage)?

I never use crazy amounts, and certainly never abuse them, and have not used them in quite a while now, and my understanding is LVH and other disorders are from heavy abuse.

Thanks for reading my post, hopefully this is in the right section. I appreciate any advice given, and i'm sure i'll be quite active on here as I learn more about this condition!

Cheers!
 
Hello.

I also have BAV with regurgitation, which is still mild at my 39 years old. In your place, I would watch the aorta size, besides the regurgitation. The studies are not very conclusive, but still there's opinion, that high blood pressure accelerates the aorta dilation (and regurgitation too, if the aorta dilates at the level of the valve). Also it seems, that regurgitating aortas are more prone to aneurysms, than stenotic. Therefore, high static efforts that increase blood pressure may bring the surgery closer. Surgery on a dilated aorta apart from the valve is quite common too, but having less of surgery is better, so to say. Having the surgery later in life is also better. That's why the doctors advise against hard weightlifting.

Regurgitation will weaken the heart at the later stages, if left untreated. With surgery in time, no big harm is usually done.

As for steroids, come on, watching your heart condition should entertain you enough.

All the best to you, we are fortunate that our problem is highly treatable today.
 
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From my own personal experience:

- You are in the wait and watch camp - Just monitor every year to see what happens
- There is some annecdotal evidence that too much exercise all at once wears bioprosthetic valves out - happened to me. I am not sure if this translates to your own natural heart valves.
- When I was first diagnosed immediate recommendation to stop all burst exercise.

- I would also not worry about it whatsoever. You can stay in the mild regurgitation territory for decades. But I would do lot of research on weight lifting/burst exercise effect on widening aorta and then perhaps take it slow with the weights.

Good luck and I know these kind of news are shoking, but:

- This is a highly treatable condition
- You are prob a long time away from treatment
- Treatment could be very different in 20 years time.
 
Hello.

I also have BAV with regurgitation, which is still mild at my 39 years old. In your place, I would watch the aorta size, besides the regurgitation. The studies are not very conclusive, but still there's opinion, that high blood pressure accelerates the aorta dilation (and regurgitation too, if the aorta dilates at the level of the valve). Also it seems, that regurgitating aortas are more prone to aneurysms, that stenotic. Therefore, high static efforts that increase blood pressure may bring the surgery closer. Surgery on dilated aorta apart from the valve is quite common too, but having less of surgery is better, so to say. Having the surgery later in life is also better. That's why the doctors advise against hard weightlifting.

Regurgitation will weaken the heart at the later stages, if left untreated. With surgery in time, no big harm is usually done.

As for steroids, come on, watching you heart condition should entertain you enough.

All the best to you, we are fortunate that our problem is highly treatable today.
Thank you for your reply.
That helps me a lot. I'll ask about my aorta size when I speak to my cardiologist this week.

As for steroids, I know- bad idea. But it's a part of the lifestyle. I will likely have to give it a miss, or keep it extremely rare at best. I have dreams of competing- so it's very unfortunate
 
From my own personal experience:

- You are in the wait and watch camp - Just monitor every year to see what happens
- There is some annecdotal evidence that too much exercise all at once wears bioprosthetic valves out - happened to me. I am not sure if this translates to your own natural heart valves.
- When I was first diagnosed immediate recommendation to stop all burst exercise.

- I would also not worry about it whatsoever. You can stay in the mild regurgitation territory for decades. But I would do lot of research on weight lifting/burst exercise effect on widening aorta and then perhaps take it slow with the weights.

Good luck and I know these kind of news are shoking, but:

- This is a highly treatable condition
- You are prob a long time away from treatment
- Treatment could be very different in 20 years time.
Thanks for the response. I appreciate your well wishes.

I'll keep doing my research, and I think the smart idea is I will continue with my training as usual, and in my next echo, if the condition has worsened, i'll back off and move away from the intense weights.
 
The best piece of advice I can give you is the following:

==> In addition to researching your conditions, it makes a lot of sense to also research the best possible medical team that you can find. Then listen to what they have to say. Your case with continuing to work out etc may require the input of cardiologists who work with atheletes.

Good luck.
 
Welcome to the forum! You will find some awesome stories here that are encouraging, uplifting, and motivating. We have power lifters, martial artists, … all kinds of people.

I have two comments.

First, it sounds like you might not need surgery for awhile and that you’re in the being monitored regularly stage. For some, this can last awhile. That’s a good thing because it gives you time to adjust, time to research, and it also gives science a chance to move forward.

Second, the biggest red flag that I see in your comments is “lifestyle”. I know you had plans. I know that you’re mentally tied into that. But, I think you need to eventually (not in this moment), come to terms with the reality of your life’s existence. This usually comes with age - and you’re still young - so you might be forced to deal with it earlier. The reality is a major heart condition that will most likely limit you. That’s the reality. The reality is also that you will quite literally be gifted a continuation of your life. Decades ago you would have just died. We are truly blessed to live in this medical time.

I had surgery at 51 and opted for a mechanical valve because I didn’t want to have my chest split open 5-10 years later due to failure of a tissue valve. Prior to surgery I would free weight Benchpress my own body weight 10x … super slow, super clean. 6 months after surgery I did this again. That said, I had a few steps back and now almost a year after surgery I started to use my basement gym again … finally.

Having surgery gives you a new perspective. You’re not really thinking about lifestyle like that anymore. You’re contemplating what is REALLY important. Hard to do in your twenties. I remember. In my twenties I was benching twice my body weight … doing pull-ups with two 45lb plates on a chain. But, I’m telling you that THAT changes.

All of that said - do a search here on ThatGymGuy. He was a power lifter prior to operation and continued to power lift after his operation (mechanical valve).

You are blessed in that if you have your operation young then your healing ability will be better than a lot of us. I bet you’ll be able to get back to working out a lot quicker and you’ll surprise yourself with the recovery. Just gotta listen to your body and not push it.
 
Hi from a slightly frosty south west(erly) Queensland

I have just been diagnosed with a Bicuspid Aorta, with mild regurgitation. I am an avid bodybuilder and into combat sports. Aged 23. I occasionally use anabolic steroids however I have stopped a while ago and don't think this is something in the future I will use.

that's a wise choice. There's nothing good that comes from that. At 23 you won't see that, but at 53 you'll sorta wish you hadn't. So its good you aren't anymore. My view is that its like alcohol, very easy to slip from "basic use" to mis-use over years and in the face of issues. BTW I used to drink and like a drink but basically now since I developed an arrhythmia I can't (long story right there).

https://www.betterhealth.vic.gov.au/health/healthyliving/steroids
The misuse of anabolic steroids can cause long-term side effects. These can include cardiovascular complications, liver disease, reproductive organ damage and severe mood swings. Support is available for anabolic steroid users who want to change their dependence on these drugs.

You're now aware that you are already pre-disposed to an existing cardiovascular complication so use of that toxic stuff will just increase your chances of making it worse.

I guess I'll start by saying that you now know you have not only BAV but all of what goes with BAV. BAV comes as a host of problems (and its genetic) which may or may not manifest immediately, but will be sort of like a dice roll for the future, this includes aneurysm of the aortic artery (which leads to sudden death if not monitored). So you now know you'll need to go in for regular monitoring, which is likely to be just an echo every other year unless more things are found. Some details (which are not applicable to you yet) are found here:

https://www.racgp.org.au/afp/2013/june/aortic-aneurysms
I include this because my goal is to inform you and lead you away from the darkness of "ignorance led anxiety". The more you know the more you can make informed decisions.

Myself I was diagnosed at about 5 and monitored yearly up at Chermside hospital (in Brisbane, Queensland) until I needed my first surgery at about 10yo (essentially a repair). I had another one to replace the valve at 28 (*a homograft) and my 3rd (last one) at about 48 to replace that valve (with a mechanical) and repair an aneurysm (using a synthetic fiber tube). I continue to be about normally active since then. I have lived OS a lot and spent the majority of my time in Finland (where I enjoy XC skiing).

So surgery is just like fixing a part that is broken or defective and the car still works.

My cardiologist was rather brief, diagnosed me with BAV, level 1 heart block as well, and basically explained what the condition is, how it happens and that my thing isn't stenosis, but regurgitation, which is mild- and likely won't need surgery for a while, but I really am stressed and want some clarification.

hard to give you clarification on that, because your cardio should do that as they have the data. But the heart block may mean you need an intervention in time. If I was you I'd scale back the exersize to "normal" not "try to be Arnie" or Ravinder Malik.

I'll out myself here and say to me exersize and training should be for some reason (mine was general health cycling and Aikido). I've done weight training (not in a body building way) since I was in my late teens, but its always been for making me healthy.

If something you are doing is not healthy then my view is "stop doing it". So in your case YOU need to work our your appropriate level of exercise that helps you health not harms it. Its an individual thing and something that you will work out over time with other considerations and measurements to guide you.


Firstly, i'd like to ask- in my follow up (I booked to clarify some things I don't understand) what should I ask about?
what he means by heart block
I didn't get much info as I was quite shocked.
I get that, so next time I recommend you ask "can I record this" and do that.

I am reading about left ventricle size, aorta size/swelling, ejection fraction, RL and RNC types, stenosis and regurgitation- and what the issue with regurgitation and risk is- and i'm completely unfamiliar with these, but obviously I should know the values here to monitor and see how 'bad' my heart condition is.

I myself don't pretend to be a cardiologist and don't really dig into those things ...
Now, since I lift heavy and hard regularly,
unwise unless you happen to have the genetics to support it, which evidence suggests you don't (also I dislike qualitative, and prefer quantitative): so how many Kg and details. There are people here who are weight lifters (a few come to mind) and they'll be better placed to advise on that, but even they'll say aneurysm makes things different.

I was told that very light weights and cardio is usually the best, which has been extremely upsetting, as it's basically my entire lifestyle, and has honestly shattered me a bit- but I want to ask you guys a few questions and I hope you can help me.

agree with that. So, solid but honest point relating to upsetting: would you rather be dead?

Everyone "wanted to be something" ... what are you willing to pay to be that for a short time?

I've been lots of things, my goals changed over time. Sometimes I changed them, sometimes the world changed them. For instance I've changed career 3 times (at least) because of external economic forces. Did biochemistry, then electronics engineering, then computing then environmental science, went back to computing.

Evolution dictates that we adapt to reality or fail as I see it. If that sounds harsh, the grand experiment of life is harsher.

If I do lift heavy and hard, will it simply bring forward the surgery date?
Or will it cause me huge issues?
probably

Also, will regurgitation effect my athletic performance- meaning I won't have the strength or power as a normal person would?

well firstly normal people don't body build. So you should return to training for health and personal fitness within your limits. Body building isn't actually healthy.

Additionally- when I have the valve replaced, will I be as good as a normal person regarding athletic

yep

https://www.newsweek.com/my-turn-climbing-everest-bionic-heart-99749
That woman probably has more endurance than you and fitter than you (or any other body builder) and had a mechanical valve and still climbed Mt Everest ...

endurance/exertion, since the valve is now sealing and functioning as normal? Or is it still not the same, meaning I am always at a greater risk when pushing weights, and will always have lowered power output?

don't conflate endurance with peak strength.

And finally, the question i'm quite sure I know the answer too- how detrimental are things like anabolic steroids to this condition?

you already know ... I'd suggest you're already heading towards abuse of steroids in your future because giving it up seems so hard.

Thanks for reading my post, hopefully this is in the right section. I appreciate any advice given,

lastly I'll say learn properly don't just read junk conspiracy, only read peer reviewed journals and go in knowing it'll take you at least a year of solid background before you actually can start really grappling with the subject. If you failed school and failed science its going to be hard to learn more and you'll have to accept some things at face value. If you have to choose who to trust: trust science.

http://cjeastwd.blogspot.com/2021/07/done-my-research.html
Take you're time, you've got your whole life to learn.

Feel free to reach out with a PM if you want to discuss anything.


Best Wishes
 
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"Level 1 heart block" is an electrical problem with the heart, ie it is not beating correctly. Level 1 is the low end, level 3 is high. It means that your heart may beat too slowly, probably only occasionally currently, which could cause you to faint at some point. I got a pacemaker in 2014 due to surgical complication when they did my aortic valve, and as a non-athlete myself I have been surprised how many athletes end up with one too. It seems that intense exercise, eg marathon running, can cause electrical problems.

For me, a pacemaker has been no problem at all, but for someone needing to raise their heart rate to high levels (I'm thinking 140bpm+) it can be a problem, though there are settings they can adjust. Worth looking into.
 
Forgive me for saying so, but it sounds like making questionable health decisions for the sake of appearances isn’t unfamiliar territory. Body builders have been doing it for decades.

You have mild regurgitation. You may or may not need intervention in the future. What you do today may or may not accelerate that timeline. When that day comes, you’ll have a decision to make about the intervention based on the options available at the time.

In the meantime, your medical team has first hand access to your test results and what is probably the wisest approach for you. And I don’t mean to dismiss your question. It’s just that presentation of this condition vary wildly. Recommendation’s range from a total shutdown of activities to nothing at all and see you in a year.
 
Hi from a slightly frosty south west(erly) Queensland



that's a wise choice. There's nothing good that comes from that. At 23 you won't see that, but at 53 you'll sorta wish you hadn't. So its good you aren't anymore. My view is that its like alcohol, very easy to slip from "basic use" to mis-use over years and in the face of issues. BTW I used to drink and like a drink but basically now since I developed an arrhythmia I can't (long story right there).

https://www.betterhealth.vic.gov.au/health/healthyliving/steroids
The misuse of anabolic steroids can cause long-term side effects. These can include cardiovascular complications, liver disease, reproductive organ damage and severe mood swings. Support is available for anabolic steroid users who want to change their dependence on these drugs.

You're now aware that you are already pre-disposed to an existing cardiovascular complication so use of that toxic stuff will just increase your chances of making it worse.

I guess I'll start by saying that you now know you have not only BAV but all of what goes with BAV. BAV comes as a host of problems (and its genetic) which may or may not manifest immediately, but will be sort of like a dice roll for the future, this includes aneurysm of the aortic artery (which leads to sudden death if not monitored). So you now know you'll need to go in for regular monitoring, which is likely to be just an echo every other year unless more things are found. Some details (which are not applicable to you yet) are found here:

https://www.racgp.org.au/afp/2013/june/aortic-aneurysms
I include this because my goal is to inform you and lead you away from the darkness of "ignorance led anxiety". The more you know the more you can make informed decisions.

Myself I was diagnosed at about 5 and monitored yearly up at Chermside hospital (in Brisbane, Queensland) until I needed my first surgery at about 10yo (essentially a repair). I had another one to replace the valve at 28 (*a homograft) and my 3rd (last one) at about 48 to replace that valve (with a mechanical) and repair an aneurysm (using a synthetic fiber tube). I continue to be about normally active since then. I have lived OS a lot and spent the majority of my time in Finland (where I enjoy XC skiing).

So surgery is just like fixing a part that is broken or defective and the car still works.



hard to give you clarification on that, because your cardio should do that as they have the data. But the heart block may mean you need an intervention in time. If I was you I'd scale back the exersize to "normal" not "try to be Arnie" or Ravinder Malik.

I'll out myself here and say to me exersize and training should be for some reason (mine was general health cycling and Aikido). I've done weight training (not in a body building way) since I was in my late teens, but its always been for making me healthy.

If something you are doing is not healthy then my view is "stop doing it". So in your case YOU need to work our your appropriate level of exercise that helps you health not harms it. Its an individual thing and something that you will work out over time with other considerations and measurements to guide you.



what he means by heart block

I get that, so next time I recommend you ask "can I record this" and do that.



I myself don't pretend to be a cardiologist and don't really dig into those things ...

unwise unless you happen to have the genetics to support it, which evidence suggests you don't (also I dislike qualitative, and prefer quantitative): so how many Kg and details. There are people here who are weight lifters (a few come to mind) and they'll be better placed to advise on that, but even they'll say aneurysm makes things different.



agree with that. So, solid but honest point relating to upsetting: would you rather be dead?

Everyone "wanted to be something" ... what are you willing to pay to be that for a short time?

I've been lots of things, my goals changed over time. Sometimes I changed them, sometimes the world changed them. For instance I've changed career 3 times (at least) because of external economic forces. Did biochemistry, then electronics engineering, then computing then environmental science, went back to computing.

Evolution dictates that we adapt to reality or fail as I see it. If that sounds harsh, the grand experiment of life is harsher.


probably



well firstly normal people don't body build. So you should return to training for health and personal fitness within your limits. Body building isn't actually healthy.



yep

https://www.newsweek.com/my-turn-climbing-everest-bionic-heart-99749
That woman probably has more endurance than you and fitter than you (or any other body builder) and had a mechanical valve and still climbed Mt Everest ...



don't conflate endurance with peak strength.



you already know ... I'd suggest you're already heading towards abuse of steroids in your future because giving it up seems so hard.



lastly I'll say learn properly don't just read junk conspiracy, only read peer reviewed journals and go in knowing it'll take you at least a year of solid background before you actually can start really grappling with the subject. If you failed school and failed science its going to be hard to learn more and you'll have to accept some things at face value. If you have to choose who to trust: trust science.

http://cjeastwd.blogspot.com/2021/07/done-my-research.html
Take you're time, you've got your whole life to learn.

Feel free to reach out with a PM if you want to discuss anything.


Best Wishes
Thank you very much for the detailed reply.

You've cleared a lot of things up.

I think the PED usage may just have to be scaled back to Testosterone replacement, as my levels have always been low. From what i've read- this is in no way detrimental to cardiovascular health, and should allow me to continue to stay in good shape.

I am not even sure at this point. It's quite a shock considering that basically my goal is now not possible, it's actually quite scary.
As for would I rather be dead earlier, who knows. Is a life that you don't enjoy worth it anyway? That's a question i'll have to battle with myself.

In the meantime, i'm desperately trying to find a good exercise cardiologist in Western Australia, but i'm struggling.

My plan of action is to monitor it every 6 months, as opposed to 12, and keep the reps higher for now. I'll be asking my cardio today how bad my LVH is, aorta is etc to gauge how much risk i'm placing on myself.

Thanks again!
 
In the meantime, i'm desperately trying to find a good exercise cardiologist in Western Australia, but i'm struggling.
probably anywhere will be hard, but WA ... its really almost another country in comparison to the East (as you probably know)

My plan of action is to monitor it every 6 months, as opposed to 12, and keep the reps higher for now. I'll be asking my cardio today how bad my LVH is, aorta is etc to gauge how much risk i'm placing on myself.
that's a good plan. I'd suggest that you give up on "body building" and work on a regime more in line with what an athlete who was trying to increase strength and endurance was after.

I'll ask around
 
Thank you very much for the detailed reply.

You've cleared a lot of things up.

I think the PED usage may just have to be scaled back to Testosterone replacement, as my levels have always been low. From what i've read- this is in no way detrimental to cardiovascular health, and should allow me to continue to stay in good shape.

I am not even sure at this point. It's quite a shock considering that basically my goal is now not possible, it's actually quite scary.
As for would I rather be dead earlier, who knows. Is a life that you don't enjoy worth it anyway? That's a question i'll have to battle with myself.

In the meantime, i'm desperately trying to find a good exercise cardiologist in Western Australia, but i'm struggling.

My plan of action is to monitor it every 6 months, as opposed to 12, and keep the reps higher for now. I'll be asking my cardio today how bad my LVH is, aorta is etc to gauge how much risk i'm placing on myself.

Thanks again!
You are in your early 20s, testosterone replacement shouldn't be needed. Be careful, testosterone replacement therapy can lead to testicular atrophy. Make sure you truly have hypogonadism.
 
I have a BAV which was functioning well and not replaced when my aortic aneurysm was repaired. While not a bodybuilder I exercise a lot and looked into what I could find in the research. For an aortic aneurysm, which I believe you are at higher risk for with a BAV, lifting heavy is particularly bad. I decided a reasonable approach was to use weights I could lift at least 20 times. This is actually the approach that Arnold Schwarzenegger currently uses though he is now well into his 70's and has had two open heart surgeries, the last one with complications as I understand. I can't recall any suggestions on number of sets. I only do 1 or 2 sets of 20 per exercise. Arnold does 4 sets per exercise, but he is not trying to be competitive.

Sounds like you've got some good advise and a good plan already. Best of luck.
 
First, take a deep breath. This could be a lot worse. I lift and have lifted heavy-ish for years pre and post surgery. Now, competitive bodybuilding will add risk (aneurysm, deterioration of valve) and likely hasten your timeline for surgery. This probably isn’t a bad thing, because it makes clearer to you that the short term gains you get from juicing aren’t worth the long term risk. Hard to see that as a totally healthy 20-something. You can be a big and physically imposing dude without juicing. I personally like that and content with it. But to be a competitive BBer you’ll need to do much more than test replacement.

For actual lifts, I think you add the most risk in the valsalva maneuver (holding your breath and bearing down as you strain maximally). What I tried to do and do now is just limit that valsalva. So doing twelve when I can do 16, and 16 when I can do 20, or whatever number works best for you.
 
You are in your early 20s, testosterone replacement shouldn't be needed. Be careful, testosterone replacement therapy can lead to testicular atrophy. Make sure you truly have hypogonadism.
Yes, they've always been low.
I think I might be overtraining. Went from 340ng/dL (clinically low) to 200ng/dL recently- maybe steroid induced but it's been months since, and my training has ramped up a lot since.
 
I did just get back my full results.
My ejection fraction is 56%, my left ventricle is 'slightly thicker than normal' but not enlarged, my regurgitation is in fact - mild (didn't specify numbers).
56% doesn't seem that good- can this number vary randomly?

My aorta is apparently normal.
(3.5mm/3.5cm- not sure of unit) and my aorta has no dissection or aneurysm.

So I plan to keep lifting, might do a bit of steroids, might not. I've got too many other problems in my life to give up on what I enjoy, without this lifestyle, it's not even worth it for me.

So i'll be monitoring my blood pressure, low sodium diet and every 6 months get a new echo.

Thanks for everyones help
 
With these results you could still be a long time away from surgery.
Having said that, any large straining exercise (heavy weight lifting) may strain your Aorta further. I.e. that is how you may eventually get an Aneurysm.

I think it is probably worthwhile to discuss your exercise plans with the specialised sports cardiologist. Honestly, I would stay off steroids.

Good luck and I will keep my fingers crossed that you can keep surgery at bay as long as possible
 
I did just get back my full results.
My ejection fraction is 56%, my left ventricle is 'slightly thicker than normal' but not enlarged, my regurgitation is in fact - mild (didn't specify numbers).
56% doesn't seem that good- can this number vary randomly?

My aorta is apparently normal.
(3.5mm/3.5cm- not sure of unit) and my aorta has no dissection or aneurysm.

So I plan to keep lifting, might do a bit of steroids, might not. I've got too many other problems in my life to give up on what I enjoy, without this lifestyle, it's not even worth it for me.

So i'll be monitoring my blood pressure, low sodium diet and every 6 months get a new echo.

Thanks for everyones help
Don’t sweat your EF. Monitor your BP at home.

If you’re insistent on doing steroids (which I’d advise against if you’re hoping to prolong pre-surgery time, which in turn opens up more options for surgery — ex: could a Foldax valve be viable in 20y?) I’d suggest at least limiting it to hormone replacement therapy monitored by a doctor who is regularly checking your bloodwork. Don’t run tren, or any other crazy stack — that isn’t the hand you’ve been dealt. Do your annual echo, be up front with your cardiologist. Report back whenever it’s time for surgery. No matter what you wind up doing, good luck and hope you have decades before they need to open you up — the tech is just getting better and better.
 
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