2 weeks post-op and concerned with sproadic vision issues and some light headedness

[JimH]

Hi. I had a mitral valve repair and aortic valve replacement (full sternotomy) 2 weeks ago. I am 51 and other than some high blood pressure prior to surgery have been very healthy to this point in my life. Excercise regularly and not overweight. I was not really symptomatic but mitral regurgitation was 4+ and 3 opinions all said it needed to be fixed and would just cause trouble if I waited. Anyway, surgery went well and I'm anxious to get back to excercising (just walking so far). My problem is I've been having some vision problems and dizziness post surgery.

My vision symptoms are seeing "stars" or points of bright light at various times. I know the stars are reported by lots of people. I also have had 3 instances where the lower portion of my vision in my left eye "blanks out" for ~ 30 seconds. The lower left image seems to be beige or grey and top is a jagged line but roughly lower 30% of vision is just gone for a short time. This might correlate to taking Metoprolol Tartrate on an empty stomach but not sure. I spoke to a nurse at the hospital where the surgery was done and she said I needed to go to ER to be checked out. The ER visit turned into a 24 hour oddessey of tests (not faulting anyone, they were trying) and telling me to start taking coumadin (possible sporadic a-fib or something causing thrombosis but no test result to back this up) and getting EEG and MRI tests next week. Nothing was found in echo, CT scan, Coratid dopler, neurologist checkup, or opthmalogist exam. I just have trouble buying it being clot related if it occurs same way in left eye each time. I've been taking it easy since the ER oddessey and vision problems have reduced. I don't really want to go on coumadin unless there's some real basis to do it and not sure the EEG or MRI tests are required.

The light headedness is also sproradic. I just sit down and rest when it occurs but I hope it goes away soon. Like the vision I'm wondering if it could be medication related. I'm off the pain meds so just taking 1.5 25mg Metoprolol Tartrate twice per day and one protonix tablet in the morning. They had me on one baby aspirin as well and I bumped this up to one bayer aspirin twice a day until I can get into my cardiologist and discuss the coumadin.

Can anyone suggest why vision problems come up after OHS? Has anyone had instances of brief/partial vision loss. The metoprolol info indicates it can cause vision problems and dizziness so maybe just not the best medication for me. I'll also discuss with cardiologist if something other than metoprolol could be perscribed to see if this is a possible cause.

Thanks for any clues, observations, comments, or links.

 

[kfay]

Well, obviously I want to make sure you rule out any possibilities that you are having a stroke before you take anything I might suggest into consideration, but to me, it sounds very much like a visual migraine, which for some strange reason seem to be very common after heart surgery, even in people who have never had them before. The jagged line and it being in in the same eye each time just scream migraine to me. The dizziness can also be a symptom of this (although that is probably a very common side effect of your med as well, but I don't know that for a fact). I've had migraines my whole life, some with visual disturbances, some without, some with head pain, some without, some with one body complete numbness and weakness, just like a stroke. I experienced a huge increase in them immediately after my surgery. I'm sure if you do a search on here, you'll find other threads discussing them because like I've said, it's not an uncommon problem.

If what you are experiencing is migraines, they will settle down with time. Just please know that I am not a dr. and so please follow your drs directions to rule out any chance of a stroke going on here. I hope what ever is going on that it all settles down for you soon.

Kim

 

[enkaynj]

JimH,
I had similar vision problem for the first two weeks after my surgery. I saw bright colorful icons whenever I accidenally looked at a bright light. After that I would close my eyes for a few minutes and it would go away.
I was told that this could have been because of a chemical imbalance that was caused by the diuretics I was prescribed after the surgery to lose the excess fluid accumulation. Thankfully everything went back to normal after a month or so.
Hope this helps.

 

[tom in MO]

I had vision problems as well. I would think there was something beside me and turn to look and it wasn't there. I thought of them as visual hallucinations. I also had some lights and floaters. I never had 30 second vision loss though. That would concern me. You may want to talk to your cardio or surgeon if it is continuing.

I also would get dizzy after walking "too much" and have to sit down. You are only 2 weeks out and that is to be expected.

 

[Laggard]

I had this thing where the upper left corner of my vision was shimmering. It made it hard to watch tv or read. I also had periods of double vision. I still feel light headed when standing but that is simply from my blood pressure being lower than normal.

 

[escargome]

in my non medical opinion, first as kfay said above, follow your doctors orders all the way. But like everyone that has also posted, it could be occular migrane. I had huge migrane headaches prior to my surgery. Vision disturbance (shimmering around outer edge of vision and total gray in center) followed by head pain and sometimes vomitting. After my surgery the visual disturbances returned but only for about 15 minutes rather than the all day stuff I had before. Periodically I still see shooting stars in the outer area of my vision. I discussed this with my cardiologist and he said that since they didn't last and since I had pictures of my eyes taken by my opthamologist and nothing was found that they were likely part of a very small migrane. So follow up with your doctors and to give yourself peace of mind see and opthamologist for an eye exam. Best wishes on your recovery.

 

[Pat J]

I had vision issues....complete loss of vision in parts of one eye for about 20 - 30 seconds before my surgery and haven't had since.

 

[JimH]

Thanks for all the responses. It is helpful to know what other people have experienced. To clarify, I had no vision issues prior to the surgery so this is new territory for me. The partial loss of vision has happened 5 times in the last week, where each episode is 30-60 seconds. They want to go ahead with the MRI and EEG to confirm no stroke related issue and they have me on plavix now (cardiologist agreed coumadin was not needed) until MRI comes back clear. Tests are scheduled for next tuesday. Sure seems like a visual migraine as I read about it. Overall I'm feeling pretty good for the most part.

I've read online that they recommend not to have an MRI for 6 weeks after a valve replacement. I asked my cardiologist and the nursing hotline at the hospital where the surgery was done (Cleveland Clinic) and both said OK to proceed with the MRI. In terms of additional parts I have a replaced aortic valve (Model 2700 Pericardial Tissue Heart Valve, Edwards Lifesciences) and a ring around my repaired mitral valve (Duran Ancore Annuloplasty Band). I have some staples to close the breastbone from the full sternotomy. Anyone know of any concerns or additional questions I should bring up as far as getting Tests done (MRI/MRA of Brain with Gadolium and EEG, focal seizures according to scripts).

I just really want to be completely sure this testing doesn't create any issue with the newly implanted parts. There seems to be some disconnect between the general guidance to wait six weeks and the answers I'm getting. Thanks.

 

[JimCA]

I had similar issues. I left ICU on the day after my surgery, but the problems boiled to the surface later that evening, sending me back to the ICU. In addition to the vision problem, for brief periods I also lost my ability to speak clearly. I had a CT scan, ultrasound of major neck arteries, and an MRI - along with visits from a neurologist, endocrinologist, opthamalogist, among others. One ICU nurse noted a very close correlation between my episodes and the pain medications. I have a history of visual migraines, which resemble these effects - and which in the past have coincided with periods of dehydration (during the days immediately following surgery, my liquid intake was limited, and these effects dissipated when I got my hands on more liquids).

 

[Rachel]

Thanks for all the responses. It is helpful to know what other people have experienced. To clarify, I had no vision issues prior to the surgery so this is new territory for me. The partial loss of vision has happened 5 times in the last week, where each episode is 30-60 seconds. They want to go ahead with the MRI and EEG to confirm no stroke related issue and they have me on plavix now (cardiologist agreed coumadin was not needed) until MRI comes back clear. Tests are scheduled for next tuesday. Sure seems like a visual migraine as I read about it. Overall I'm feeling pretty good for the most part.

I've read online that they recommend not to have an MRI for 6 weeks after a valve replacement. I asked my cardiologist and the nursing hotline at the hospital where the surgery was done (Cleveland Clinic) and both said OK to proceed with the MRI. In terms of additional parts I have a replaced aortic valve (Model 2700 Pericardial Tissue Heart Valve, Edwards Lifesciences) and a ring around my repaired mitral valve (Duran Ancore Annuloplasty Band). I have some staples to close the breastbone from the full sternotomy. Anyone know of any concerns or additional questions I should bring up as far as getting Tests done (MRI/MRA of Brain with Gadolium and EEG, focal seizures according to scripts).

I just really want to be completely sure this testing doesn't create any issue with the newly implanted parts. There seems to be some disconnect between the general guidance to wait six weeks and the answers I'm getting. Thanks.

Hi JimH,

Just also wanted to respond, I think it's wise to get this all checked out. I had ocular migraines which started 15 years ago, every so often I get a blind spot right in the center of my vision which lasts about a couple minutes before it breaks up and pulses, slowly moving away from the center to my peripheral vision. It's usually jagged lines and very bright - and I hate when it happens.

Right after my surgery I would get these about once a day for the first two weeks. Since then I've had maybe three more in a 20 month period.

I don't know anything about a "safe" time frame to have an MRI after OHS - but I've had two MRI's since my surgery (one at 6 months and one at 19 months) - I presented my card to the MRI tech and was good to go (I have the same aortic valve as you have, but that's it - my mitral valve was not repaired).

Sounds like your doctors are okay with the MRI at 6 weeks.

Rachel

 

[jake]

Boy do I know this story!

Before OHS, I used to get migraines occasionally that brought on debilitating pain. After OHS, they went from painful to optical migraines. They started with a flashing colorful horseshoe shaped disturbance, than one time, my right eye just kind of blanked out kind of like an old television would do when the picture tube would go bad, black on top, black on the bottom, and a white line in the middle. That lasted about 10 minutes and really freaked me out! It hasn’t happened since but the optical disturbances still plague me from time to time.

As for the unsteadiness, yep! Got that too! As a matter of fact, I have two ENT's who are debating whether it is Minier's syndrome (water on the ear) or migraines that are causing my balance issues. When I have an attack, it ranges from mild unsteadiness to a full blown drop attack that lasts from a few minutes to several hours to one that lasted two days. I never had this before the heart related stuff started. They have not been able to replacate the events in balance testing and only note minor deficits during the extensive balance testing which leads some to think its migraine related.

The visual ora's are not too frequent, but the vertigo attacks really suck! There is not much I can do about them and until the last month, were getting fewer and farther between. I believe that they are brought on by stress although I do see an increase in the optical issues when I have a second cup of coffee too close to the one in the morning. Now, I dont have ANY coffee ;o(

My surgeon told me that if the optical disturbances were bothersome, he could prescribe me Plavix but I truly do not want to go onto an anti-coagulant unless I absolutely have to. Visual disteurbances are not enough to drive me to an anti-coagulant.

Finally, the last issue I have not of yet been able to reconcile after surgery (over two years ago) is the mental fog and poor memory performance I inherited from surgery. Pump head is what they call it, but truth be told, this is the single most disappointing thing about my recovery. I guess the alternative (sudden death from dissection) would be much worse.

I wish I could assure you it will go away or get better, but for me, it has not yet let me out of its grip. It hasn’t stopped me from doing my daily routine (inline skating, drag racing, working on cars, welding, etc).