Anyone else experienced exercise induced SAM?

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aobauer

New member
Joined
Dec 9, 2015
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Location
Berkeley, CA
I was wondering if anyone else has experience with what's happening with me after my mitral valve repair. Immediately prior to the surgery, I was able to run for 30 minutes at a pace between 8 and 9mph. I had been completely asymptomatic (murmur during physical lead to all the rest of the tests), but the guideline given my situation was for early surgery before symptoms actually appeared. My recovery after the surgery last April wasn't as I had hoped, but I'd frequently heard you shouldn't expect to be back to normal before a year. Though I was experiencing fairly extreme lightheadedness during exercise and wasn't able to progress beyond 5mph for 30 minutes, a echo stress test over the summer found nothing. Though I continued to feel like I hit a wall at 5mph, my lightheadedness got better.

It turns out the doctor just didn't work me out enough on the stress test. In December a more difficult repeat (I had been complaining about not progressing) found that I had systolic anterior motion, but only when my heart rate was very elevated. I know SAM isn't an uncommon outcome of mitral valve repair, but my cardiologist couldn't find any reference to it just occurring when exercising (I can't either). They do seem to understand why it's happening- when the heart beats faster, the pressure increases more on one side than the other, which like a plane's wing pulls the flap back into the chamber. End result is my blood pressure doesn't go up when I exercise hard.

The proposed solution was beta blockers, which would increase the size of the heart when the blood is pumping. The increased size would reduce the pressure, which would change the point at which SAM would occur. We started out at a half dose, and I actually can now go a bit faster for a long period of time (maybe 6mph for 30 minutes). Any time I sprint for more than a second or two however, I basically shut down and get really tired. Which means I can't keep up with my 6 year old son when we try to play sports together. I'm going to try a whole dose again, but the first time I did a few weeks ago it made me feel pretty bad (more lightheadedness walking up stairs for example). I'm not terribly hopeful it will work.

As I can't find any reference anywhere, I was wondering if someone here has experienced something similar and can share thoughts. Reading the community here has been really helpful over the months. I've wanted to post before, but as you can see I tend to write a lot.
 
Hi

aobauer;n863356 said:
I was wondering if anyone else has experience with what's happening with me after my mitral valve repair.

it would have been helpful to have mentioned what a SAM was in your post ...

I googled it and found this:

http://journals.lww.com/thoracicima...c_Anterior_Motion_of_the_Mitral_Valve.15.aspx

same thing?


I think there is problems because the advice you've been given of "shouldn't expect to be back to normal after a year" is not the experience of most of the valvers here. If you're sick and weak going in then it may take more than a year to return to age related population normals, but for your own normal ... I think a year is enough. 6 months is probably enough.

You expressed dissatisfaction with some of your team, go get other opinions. I know its tedious, but it may be needed for your best outcome
 
Yes, you are right- Systolic Anterior Motion of the mitral valve. I put it in the body but didn't capitalize and as I mention tend to write too much. Definitely going to get another opinion if I don't see progress. And you are right, I'm pretty unhappy with the first stress test people, which I had to have done in a separate hospital. The second one (that found the SAM) was done in our local hospital by my cardiologist's close colleague. They found it, and I've been happy with them. Not sure where exactly I got the idea of a year being the significant milestone. I don't think my doctors ever said that. In fact, the expectation was that as a fairly young (38 now) healthy person my recovery would be fast. But as my outcomes were worse, it never seemed too surprising to them.

And thank you for your response!
 
I may have been one of the sources of that "1 year to full recovery" idea. That's about what it took me, and I have been told that others also had similarly long recoveries - BUT I can't remember the ages of the other patients. I was 63 at time of surgery, so that may be one of the drivers to my recovery time. I also had some complications in surgery and in recovery, which may have impacted things.

I'm with pellicle on the second opinion. It seems that you definitely have something going differently than planned, and the sooner you get to the bottom of it, the sooner you can get back on track.

Be mindful of the beta blockers. Aside from the effects you've already noted, they also limit your maximum heart rate. I've been taking beta blockers since my valve surgery 5 years ago. Even now, at just 1/4 of the original dosage, I feel that the beta blocker keeps me from being able to run at all. (OK, my knees said "NO" but the beta blocker seals the deal.) I cannot work my heart rate up any higher than about 140 BPM - hardly high enough to support any respectable running/jogging pace. Before surgery, I used to work my heart rate up to the low 160's, and at age 60, was running 7:30 miles. No longer.

I recommend that second opinion. Have a real conversation with the cardio. Tell him/her what you are experiencing and what you want from your physical life. Then you can have a meaningful dialog about how you can get there from where you are.
 

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