Attachment of the heart to the rib cage

[R. Houston]

Hi everyone,
I am the proud recipient of a St. Jude valve in 2007. I have stumped my cardiologist with a pounding that occurs when I inhale deeply. Another cardiologist says that he thinks that my heart has somehow attached to the inside of the rib cage during healing and yet another says it is just the proximity of the synthetic aorta to the rib cage that causes the clearly audible thumping. Does anybody else have this very annoying thumping and what have your doctors said to you about it?

 

[JimL]

As things healed up inside after surgery, it often felt to me like things were tending to reattach in the wrong places. But as if moved around, things turned out all right. I haven't felt that way in a long time. Although there might be something special with your pounding and thumping, it could just be the normal experience. Sometimes the valve is very quiet, but many times it is very loud. I always sleep with the fan on to drown out the sound. But at other times I use the thumping as a stopwatch. When I put my arms together in front of me, the volume tends to increase. Welcome to VRorg!

 

[kfay]

You may want to look up a member named Seth. He has suffered terribly with pounding and vibrations from his valve/aortic graft. He doesn't really come around much anymore, but if you do a search, hopefully, you'll find all of those all threads.


Kim

 

[Bina]

Hello and welcome.
Yes, I have thumping if I lean back or bend over or twist a certain way.
It is very annoying, but probably won't change this far out from my surgery. Oh, and I don't have a graft, just the AVR.

 

[Piet]

Hello,
For two months after op I had a feeling of loose parts movements inside my chest or on diaphragm when I was walking or standing up. Fortunately I don't feel it anymore.

Piet

 

[ALCapshaw2]

You may want to look up a member named Seth. He has suffered terribly with pounding and vibrations from his valve/aortic graft. He doesn't really come around much anymore, but if you do a search, hopefully, you'll find all of those all threads.


Kim

You should be able to find Seth's threads by doing an Advanced Search for Keywords: "water hammer".
He found a few other members with similar (though less potent) 'Pounding Heartbeats", most with St. Jude Aortic Valves with attached Aorta Conduits.

Water Hammer is a plumbing term that describes a phenomenon that happens with pumped liquids if there isn't a relief valve. Seth has a particularly pronounced pounding effect. I suspect that may be a function of the dimensions of his Artificial Aorta Tube and his heart's pumping rate / force.

'AL Capshaw'

 

[starburstcoral]

thumping sound

thumping sound

My husband just had a re-operation a few days ago, AVR. When they pulled the chest tube out in ICU the heart began rubbing against something. It made a very loud and rythmic clicking sound, it was so audible that I could hear it just standing next to him. He was really upset to say the least. They did an echo and did not find anything to show that there was a problem with the valve or the heart. As he moved side to side he found that it got better. Now post op day 5 he can barely hear it. I really think they dislodged something (cartiledge perhaps) and then his heart was rubbing against it....I hope yours goes away or you don't notice it at some point. His doctors/surgeon reassured us that it was not going to impact his heart. Mary

 

[Bill B]

Just for clarification, it is normal for the heart beat more forcefully when you breathe in deeply. This is because as the chest wall is moved out to expand the lung, the pressure inside the chest cavity drops dramatically, so the vena cava and the heart chambers expand as well and take in a lot more blood. You don't notice this much with a native set of heart valves, but with mechancial valves snapping open and closed it can be very pronounced, especially in the first few months after surgery. That has been my personal experience. Man, was the effect of breathing in dramatic at first. Now, almost 6 months out, it is less dramatic but still apparent. Some people seem to experience this worse than others. I was worried that my thin frame might cause this to be a real problem, but I am really not much bothered by the pounding. I know that is how the heart responds when you breathe in. Seth, the fella mentioned previously, seems to have a MUCH more pronounced problem. I think he has a pounding pulse even when not taking a deep breath, and it is so strong it shakes him. Mine is just a mild but pronounced sensation produced by the mechancial valve. I'm not saying your thumping is entirely normal, but it has a physiologic base. I too suspect that the dacron graft, which is less elastic than normal aorta tissue, exaggerates the pressure wave transmission.

 

[ALCapshaw2]

The Easy Way to find Seth's posts (or any member's posts) is to click on "community" on the red line at the top of the page, then click on "member's list" from the drop down menu. A listing will appear with the letters of the alphabet in a line at the top. Click on the first letter of the member's name and scroll down until you find that name.

You can select "find all posts" by that member, or "find all threads" started by that member.
Most of Seth's posts are in the Post Surgery Forum and the Heart Talk Forum.
It would be interesting to know what came from the University Studies that were promised to investigate his "pounding heartbeat issue".

FWIW, following surgery, some patients hearts have been known to 'stick' to the Sternum (as opposed to the ribs).

'AL Capshaw'

 

[terodac]

I had this the first year or so and every now and then hear it, sounds like it is a loud pop. I asked my doctor back then to check it and he said it was normal and would go away sooner than later and it did!

 

[realkarl]

Just for clarification, it is normal for the heart beat more forcefully when you breathe in deeply. This is because as the chest wall is moved out to expand the lung, the pressure inside the chest cavity drops dramatically, so the vena cava and the heart chambers expand as well and take in a lot more blood. You don't notice this much with a native set of heart valves, but with mechancial valves snapping open and closed it can be very pronounced, especially in the first few months after surgery. That has been my personal experience. Man, was the effect of breathing in dramatic at first. Now, almost 6 months out, it is less dramatic but still apparent. Some people seem to experience this worse than others. I was worried that my thin frame might cause this to be a real problem, but I am really not much bothered by the pounding. I know that is how the heart responds when you breathe in.

Bill, thanks for a wonderful explanation. I have noticed the same feeling, and have been wondering if it's normal. I tried to ask my cardio about it, but probably phrased my question wrong, and did not get a good answer. Along with the pounding, I also still have some discomfort/pain, and the based on some other threads, the question the original poster brought up "attachment of heart to rib cage", has crossed my mind as well.

Karl.

 

[Bill B]

Karl:

The increase in cardiac output, which we notice more with mechanical valves, is normal with a deep breath, but pain and discomfort is not. I just wanted to make sure people who feel pounding or louder valve sounds when they take a deep breath don't worry unnecessarily about it. It is "nomal", although it can be annoying. Pain and discomfort is something that should be investigated. I've had so little, I would consider it abnormal. I have a bit of stinging, irritation and itchiness in my scar in the area of my lower sternum, but that's it, and it's getting better slowly.

I kinda ignored the stuff about the heart being attached to the rib cage. Not sure what to say, but my understanding of the anatomy is the heart is separated from the chest wall and other structures by the pericardial sac that surrounds it. The lungs have pluera surrounding them. These "liners" allow these structures to all move independently. They can get inflamed after surgery or for other reason (e.g., pericarditis and plueritis) and this can cause pain on breathing. Whether your pain is that or something else that may be a normal part of recovery is something to review with your doctor. I see some people here who have shoulder and rib pain after surgery, some for quite a while. I'm one of the lucky ones who had none of that at all. I'm such a small guy that I was expecting much more post-suirgical discomfort from all the trauma of stretching the chest apart.

Bill

 

[realkarl]

Well, the pain and discomfort is not by any means severe or a problem. I have to breathe in more than I do even at max exercise exertion levels. I mentioned the discomfort at MAX breathe in, before my latest echo, and my cardio said, let's wait and see for the echo, which was all clear, and an improvement in LV size and EF since the last, so I don't think I am going to pursue it any further for now.

 

[james]

When I try to play saxophone or the harmonica I get this still.