BAV - Am I Symptomatic?

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Hi. I'm an otherwise healthy 49 year old man with a BAV, moderate-severe stenosis (1.2 valve area, 48 mm/hg gradient). I've seen two respected cardiologists here in NYC, one with a specialty in congenital valve disease, and they both say that I'm aysmptomatic, and indeed have both cleared me to continue my strenuous exercise routine. I trust my doctors, but my "symptoms" seem very unusual (neither cardiologist could explain them) so I guess I was just wondering if anyone else had anything like this.
Basically, the main issue is that I can't jog or run, almost at all. I can bike hard, I do indoor rock-climbing (very strenous, heart rate gets elevated fast), I do calisthenics and stretching in the morning -- no problem. I definitely don't experience any of the classic triad (shortness of breath/fainting/angina). However, if I go jogging for more than a couple of minutes, I start to feel a pressure in my chest, which radiates up to an ache between my temples and the back of the jaw and a kind of mild nausea. This is extremely uncomfortable, and goes away almost immediately if I slow to a walk. It appears related to the heart rate when I'm jogging, but at very low rates (typically kicks in at around 90-100bpm, although if I rest and continue, the rate at which it kicks in elevates, so that by the end of a jog/walk I can get it up to maybe 120/130 with only mild symptoms as above.) And again, when I climb or bike, my HR goes over 150 easily with no symptoms -- certainly nothing like this strong chest pressure/ache.
In addition to this, I have had a couple of episodes of a kind of double-vision, where the eyes are not focusing on the same point. And I do get some occasional arrhythmias, which except for an occasional "skipped beat" have mostly resolved after I quit caffeine.
Again, cardiologists are both saying wait and see. My aorta is not enlarging and walls not thickening. I have mild/moderate regurgitation, but they're not concerned about that either. Basically, they say apart from the stenotic valve, the heart is still looking good.
Does any of this -- particularly the jogging -- sound familiar to anyone? I feel like I'm in pretty good hands, but it is unnerving reading about the importance of intervention when one becomes "symptomatic."
 
Interesting. Could it be related to the impact of jogging somehow? Do you have similar symptoms with jumping jacks or something similar?

My take would be if you saw two doctors and were cleared, to carry on with the exercise that feels good - and just don't run!!
 
Have you had any evaluation of the blood flow to your heart? I am NOT a medical professional, but your symptoms sound a bit like those of a patient having a partially/mostly blocked artery supplying blood to the heart. It could be a blockage, it could be a spasm, or I could be way off base. I would suggest you discuss your activities and symptoms/lack of symptoms again with your cardio and ask if it is worthwhile to have a cardiac angiogram (or the newer, less invasive, C-T version) to ensure that you are not suffering some impeded blood flow to your heart in addition to your valve issue.

One difference between your activities could be that jogging/running elevates your heart rate and keeps it up there, demanding high blood flow to the heart. Other activities may attain higher peak heart rates, yet may not maintain these peak rates, instead maybe they go up high, then down some, then back up again. This sort of intermittent peak rate may not require as much blood flow to the heart, so a partial blockage may not become symptomatic.

I was also an "asymptomatic" aortic stenosis patient, but when they did the angiogram in preparation for my valve replacement surgery, they found I had a major artery that was 50% blocked. In my case, they just did a bypass in the same operation when they replaced my valve. Two fixes, one recovery.
 
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Thanks for the replies. Yes, arterial blockage seems like a possibility. I recently had a cardiac MRI -- I'll ask my cardio if that ruled out blockages or not. Can't remember.
I suppose it's possible that at a steady biking rate my heart never gets above 120 or so, but with the jogging, the symptoms start well below that -- 100bpm or so, a very light jog. Maybe running is just uniquely strenuous somehow, although can't imagine how since the heart just pumps slower or faster, right? It doesn't have an "intensity" setting.
Indeed, I've wondered why there's the restriction on strenuous physical activity at all. I know that stenosis is associated with a (low) risk of sudden death, but there doesn't seem to be any evidence linking that to exercise. There's the possibility of fainting if the heart can't pump enough blood through the narrowed valve, but other than that, what's the harm, apart from discomfort? I asked my cardios and they weren't able to give me a clear answer either.
 
It has been a while, but as I recall, part of the caution against heavy lifting or exercise having high dynamic range (from full stop to full speed in short intervals, like tennis, football, soccer, etc.) was that BAV patients are at risk for also having aortic aneurysms, and having high pressure in the aorta could exacerbate an existing aneurysm, causing dissection.

When I was in The Waiting Room, my cardio said that any cardio activity was OK, as long as it was consistent intensity and I ramped up to my "cruising
level. So, jogging or running was OK, intense interval training was not.

Zonker, there are many possible causes for what you're experiencing. Enough of those potential causes are serious, so you would be well advised to stay with the evaluations until you have the full cause outlined. It is very possible that there is nothing additional amiss, but good to know what's what.
 
Well, I've had a bunch of echos, a stress echo, a cardiac MRI, and I'm going to have a Cardiac CTA on Tuesday. So they're looking!
 
I am a BAV with severe regugitation no stenosis and I don't have similar feelings when exercising. Planned for AVR on April 4. in play hockey (really gets the heart beating) and also run and bike regularly and never experience symptoms you are describing, everyone is different though. My bro and uncle have BaV as well an neither have it as bad as me. Trust your Drs. they see this a lot.
 

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