BAV and symptoms

[Karen]

My next appointment for an echo and to see my cardio is in October. I have a question that I want to ask him, but I'm hoping that I might get some feedback here in the meantime.

There was a question last fall about my having pulmonary hypertension because of changes in the numbers between two echos done in April and October. I actually had a heart cath done to answer the questions my cardio had about those findings. In scheduling the cath, he told me that "symptoms are more important than numbers." I assume he was referring specifically to PH issues.

My question is this: How important are symptoms vs. numbers when just considering the BAV? My aortic valve has remained 1.6 cm2 for the past 3 echos and my EF fraction is 60-65%. Would symptoms ever be a cause for concern with those values?

You might remember that I have the costochondritis thing going on, and so I've learned to discount many things that otherwise might be considered "symptoms." However, in the past 2 months, there is no question in my mind that I am more breathless running up one flight of stairs, and my exercise tolerance otherwise is NOT what it was 2 years ago. I've lost 10 pounds in the past year, so it's not a matter of my having gained weight. But I DON'T exercise as long and as intensely (just treadmill stuff) as I have done for the past 15 years as per my PCP's recommendation to keep my heart rate around 140. Instead of doing 2 to 2 1/2 12-minute miles, I walk 2 15-minute miles 5 days a week. I avoid doing any "sprints" or putting the treadmill on an incline because I feel very much more short of breath and start feeling this breathing cold air kind of sensation. Also, my heart rate gets higher than the recommended HR.

With a 1.6 cm aortic valve, could these be "symptoms" worth noting, or is it because I've cut back in the intensity of my exercise, or is it 'cause I'm just a year or two older?

Thanks for any ideas!
Karen

 

[epstns]

Karen, I think what the cardio meant is that numbers give the doc's an approximation of the progression of your condition, but that a given set of numerical observations will affect different patients in different ways. That said, the statistics seem to indicate (as my cardio tells me) that the mortality rates for patients with aortic stenosis (with either bi- or tri-cuspid valves) do not seem to be statistically significantly different than the normal population until one or more of the "cardinal symptoms" arise. These cardinal symptoms are angina (chest pain/tightness), syncope (fainting) and shortness of breath. Any of these are cause for review with your cardio.

The difficult thing is that there are degrees of symptoms, such as light-headedness, which might be an early sign that fainting is next. Or reduced exercise tolerance, which might indicate that shortness of breath is approaching. The important thing here is to remain in close contact with your cardio to assess what your particular degree of symptoms mean for you.

An example, from my own case. I have moderate to severe aortic stenosis, with a probable bicuspid valve. At age 58, my most recent echo shows an average valve area somewhere just larger than 1.0 sq cm. For most people, this would be the entry point to the "severe" level of the condition. BUT, since I've been active all my life, I am still jogging 4 miles a day, 5 days a week, at a 9:30 pace. Compared to the typical guy my age, I'm doing fine. Compared to where I was 5 or 10 years age, like you I see the decline. My cardio and I have so far agreed that I do not display any of the cardinal symptoms, so life goes on. Others with valves even larger than mine have needed surgery much earlier. We're all different, and only you and your cardio can really assess the importance of your observations as symptoms.

Sorry for being so wordy, but what I'm trying to convey is the idea that we're all different and numbers are only one dimension of the management of our individual conditions. Here, a good cardio is priceless.

Hope I've helped.