BAV, aortic dilation and strenuous exercise

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Rick

Well-known member
Joined
Mar 31, 2008
Messages
123
Location
Latin America
I have bicuspid aortic valve, moderate or moderate-severe aortic regurgitation (depending on the MD), mild dilation of ascending aorta 3.7 - 3.8 (looks like a sausage where it gets wider and then back to normal). After diagnosis 4.5 years ago, I was told to (i) reduce my weight - check, meaning I did it; (ii) take meds - Altace 10mg, Carvedilol 6.25, Lipitor and Baby Aspirin (81mg) - check; (iii) low sodium diet - vast improvement on my diet; (iv) brisk walking -- generally a check and (v) avoide heavy lifting or competitive exercising - check. Was told we would monitor.

Four and a half years later, things have held rather stable without a significant progression. The only thing I notice is that the lower of of the two BP readings (diastolic?) no longer goes up much even when the higher reading (systolic) does.

Though I feel grateful for how things are going, the hardest thing for me to do is the limitations on sports (not the diet, meds, weight). I really love sports and did competitive sports all my life growing up -- loved soccer, basketball, some boxing and did weights. I go to a local MD in Latin America who has managed my care all along and complement with US care every couple of years, especially since some tests are not available here. I have heard three opinions on the matter:
1 - First US cardiologist at Cleveland Clinic (2008): stress echo showed you should do brisk walking and avoid competitive and strenuous exercise...just do walking 5-6 times per week. Something happened with my heart contractility when I was walking on the incline on the stress echo. Told me running was probably not the best and no competitive sports or weights.
2 - Second US cardiologist in Miami (2012): have aortic dilation, but follow exactly what you have been doing with local MD because seems to be working. On sports, avoid heavy lifting but otherwise no restrictions.

Having literally followed MD requests very closely, I did what the man said. I took up boxing and love it! Though in my 40s, I am still quite agile and not so bad. Then included kick-boxing. However, I have had chest pain three of the four times I have done it, including the last bought which lasted over 24 hours, which took me to my local MD.

3 - Local MD: if you love it, do it but lightly and max twice a week, but it does place stress on aorta. Told me I could lift light weights (i.e. 20 pounds) -- which i something I do not like but I hate feeling weak muscularly like I have the last 4.5 years - and walk.

So I have not been boxing again, am doing light weights and walking, but I am frustrated. I have a son who likes surfing, skateboarding, kickboxing etc... and I really love these things too --- all of which I have done in this brief time of "no restrictions other than lifting". I feel sad, I want to share these things with him and love to do most of them too myself (skateboarding less so.

My intention is to follow my local MD suggestion but not do boxing -- you cannot spar lightly, he must have not done this - because I also know once I do these things I cannot do them lightly (i.e went surfing once and ended lying down on beach for 10 minutes a little dizzy catching my breathe and asking people not to talk to me :().

Anyways, wanted to vent a little and also listen to what others have heard from their MDs as my MDs give me slightly different recommendations (normal I guess) and sticking to the most conservative approach has seemed to work for me thus far.

So what have your MDs told you about exercise if you have BAV and mild dilation of aorta? What experiences have you had on the matter? (I posted this here rather than in exercise because it is in the context of BAV and aortic dilation)

Best regards,

Rick
 
I have to add that the local MD told me my chest pain was stress related but muscular. It hurt when I breathed in. Maybe so ...but sometimes I think heart or aorta pain is hard to diagnose...one MD told me that the aorta does not hurt but from this site, I have noticed that many with aortic dilation have chest pain more often than others I know that do not. Sometimes scientific proof follows years of anecdotal information.
 
Hi Rick. I don't log on to VR much these days. Just once in a while. It's been just over 4 years since my aortic valve replacement. My aorta had enlarged a bit leading up to my surgery but it didn't get large enough for my surgeon to fell surgical intervention was necessary. My last 2 echos showed it in the normal range. Regarding your situation, I'm frankly surprised no one has responded to your post. I'm not sure if my response will be helpful, but I can certainly relate to your sentiments being a very athletic minded person myself. In my case, I had to cut back on the heavy lifting for years (and still do even post op) but I kept up my strenuous exercise until the last year before my surgery, when I started having A-fib bouts. I may have waited too long. I never had chest pain though.

Obviously, I can't advise you medically; however, if your pain and any symptoms you're experiencing are caused by your exercising and they are due to more than just fatigue from a tough workout, then common sense would dictate you shouldn't be doing them. An aortic rupture is a life threatening emergency that's tough to reverse (see John Ritter). I feel for you, man. Can they get you on the schedule and take care of your valve and aorta so you can lead a normal life or are your docs waiting for your numbers to get worse?
 
My heart issue was very different, so I can't really answer you specific question. It seems to me that if your condition is life-altering and you are having symptoms like dizziness and chest pain, you should be having your surgery sooner. I know that others here have gone back to some pretty strenuous activities after surgery.
 
My situation was also very different but as I just posted in another thread, this 'wait and see' approach (at least in my case) was really ill advised. There was no way the heart was going to get better and I was maxing out on meds to feel ok..If I could do it all over, I would have been much more proactive and marched into surgery 5 years ago instead of 2 years ago.
 
Hi,
I've got bicupsid aortic valve with severe regurgitation and mild dilation of aortic root and ascending aorta (3.8cm)
Start stats of LVD 6.4cm - LVS4.3 - EF 60-65% 2012
Now stats of LVD 7.1 - LVS 4.7 - EF 60-65% 2014

I have had no symptoms and am running 4-5 miles at average pace of 7min 30sec miles almost every day.
I also do lightish weights up to 50kg (curls 25kg --- bench press 50kg ) 3 days a week for about an hour
I' m on my feet all day at work.

My consultant wants me to get surgery asap but i want to put it off till Oct.
If i feel any sort of tiredness or other symptoms i will report to him straight away
And hopefully have one more echo to confirm his decission for surgery
 
My consultant wants me to get surgery asap but i want to put it off till Oct.
October is a long ways away given a Dr has advised you to have surgery asap. I suggest you meet with a surgeon or another cardiologist for a 2nd opinion. There are significant risks in waiting too long.
 
Hi Rick.
I had a BAVR ascending aorta dilated to 56mm looked like a pear :) with mod regurg. I had no symptoms, was running half marathons, swimming, boxing you name it. I stopped exercising when I found out (by chance - how lucky am I!!). I was 37. Had the op. 8 weeks later back at work, 3 months later back swimming 1.5km 4 times a week and light running/ walking 60 mins. 16 months on I feel better now than ever before.

If you're fit and healthy now you'll be just the same after you need to have the op. It changed me for the better but we're all different. Stay proactive in your care, look forage ask for answers and if/when the need should arise you need to have the op, rest assured , most have been through it and come out bigger, fitter and stronger people.
Good luck.
J
 
Hi Rick,
I am 6 weeks post-op from Aortic Valve Replacement. I was 35 when I was diagnosed with BAV and my regurgitation was mild-moderate. Over the course of 7 years, it progressed to severe yet during the entire time, I was asymptomatic and my root was mildly dilated. Three years ago, my cardiologist was recommending surgery but the surgeon said I was still not quite there, perhaps a year away he said. At that time, he gave me no restrictions. I told him I was very active, running about 5 miles every other day. He recommended I maybe dial it down to about 3 miles. He also stated that if at anytime I am modifying my lifestyle/activities for the sake of my disease, that would be an indicator it was time to have the surgery. I thought this was a good way of looking at it. Keep in mind my doctors are also considered to be on the conservative side. If they are telling you no restrictions other than lifting, by all means, I'd follow that (including the boxing, you're not on blood thinners yet!) Don't limit yourself any more than you have to. If you are having actual symptoms during these activities (or during rest) that is another story. The better you can stay in shape pre-op, the easier of a recovery you will have post-op (if you even ever have surgery).
Hope this helps!
Dean
 
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