Mechanical Valve and Intense Exercise

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C

conk

Looking for others who have had similar desires and experience

I recently (8/26/03) had a redo of my AVR (first was on 12/20/02, with a Homograft) and now I have a St. Judes Regent valve (23mm).

I am one of those individuals that is just not happy unless I'm able to push myself physically. Before I had my first surgery I was just starting to get into road biking with a group of very good riders. After the first surgery I was back riding with the group at about 2 months after surgery and road with them for 1.5 months before I was told to back off by my Cardiologist since my Homorgraft valve was beginning to leak more and I had severe AR. I stopped riding at that point and limited my exercise to light weights and stationary bike. At the point I stopped, I was riding about 70 miles (about 4-5 hours) in a weekend at an average heart rate of 140.

I am now riding a stationary bike and kinetic trainer (my bike attached to a kinetic resistance device) about 4-6 hours a week at an average of about 130 HR.:) :D :)

My question is -
"Does anyone have experience cycling or exercising at an intense rate after recovery from a Mechanical AVR in the range of 3-4 hours at one time with a HR average of 80-90% (136-153 for me) of Max up to Max (170 for me)? I will be 52 this month.

My Cardiologist said that he does not want me to exercise at more than 140. When I asked him for how long, he said forever since he didn't want me to hurt myself. I clarified his concern and he was referring to physical injury, not injury to my heart since I'm now over 50. I kept my mouth shut, but I think he could tell I wasn't happy with what he had just told me.

Am I crazy to want to ride with this very fast group of riders again which will take me to fairly aggressive heart rates with the potential risk of a going down. I had been told my Surgeon and Cardiologist before the surgery that there really wouldn't be any restriction on my heart (once I recovered). Certainly injury is a consideration being on Coumadin. I am willing to take that risk, but is there a serious risk of overdoing a health heart (other than the Mech AVR)?

Sorry this is so long...this is such a Great group I'm sure you won't mind and I anxiously await the cojent advice.

Regards...Conk:) :D :) :D
 
Conk,
I know someone with an MVR that does bike riding long distance, but I don't know how hard he pushes.

I also know that your target heart rate should be lower than a "normal" person.

Personally, I wouldn't risk it. It sounds like this group is pretty aggressive in their riding. At the very least, I wouldn't jump back into anything too quickly. Take it in stages and let your body adjust.

Since this is a great group, maybe there are some that would be willing to step back a bit occasionally and ride with you.

Your surgery was very recently. Are you already starting to feel up to resuming that kind of activity yet? If so, WOW.


Karlynn
 
I'm not sure I understand. Conk, are you saying your cardiologist doesn't want you to get your HR over 140 because your over 50 and not because of the valve?

There are members here that run marathons with a mechanical valve. I'd be surprised if their heart rate never gets above 140.

I had my 2nd avr the same day as you. If what your doc is saying is true, its the first time I heard anything like that. It would be devastating to me also...

Karlynn, could you explain why our target heart rate should be lower? Is that just for mechanicals or any valve replacement. I'm asking because I've never heard of that before. My cardiologist and surgeon both said I could resume running and biking with a mechanical, but we never discussed effort level. They never mentioned to take it easy.
 
Reply

Reply

Rob,

When I queried my Cardiologist about his comment, he didn't indicate it was the heart or valve that was of concern, but that he knew of many 50+ people that have sustained injuries in the knee, back, arms, etc. by exerting at a high level of intensity.

My reaction to this is that many injuries in this group are caused by not warming up properly or doing sports where those types of injuries occur (although I think he was specifically referring to bike riding, since he knew that's what I like to do). I think there is much less risk of those kind of injuries on a bike, not counting a fall that could occur. I have only sustained injuries playing sports such as softball, flag football, etc., but these were only pulls and strains, never needed any kind of surgery. I have never sustained an injury riding my rode bike???

What I would really like to do when I'm fully recovered is ride road bike competitively in my age group. I think my cardiologist is very fearful of this, although he is a very knowledgeable and competent doctor when it comes to the heart itself. Does this sound like undue risk on my part or concern on his part?

Regards?Conk
 
About Dave Cullinan

About Dave Cullinan

Nancy --- Thanks for the links

I can understand why Dave needed to revert to a tissue valve. The mountain biking and X-Games type of competition has an intense risk of injury and some serious as Dave encountered with an injured heart from one of his accidents.

Road biking performed with a bit of caution is a much safer sport, in my opinion, although the risk of a fall type of injury is certainly there, I don't this is as routine compared to what Dave does.

My assumption is that even if you fall on a road bike, which I have, usually the injuries are mostly external, not internal and could be sustained by someone on coumadin, although you better be riding with someone and have some compression bandages fairly handy. I read my response and think...Am I being bull headed, I know I have this tendency.

Thanks again Nancy!
 
I can't really speak for competitive cycling. I've done a few triathlons, but the biking isn't the same with the no drafting rules. I guess the scariest thing would be a head injury.

I'm not sure where you draw the line. Right now, I'll be happy just being able to work out and enter an occasional race for fun. Its a tough call for you.

There's another member here - chilihead - a competitive cyclist deciding on whether to have a Ross procedure or get a mechanical valve. He also mentioned his doctor told him he would have to give up biking if he got a mechanical valve (though he seemed to emphasize mountain biking). See the 'One valve for life?' thread in Heart Talk.
 
Rob, I have a mechanical mitral valve and my card told me to "stay around 140" when working out. I'm 44 and that's a little less than what is recommended for my age. But one of the symptoms that MVP people (mitral valve prolaspe, not most valuable player, unfortunately!) deal with is a heart rate that jumps up quickly upon exercise. So maybe that's the reason for the recommendation for me.

I also read it doing some web research a few years ago, but can't remember where. However, I think part of the equation is how fast your heart gets up to that target rate. It sure doesn't take long for me. But then, I've never been an athlete. My husband's resting heart rate is about 60. It takes him forever to get to 140 - let alone beyond. And then the other key element is recovery rate.

Conk - just out of curiousity - does the doctor look like someone who works out or participates in sports? It seems strange for a doctor to discourage people from participating in those activities you mentioned because of their age, particularly if it's something they've been doing. When first reading your post I assumed his concern was the heart/coumadin issue.

Just for safety sake - I'd assume the worst could happen - a fall with an injury that requires surgery, or a head trauma, and then decide what the likelyhood would be for an injury and if that's a risk you want to take. Bottom line is it's your life to live and you need to decide how to live it. It certainly doesn't sound like you are being careless about the decision. Educate yourself (which you are trying to do) then make an educated choice.
Maybe get a second opinion from a cardiologist who also works out. :D

Karlynn
 
Heartrate

Heartrate

Conk,

It does sound like your cardio is hedging on injury. I'm not sure why though. When I talked to my surgeon before my AVR, he told me that I could do anything I wanted after the mechanical replacement except extreme sports. He did mention downhill skiing and mountain biking as belonging to the "extreme" category.

However, at no time was I told that I should keep my heart rate down. As a matter of fact, when I was in cardio rehab, my target heart rate was 150-160! My rehab techs would give me the "evil eye" if I didn't get over 145!

My opinion (for what it's worth) is that your road biking shouldn't be a problem as long as you take the proper precautions, i.e. wear a helmet, have the proper first aid supplies along, and most important of all-- wear a medic alert bracelet that says you are on coumadin.
 
Thanks for the inputs

Thanks for the inputs

Yes I do wear a helmet, one I bought just over a year ago to replace my old helmet, but I think I'll be looking to get an even better helmet if I don't think it will protect me. I've been meaning to get a medic alert bracelet, just haven?t looked into where to get one. Any suggestions would be appreciated.

I'm pretty good about looking at all the data I can get my hands on, but in the end, I will decide what I do and don't do. I'm sure my Cardiologist is just trying to instill a bit of fear since he knows I'm such a type "A" personality when it comes to exercise.


Kristy,
Thanks for HR information. I think he just wants me to be cautious and he likes me, so he doesn?t want to see anything bad happen. As far as that goes neither do I, but when you've seen the seen the back of a Carrier Deck on a dark night almost 100 times, this just seem to be quite as risky. I?ve still got some time to think about all of this since I?m still on the road to recovery, although I was riding with the group after only two months after the first surgery, I believe it will take me a little longer this time, since I?m taking a more conservative approach, at least in the early stages.

Susan,
I talked with Bruce last weekend and he is going well now. I don?t think he has gone back to work yet, but should soon. I will be talking with him within the next couple of days so I?ll update you after that.
 
I say do what motivates you. Everthing has its risks - and rewards. Doing nothing can have the greatest risk.

Just get a clear reading from the cardiologist about your heart function and any risks associated with your heart condition.
 
Conk,
You can order a bracelet at www.medicalert.com

They come in many different styles and prices from the very inexpensive, to solid gold ones ( in my dreams!)

Karlynn
 
MedicAlert Bracelet

MedicAlert Bracelet

Karlynn,
I ordered the bracelet last night on the web and talked with them this morning to verify what would be placed on the bracelet. I got a sports bracelet. I forgot to ask if these can be washed, but I assume so. I'm prodigious at producing sweat when I exercise, so maybe I should order an extra. Can I get another bracelet at $5 or will I need to pay $30 for an extra bracelet?
 
Working out

Working out

Conk,

I feel like a slacker after reading about your regimen. I have a mechanical mitral valve, and never got any flack about my exercising from my GP or my cardiologist. My sport of choice is swimming, though, coupled with weight lifting. I need the weights to get stronger for the water, and I can't hardly hurt myself in the water! My heart rate doesn't approach 140 in the pool. I'm 53, we just had our first grandchild, and life is wonderful. I feel as you do that it's all too short to not squeeze every drop of fun out of the time we have. After every setback, I'm always anxious to get back to my regular workout schedule. So my uninformed unscientific view is to do what feels right. Your body will let you know when you're pushing too hard.

John S.
 
Valve is tough

Valve is tough

Conk, soon after my surgery when I was starting rehab I called St.Jude and talked to one of their engineer -scientists that actually design and manufacture my mechanical valve. He was very reassuring and as I remember among other things he told me they had a valve in a stress test setup in ther lab that had been clicking away at 220 beats per minute for 15 years, now maybe 20. So I don't think you need to worry about the valve being the limiting factor in your future plans.
 
hi conk!
first of all, it's great to see that you are doing so well! so happy for you!
it seems like your doctor is more concerned about you injuring yourself during biking than he is about your heart rate, right?
i think it's a great idea to get in touch with jim/ chilihead. he is contemplating a mechanical vs. a ross procedure. you may want to pick his brain, i know he is thoroughly researching this.
also, if your concerns are h.r., maybe ask mark wagner our in house marathoner. he has a mechanical and certainly runs his body ragged!!!
hope these help.
glad that this is your difficult decision; it's a really positive one!!
stay well and happy biking!
-sylvia
 
Somehow my post didn't go thru correctly - 4th try -
Thanks for the info Marty - do you think the heart tissue the metal valve is bound to - the sutures or whatever will hold up as well as the mechanical valve itself? I just wonder since I tend to run a higher heart rate a lot of the time - (105-120) and it doesn't bother me - I just hope the heart valve holds up OK and I've seem some say it's the sutures or whatever that would fail before the valve itself.
 
Mechanical Valve Sutures

Mechanical Valve Sutures

Jim,

I have the same questions about the sutures. Since there is no tissue to bond with, then I began to think that the tissue valves are not live, so I would think that they would have the same possibility of suture bonding problems. However, I haven't heard much discussion of problems myself.

I'm not really concerned about the valve itself. From what I know and have read in studies, they are very reliable.

I will try to get in touch with chilihead. He might want to talk with Bruizer about his Ross AVR redo operation he just had after only 3 years downstream from his Ross procedure.
 
Hi Conk, I have a homograft valve and I remember them telling me not to have HR up to 120-130 for about 4-5 to five months,due to the healing process and pressure changes. I guess I had alot post op complications and I was really strict about staying in that range . I was a competive racquetball player,so you know how hard that can be. I started with aerobics at 12 weeks for 1-2 months then progressed to racqetball at 6 months had HR up to 170 felt great , my doctor had me come in and do treadmill and I did great . So I have no Hr restrictions he always says "if you feel alright, continue if not slow down". I will say the first time I was back in the court playing , I truly had tears in my eyes because I felt now I was really back.If you know what I mean.HFK
 
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