News from my cardiologist

[middleman]

I am now four months post op. I am working out about an hour of cardio exercise four to five times a week and feeling pretty good over all. Now last Friday my cardio wanted me to wear a heart monitor for 24 hours to watch my heart rate. He was thinking that my resting heart rate was too high. This doctor keeps reminding me that I will wear out my new valve if I get my heart rate too high, even exercising. So I wore the monitor for the 24 hours and returned it to the hospital. It was an uneventful 24 hours. I made sure that all stress makers were turned off just to be sure my heart rate was not too high. It was great to have a lazy day.

So tonight I got a call from the cardiologist and told me that my pulse was too slow during some times during the monitoring session. He asked me if I felt any dizziness or light headiness, I said no. He said that the slow rate could have been caused by the sutures of the heart valve. Then he said that the solution to the slow heart rate is to implant a pace maker. He said that he would send me to a rhythm specialist and he would consult my surgeon. I am to meet back with him in a month.

Are you guys confused, well so I am too along with mad, frustrated and a few other negative emotions that I should not post. Has anyone heard of this problem where the surgery suture causes heart rhythm problems? Has anyone had or heard of problems with the heart rhythm due to the AVR. I know one thing is that a pace maker is the last thing I want. :eek2:

 

[epstns]

Jim, I can't speak for any issues where sutures affected mech valve operation, but I can speak from experience that rhythm issues can and do appear after valve surgery. Pre-surgery, I had no known rhythm issues over the 8 or 9 years we had been watching my aortic stenosis progress. I did have a relatively low resting heart rate, often down to the mid-40's at rest, which we attributed to 30 years of running and jogging. I felt good, did everything I wanted to do, generally had no issues. The only possible indicator was that I sometimes got light-headed when quickly rising from the kneeling position. This we attributed to my narrowing aortic valve.

Fast-forward to the days immediately following surgery. While I was in the CICU, my heart rate and rhythm was all over the map. It went from the 30's to the 180's, in and out of afib, was not stable at all -- then my heart stopped for 15-20 seconds. It re-started without prodding, but did this several more times within a span of a couple of hours. Finally the doc's admitted defeat and we discussed implanting a pacemaker. For me it was a fairly easy decision. My mother had a pacemaker for the last 4 or 5 years of her life (her cause of death was cancer, nothing to do with the pacer), and had literally no problems with it. So, I told my doc's that if they were concerned about controlling my heart rate and rhythm, and if they felt that the pacemaker was the safest route to take, then let's do it asap. I had my valve replaced on Monday and had the pacemaker implanted on Friday, and as far as the pacemaker goes, I haven't looked back since.

Yes, we have "tinkered" a bit with the settings on the pacer, but if you look back to my older posts, I wrote that even the starting point was better than I felt without the pacer, and if that was all there was, then it would be good. Now, seven months post-op, I am back to the gym 5 days a week. I no longer run - my knees complain too much. I do "speed-walk" on a treadmill, at a hefty incline, and I ride a stationary bicycle. I also lift light weights (curls with 30 lbs, etc.) to modestly high reps (20 to 60 reps, depending upon the exercise). I don't mean to ramble on, but I guess I'm trying to explain that after heart valve surgery, the pacemaker is really not an issue to me. My only complaint is that the skin over the implant is sometimes irritated when things rub on it (car seat belts), and I sometimes have to adjust my exercise pace until the pacemaker catches up to speed. My only "worry" is over the unknowns when it becomes time to change the pacemaker. Since I am highly dependent upon it (thus it is working a lot), the projected battery life is about 6 or 7 years. They tell me that the replacement procedure is usually an outpatient visit, so It can't be much (can it?).

Don't let it get you down. Make sure that your valve is OK. Get a second opinion if it helps you to decide. Life with a pacemaker is still very good.

 

[pem]

Are you taking any blood pressure medication? My surgery was about a month after yours and I find that my heart rate is a bit low when I'm out walking (70-80). But I attribute that to the Toprol that I have been taking. What do they consider low?

What frustrates me is that there often seem to be rules of thumb that guide treatment decisions. These rules of thumb apply to populations and not individuals. Each person has an oxygen transport system with different characteristics. Some of this is vascular, some is related to the heart, and some is microcellular (mitrochondrial, etc.). If your heart rate is lower than your doctor would like to see, ask him why he thinks it's too low, is he concerned that you aren't getting enough oxygen? Can that be measured under stress (exercise)? And seek a second opinion. I would certainly get a second opinion before getting a pacemaker. Not that a pacemaker is a huge deal (I think they have become fairly routine), but it seems nontrivial.

Good luck!
pem

 

[tprice54]

I rarely say this, but please consider a new cardio. There is absolutely no evidence that exercize wears out a valve. To say that is borderline ridiculous. Please consider keeping up your exercize, as you know the many benefits it affords. As far as a pacemaker, I know many runners that have one, with no problems at all.

 

[pem]

I rarely say this, but please consider a new cardio. There is absolutely no evidence that exercize wears out a valve. To say that is borderline ridiculous. Please consider keeping up your exercize, as you know the many benefits it affords. As far as a pacemaker, I know many runners that have one, with no problems at all.

I agree, in that as far as I know there is no conclusive evidence to suggest that exercise accelerates calcification. My old cardio once speculated that it might, but that was conjecture. Also, I might point out that if you exercise regularly, your heart will beat fewer times on average than if you don't exercise (I refer you to some of Sally Edwards' books). While you exercise, of course, your heart will beat faster, but the training effect will lower your resting heart rate, which more that compensates for the extra beats during exertion.

pem

 

[dick0236]

:frown2:

......This doctor keeps reminding me that I will wear out my new valve if I get my heart rate too high, even exercising........ I know one thing is that a pace maker is the last thing I want. :eek2:

The major point of getting a mechanical valve is that they are hard, if not impossible, to "wear out". I also have a slow heart rate....usually under 60 bpm. I had my annual echo about two weeks ago and my pulse was running about 54 bpm. My cardio, who is an "old timer", about three years older than me, asked if I ever felt dizzy. I said "no" and his only comment was for me to call him if I started getting dizzy or light headed. My own opinion is that many young docs are too quick to add unecessary medical procedures or devices. Like you, another implanted device is the last thing I want....:tongue2:

 

[Mentu]

Hi, Jim, I have a tissue valve but my surgeon says that there is no evidence that exercise reduces its functional life. With a tissue valve, the problem lies in them becoming calcified like the original did. Several months after my AVR, I began periodically experiencing very low pulse rate. It proved to be caused by the Metoprolol so many of us are given after surgery. During the periods of low pulse rate, I felt sluggish and even sleepy. Within a short time after my Cardio removed me from the drug, my heart rate stabilized and I began to have much more energy. I agree with the comments of the others here. Without evidence, one's doctor should consider the simple things rather than leap to the worst. My vote is for a second opinion; if this bothers your current doctor then he should not be practicing medicine.

Larry

 

[scott.eitman]

I rarely say this, but please consider a new cardio. There is absolutely no evidence that exercize wears out a valve. To say that is borderline ridiculous. Please consider keeping up your exercize, as you know the many benefits it affords. As far as a pacemaker, I know many runners that have one, with no problems at all.

I agree. Thanks Tom. I talked to a patient last night who talked about "doing things to help the new valve to last longer" Again, as far as I know, there is nothing we can do. Heck, I always felt that a fast pulse is like sandblasting the calcium build up off (no science here either).

It is said many times that younger people wear a bio valve out quicker than older patients. I am not sure there are numbers to support this claim either.

 

[pem]

It is said many times that younger people wear a bio valve out quicker than older patients. I am not sure there are numbers to support this claim either.

I have seen numbers to support this claim (you might find reference in my earlier posts - if someone really wants to seem them, I'll have to dig them out). However, such numbers should be regarded cautiously. I think it really depends on the individual. So, although age may be one factor, there could be other factors that play an even bigger role, like metabolism, etc. I chose a mech valve in part because my intuition tells me that I would calcify a new tissue valve relatively quickly - but that's just me.

pem

 

[ElectLive]

Jim - Wow, I'm not sure I've ever heard so many surprising things from a single cardiologist. As others posted, avoiding exercise to prevent wearing out a valve is almost incomprehensible for mechanical, and at best, is pure speculation even with tissue valves, no firm evidence. Further, a high heart rate is fairly common in the months after surgery, it takes time to return to normal.

For "slow" heart rate, whatever that in fact is, pacemakers are done when medically necessary, i.e. symptoms. When my pacemaker is turned off, my rate drops to around 40 or so, which kind of makes it impossible to stand, walk, etc. Now, occasionally, pacemakers are used strictly for intermittent "on-demand" use. One example would be an A-Fib patient whose heart rate "bottoms out" temporarily after converting back from an episode. This has a classic falling out your chair symptom, though, so even though it may only happen once every few months, it is recommended. This is just an isolated example, does not at all have anything to do with you. The problem is, it is hard to tell what your cardiologist's concern for you is, quite honestly, based on what you've been told.

Best wishes in getting better knowledge and guidance then you have thus far. Your experience is disappointing to hear. And by the way, even if it is actually necessary, to echo Steve's comments above, pacemakers are not that big of a deal, big picture. But certainly there are risks, not something to take on unnecessarily.

 

[Rocky]

I read somewhere that a modern Mechanical valve will last indefinably, 50,000 years in accelerated tests, and somewhere else that they are good for 20 to 30 years.

But this is the first I have ever heard that a high HR will wear them out prematurely.

With all due respect to Doctors, one of the big problems with Allopathic medicine, is that if someone presents symptoms, they like to find a cure. Possibly even when the symptoms are not a threat, or not enough of a threat to deal with.

MY experience with my Chronic Lateral Epycondylitis was exactly that. I was not happy with the opinions I was getting so I went to one of the top surgeons in the world for his opinion. He said, "yes, there is a significant problem, but i will not do surgery on you. It may, or may not, help and there is no way of knowing". Then he said, " you will find someone who will do that surgery, but think about their motivation. They are surgeons, they are suppose to do surgery. I will not operate on you. And if you decide to do the surgery, do not bring the mess back to me. We cannot help you on this side of medicine, try everything else".


He was an excellent surgeon, and a wonderful doctor.

I found a surgeon who would do the surgery. Not one of the best in world. Probably the 145th best in British Columbia. I chose not to do the surgery.

In the end, the only thing that helped was deep tissue massage therapy.

 

[Luana]

I would see a different cardiologist.

 

[middleman]

Thanks everybody, the shock of the news is starting to wear off and I am starting to sort it all out. I spent yesterday in a fog thinking about what the cardiologist said. It has been a lot to deal with over a short time. Obviously it has major life changing implications. I did not get any work done but I did get in an hour and half of rehab. Your posts help me clear my head and point me in a direction.

Most definitely I am going to get a second opinion and I am also quickly coming to the conclusion that I also need to start to look for a new cardiologist. I am now questioning all that he has said and the little annoyances of the medical profession that he does are becoming a more noticeable. In reviewing his opinions’ on exercise, I have found them counter to the surgeon and even my GP. The surgeon has been prescribing increasing my intensity of my rehab sessions over time while the cardio has taken a flat line approach. I am glad that my therapist is following the surgeon lead over the cardiologist. That action tells me a lot of the character of the cardiologist in the eyes of the therapist. The more I hear and think about it, I am becoming more and more confident that I won’t wear out my valve by exercising and my cardiologist is out to lunch.

As to my slow resting heart rate that the cardio is worried about, I am thinking it just might be me. In 1981 I spent the night in the hospital when I was 18 due an extreme migraine headache. During the night the nurse told me that they were concern when my heart rate dropped down to about 35 beats per minute. My wife also has said that I have a weird heart beat. She has listened to it for over 16 years.

I do take blood pressure medication but it is a water pill not a BB. I have been on the same medication and amount since 2007 without any problems. I did take BB after surgery but I got off them two weeks after surgery. The BB would slow my heart down to the point I would almost pass out. The surgeon pulled me off them and I have been glad ever since.

As to the pace maker, I am not against it completely but since I am not symptomatic or that more evidence has not presented itself, right now, I am going to need a lot of convincing to have one implanted. What a pace maker does to me is that it basically kills my career as a line officer in the fire service. Most likely, the powers to be will force me to medically retire. I am working very hard to get back to full duty status as quickly as I can. I still have a few good years left in me before I am done. Can I over come a pace maker and get back to full duty, maybe but the odds are against me. Most firefighters at the hint of heart problem get out. There are only a few of us out there that are willing to fight to stay in. In the end, I won’t jeopardize my life by not having a pace maker. A career is not worth being dead for.

Thanks everyone for listening to me rant. Your comments help immeasurably.


Jim

 

[Luana]

It's common for several months after VR surgery to have heart rates that are slower or faster than normal. My resting pulse is low to mid 60s, though after surgery there were times it was in the 50s. Cardiologist said nothing to worry about. Now if you had a heart rate that low for a full day or more, I would ask doc about it, but here and there, I don't think is much of a concern unless you have other rhythm problems going on.

I would agree that increasing exercise intensity would be good for you at this point. Though I don't know your heart history, it sounds to me that a pacemaker for you would not even be a blip on the radar screen. This and advising you not to wear out the new valve really concerns me about your doc.

 

[ElectLive]

As to my slow resting heart rate that the cardio is worried about, I am thinking it just might be me. In 1981 I spent the night in the hospital when I was 18 due an extreme migraine headache. During the night the nurse told me that they were concern when my heart rate dropped down to about 35 beats per minute. My wife also has said that I have a weird heart beat. She has listened to it for over 16 years.

You are right, it may just be you. I know someone who has had a resting heart rate in the 40s as long as he can remember, no heart issues, never a symptom. I personally would be fainting left and right at that rate, but he has zero issues. Everyone is different.

 

[tprice54]

Jim, I am glad you have pulled through the nfog, and have a clearer picture for yourself. Reading your reasons for not wanting a PM, I understand its impact on your career. My simple advice, get back in the game, crank it up sensibly, and let's get to work!

 

[Lynlw]

I'm glad you took some time to think about everything and are going to get a 2nd opinion.
As you said, even tho pacemakers save lives, there is no reason to get on unless you really need it especially if having one could keep you from doing the job you love. I'm curious did you have to deal ith any issues about your career because of your on Coumadin?

 

[middleman]

Lyn,
I am still on light duty, so the issue of being on Coumadin has not been brought up yet. But the way I see it, the issue of the Coumadin won’t be a top concern. Most injuries that I see are heat related, twisting or lifting ones. Cuts injuries are a minor problem in today’s fire service. The new personal protection equipment is designed to minimize these type injuries. The biggest problem is getting firefighters to wear them correctly. When a firefighter has a cut to the hand, I usually have found that the person still had his/her gloves still in their pockets.

They are more likely concern of how stable the heart is and if it can take the stress. In the fire service you go from resting to full speed a short amount of time. That is why I want to get my heart back in shape.

I am a chief officer so they(the firefighters) rarely let me do much physical work and to get into the fire. But I have been known to do a rescue if I arrive first.

Thanks Tom, I just hope that the doctors are sensible.

Jim

 

[carolinemc]

What you did, did not help matters any. You needed to do your regular daiy routine while being monitored, instead it showed you being too careful. Ask the doctor about doing it again, this time doing what you normal do. Than that will give a better picture of treatment. Taking great care not do something will make matter worse, in some cases. Just do it again, just doing regular routine, he will see if you are really stressed, or having a slow heart rate. Hugs for today.

 

[rubywhistle]

I agree, in that as far as I know there is no conclusive evidence to suggest that exercise accelerates calcification.

It is said many times that younger people wear a bio valve out quicker than older patients. I am not sure there are numbers to support this claim either.

So, although age may be one factor, there could be other factors that play an even bigger role, like metabolism, etc.

Just on this issue my cardio and surgeon both said it is to do with 'the chemistry' of a young person... everything from hormones, reproduction, metabolism and even lack of wrinkles/skin being elastic – maybe everything in the body works a bit harder? I’m not sure but it’s a proven thing anyway.

If it was me I’d do the test again being a bit more ‘normal’. Sorry to hear you have had such conflicting ideas in the health team hopefully you avoid this set back and get back where you like to be.

Ruby