Pericardial Sac? Who can elaborate...

[almost_hectic]

Okay so Ive had my follow up appointment at the surgeons office. Unfortunately however, my surgeon had to travel out of town so I was seen by a physicians assistant. I was explained thisprior to the appointment and while I was disappointed, I did not want to be a pain in the ass patient and make a fuss, I thought I was being helpful to my surgeon by accommodating his change in schedule. This was just a checkup to see that I was doing fine anyway.

Anyhow, one of the questions I had at my appointment was how strong my heartbeat felt at times and was that normal or something to be concerned about. Even if my heart rate is not elevated no my blood pressure, there are times when I can now feel my heartbeat throughout my torso as it will move my body with each beat, and other times its very calm. He said its because when operating on the heart they have to cut open the pericardial sac, and then after surgery the sac is left open. Well that was the short explanation, but without medical knowledge of what that meant Ive been trying to dig deeper on my own for a greater understanding. Ive found some info but not a lot. As I understand it the pericardium is the sac surrounding the heart. Its made of connective very strong connective tissue and acts as a cushion of sorts protecting the heart while the body is in active movement. And it also acts to restrict the heart from expaning to greatly at times during pumping. So with that knowledge I can now understand why at times I feel my heartbeat so pronounced.

What I dont completely understand is what to expect going forward. Ive read that some surgeons will close this sac back up to complete the surgery. However the vast majority routinely leave it open, it said to reduce complications after surgery with fluid drainage. Does anyone know will the sac always remain open. I started to read something I found stating that the sac will heal very quickly, but it wasnt clear if that meant it would close and resume its normal function. Im very curious to know if this exagerated sensation of my heartbeat at times is something I will always have or if it will diminish with time as the pericardium heals itself. Can anyone elaborate in this topic?

 

[cldlhd]

My surgery was in February and I remember at first definitely hearing and feeling my heart beat more prominently, especially the valve ( repaired) closing. At this point in time it seems to be back to normal. I thought maybe I just got used to it but I'm pretty sure that's not it, so I'm pretty sure it heals up over time.

 

[pellicle]

My advice is this. Trust your surgeon or don't. Don't attempt to pretend to understand what they have taken 20 or 30 years of intensive daily training and learning to do. Do not attempt to micro manages surgeon (or you will learn first hand about their fabled egos)

There is a big difference between managing ones INR and taking issue with surgery at this level of detail.

Sit back and enjoy the ride. Once you trust your team, and have chosen valve type, any other view just leads to anxiety. Remember, you are not in control.

PS, the heightened feeling of heartbeat is most likely scar tissue creating greater conducting of vibration.

 

[AZ Don]

Following my OHS, it felt almost as if my heart were pressing on my sternum whenever I took a deep breath. I could feel it and hear it. In the first month or more it was even a little painful at times. On follow-ups I discussed this with the Dr's. Mostly they were surprised by the symptom and considered it unusual. The best explanation for it initially was that about the pericardial sac. Mine was left open and I was told that within a couple months it would heal over with scar tissue (closing it back up). At that point it was thought I wouldn't feel my heart beat in this way anymore. Well a couple months came and went and it hadn't changed, though there was never any pain with it anymore. So the next explanation was that changes from the surgery caused different conduction of the heart beat, similar to what Pellicle suggested.

It took some digging but I found a couple discussions about this on the forum. As I recall, I think this was associated more to those with aneurysm repairs than valves, and mostly the issues resolved within a couple months - so probably yours will too. Not sure how many didn't resolve, but I'm one. It's been over 2 years and every time I take a deep breath I can feel my heart beat, as if my heart or aorta is pressing against my sternum. It is still a little annoying at times but mostly I am used to it. I just take it as a reminder of my surgery and consider myself lucky to live in an age where such a serious issue can be repaired with such a minor consequence.

 

[Zoltania]

I'm at one month post-surgery and my heart's behavior is quite variable. The rate changes, the perceived intensity changes (what you are describing), and the regularity changes -- sometimes it's regular and sometimes I have PACs or PVCs, which feel like skipped beats (I only notice if I'm taking my pulse) and which I've been told are normal. My surgeon had a great description for all this variability: he said that after surgery, the heart is "irritable." My cardiologist says this should all quiet down over time.

 

[almost_hectic]

Well, I do trust my surgeon. I would never attempt to micro-manage him or his staff. Nor am I taking issue with my surgery, and I know full well I am not in control. Knowing that I am not in control I find comfort in understanding. So I am merely trying to gain an understanding and educate myself. That being said, thanks to everyone sharing their own experience. Ive been a bit trepidatious about experienceing irregular heart beats as I have had afib in the past but any flubs that I have had have been very minor, few and far between. Moslty any "irritability" my heart has had has been an occassional elevated rate, but I think that may well be attributed do different meds and or my condition so recent from surgery and for the most part nothing to worry about. My bp and my resting heart rates have been excellent and improving every day since returning home from the hospital and walking every day. I was eager to better understand however why my heartbeat was sometimes so much more pronounced. Sounds as though most of you have experienced this but have also seen it diminish with time. Thats good to hear.

 

[pellicle]

Hi

Well, I do trust my surgeon. I would never attempt to micro-manage him or his staff.

that's good ... I wrote what I did because I see a lot of anxiety here lately and to be honest even though I'm a scientific sort of guy there are things which I just "black box" and leave as "known unknowns" unless there is something I need to do to make things better.

... I was eager to better understand however why my heartbeat was sometimes so much more pronounced. Sounds as though most of you have experienced this but have also seen it diminish with time. Thats good to hear.

I feel that its always good to learn more to understand, however sometimes one can get lost in the rabbit hole for no net benefit. Calling when to stop learning and just accept is an individual thing.

you wrote:

here are times when I can now feel my heartbeat throughout my torso as it will move my body with each beat, and other times its very calm. He said its because when operating on the heart they have to cut open the pericardial sac, and then after surgery the sac is left open.

but I somehow think that's only a small contributor ... I really like Zoltania's "simplification model"

My surgeon had a great description for all this variability: he said that after surgery, the heart is "irritable."

my own surgeon said that "the heart does not like to be touched" and reacts ... it takes time to settle down

 

[Lawdog]

Hectic:

I think my surgeon implanted a ticking watch in my head. And I have occasional visual "pinwheels" in my left eye. Both of which, I have been told, will get better with time. My guess is that your heart beat issues will too, Four weeks out, today, my heart rate is much better than it was pre-surgery. I am so happy and thankful to have my heart fixed! The Warfarin, ticking, and remaining pain is a bit of a bummer, but now I can look forward to seeing my kids grow-up, and not worry about making my wife a young widow. Everyday is a gift for us. And while I am probably one of the most skeptical, questioning people my surgeon has ever had as a patient, I have absolute confidence in his judgment and expertise. Try not to worry about your heart rate. If it is a real problem, you will be back in the hospital. When I originally got the "pinwheels," my surgeon admitted me for two days to observe me. These guys take everything seriously. Good luck with your recovery!

 

[almost_hectic]

Hey Lawdog, sorry to hear your recovery has been so eventful. Isn't that twice now you've been back to the hospital? Overall I'd say I'm doing pretty well and improving every day. I think a big contributor to that is my walking, getting out two or three times a day and upping my steps every day. I'm up to 6,000 steps as of today. Supposedly a mile is on average 2,000 steps. I couldn't do it without my pain pills, but I think the increased blood flow has a great healing effect on my heart and my chest incision. As for your pinwheels, that sounds to me like ocular migraines, I've experienced those as well, mostly over the years prior to surgery at random times. Think I've had it happen once since surgery, I don't pay much attention to it and it goes away in about 15-30 minutes. One thing I've noticed with regard to chest pain. I already have some osteoarthritis in my neck and back. But being aware of it is key. Often my chest and or shoulders hurt but I often think it's fatigue due to my own tensing up, sometimes called guarding, because of the sensitivity to pain from movement and using my arms. Do it long enough and everything gets very tight and achy. The pain pills allow me to ease up and relax. Of note though, tightening up in my neck and shoulders often accompanies my ocular migraines, don't know the exact connection. But I know one exists. What I'm suggesting is that hopefully when you're healed and without chest pain the visual problems will go away.

 

[DachsieMom]

I had ocular migraines, too. First time in my life - the week before surgery - then several for the first 8 -10 weeks after surgery. I haven't had them since. I was advised to take a Tylenol as soon as I felt one coming on, and that really helped - but check with your doctor first.

 

[pellicle]

Hi

I think my surgeon implanted a ticking watch in my head. And I have occasional visual "pinwheels" in my left eye.

do they look anything like this:

or this?

starting smaller, maybe moving from one side to another ... if so you now have migraines... I've had them for decades. I've found that chiropracter visits and loosening up my back and neck helped me. Others don't.

At least you may now know what they are

 

[harrietW]

I am so grateful that l stumbled across this forum. Knowledge is power and l am feeling very strong educated and informed about what to expect and what not to. What some of the challenges may or may not be both before and after OHS. So blessed !! I cannot thank you all enough your experiences .. l truly feel that l am ready as mentioned earlier in another post that in both an emotional mental and spiritual way .. physical maybe not so much but l trust that the other areas may make up for that.
Thank you all so much for your curagous fight to survive and continued support and strength and experience.
I'm so blessed to have found you all here.

 

[knotguilty]

Before my surgery, I asked my surgeon if he does anything to help facilitate another surgery in the case if I have to most likely have my tissue valve replaced at some point down the road. He told me he sows up what I believe to be what you are talking about, the pericardial sac. I don't remember what he called it but I think that is what he was talking about. He said they will see it as soon as they go in. I did feel my heart beating a lot after my surgery, but it has long went away.

 

[Tank]

Hectic, the pericardial sac or pericardium as it is sometimes called is a fibrous and membranous sac surrounding the heart. It is composed of 2 layers, the visceral pericardium, which adheres to the heart and the parietal pericardium, which lines the outer fibrous coat. The pericardial cavity, which is the area between the visceral and parietal percardia, normally contains about 10-15 ml of fluid, which lubricates membranes as the heart beats. Often times you will here of somebody having a tightness in the chest or a squeezing sensation that sometimes indicates a leak or myocardial infarction due to a leak causing the sac to fill up and causing the tightness or squeezing. Anywho, hope this helps with your question and hopefully I didn't cause more questions than answers. Thanx, Tank.

 

[Tank]

Tank again, Hectic, this is my 2nd go around and I do remember my heart feeling as though it was going to pound out of my chest. I shoot guns a lot, about 500-1000 rounds per week. I have had to wait until the heart is between beats as my whole body moves thus causing the gun and crosshairs in the scope to move also. This was still going on 10 years after my first surgery but was sporatic and didn't always have these affects on me. As stated in previous posts all people are affected differently and you may get used to it sooner than others. I think this new mechanical valve is actually smoother and maybe doesn't beat quite as hard as the bovine I had prior, I will find out here shortly as I'm going out to test a couple hundred round this afternoon. Thanx,Tank

 

[Lawdog]

Hey guys: Thank you for your responses. The neurologist seemed to think that my visions are ocular migraines. Funny thing is I don't get a headache when the pinwheels start spinning. Hope everyone is doing great.

 

[pellicle]

Hi

Funny thing is I don't get a headache when the pinwheels start spinning. Hope everyone is doing great.

For what its worth I don't normally get headaches either with mine. Just often an uneasy feeling and inability to concentrate on tasks like coding.

 

[cldlhd]

Hi



do they look anything like this:

or this?

starting smaller, maybe moving from one side to another ... if so you now have migraines... I've had them for decades. I've found that chiropracter visits and loosening up my back and neck helped me. Others don't.

At least you may now know what they are

What I get is very similar to the bottom picture. Before my surgery I would get a couple a year followed by a migraine with nausea. Now I get a couple a week with no migraine, sometimes I feel a little "off" after but that' it. I thought occular migraines were when the aura only occurs in one eye?

 

[almost_hectic]

I get them in one or both eyes, it's always different. I only get the visual disturbances, never anything else like headache or any other ill feeling. For me and my history of the problem it's always related to my neck, whoever I get one I stretch out and massage the tightness in my neck and every time I get a pretty loud crack and the visual disturbance begins to subside. But I have neck problems as a result of osteoarthritis and previous whiplash injury. From what I've read on ocular migraines they have no explanation for what causes them. For me it's always my neck, don't know what the connection is, but it is undeniable that there is in fact a connection.

 

[cldlhd]

They're not sure what causes them but I've read but that there is a specific nerves in the brain that they think trigger the aura. Also people with heart conditions are known to get them but they don't know why, they fear a rise that it's a connection between the nerves around the heart and that particular nerve cluster in the brain but who knows.