Second Cardiologist Visit

[Nocturne]

Visited my new cardiologist for the second time the other day. She reviewed the information from my echo.

There were no huge surprises. As I said before, Vmax got worse but not by a huge amount (2.36 M/s to 2/40 M/s), still technically below the common 2.5 M/s threshold for AS diagnosis. Mean pressure gradient of 16 was well within the bounds of Mild AS, and V1/V2 of .48 or so was technically Moderate AS. I'd known all this before; doc said she'd "averaged it all out" to "Mild AS".

I asked her about whether my valve was bicuspid or not, and she pulled up the echo comments that said "morphologically bicuspid" and actually watched the little movie of my valve opening and closing. It was funny -- she made the same funny, squinting, lip-chewing face I'd seen the techs do, and really deliberated for a while. "Well, it isn't BICUSPID... but it's not NORMAL, either... Hmm... There's definitely some morphological abnormality here... There's such a thing as a quadracuspid valve, but... This doesn't look like one of those, either... I'm going to make a note in your records of structural abnormality, though..."

So apparently I have a "weird valve" of indeterminate type. ???

She made me cringe a little when she assured me that statins can slow or reverse CAC scores (this was a common belief in maybe 2005, but subsequent research has not supported it and in fact seems to point to faster CAC progression with statin use -- it's complex and there are theories on why this might be so, but not a lot of certainty). I fired my old cardio doc in part because he tried to tell me this, but this woman really seems to know her stuff otherwise, so I'm sticking with her, but I may ask her if she can point to any recent studies that indicate that statins can "freeze or reverse" CAC progression and counter what I've actually seen in publications like JAMA.

She was very knowledgeable about FH, knew about how much better it has historically tracked and treated in the Netherlands than here in the states, etc. Statin increase improved my numbers, too: Total 125, LDL 67, HDL 45, Trigs 47 or so.

I also learned that of my three children who were tested (gotta get the 17 year old done soon), only my youngest son (age 9) has abnormally bad cholesterol -- LDL 135, I think, which isn't godawful but it does raise a red flag. My wife saw these numbers, I have not pored over them yet. It's upsetting but I can at least be vigilant about tracking his cholesterol in the future and nagging him about it through his twenties, assuming I'm able to.

So it's just "watch and wait", which I pretty much knew it was going to be.

 

[epstns]

Nocturne - When it comes to valve anomalies, echo's are notoriously vague. For many years, my echo's were noted "probable bicuspid valve" but this was not confirmed until surgery. They just couldn't see it well enough. When you get down to facts, though, it almost doesn't matter. The treatment/surgery decision is driven by flow statistics (which are used to calculate theoretical dimensions) and symptoms, and if any of these get bad enough, they would recommend replacement surgery whether your valve had 1,2,3,4 or lots of leaflets. All we can do is watch our valve's performance and statistics, be watchful for symptoms, and continue to live life as well as we can.

The first couple of years after diagnosis were a bit rough. The next 6 or 7. . . not so bad. Then as the time for surgery approached, I had to re-learn my coping skills again. It was not that I didn't care. It is just that I accepted it and worked through it.

Hang in there.

 

[Duffey]

I agree with Steve about determining valve abnormality from an echo. The final determination comes during surgery when it is replaced. As Steve says, it really doesn't matter in the long run.