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sensei Ade

Well-known member
Joined
May 4, 2011
Messages
57
Location
uk
Folks, as my user name suggests, I'm a keen karate person. I have a 3rd dan black belt in shotokan karate. I also play field hockey, again quite a vigorous sport. Last November I had my SECOND heart operation to have my failed aortic valve replacement sorted. With my level of activity I so shouldn't have been given a tissue valve in the first place because active people wear these out so quickly. After surgery I built things up slowly slowly until I was able to lightly jog once around the field hockey pitch which is about 400yds in perimeter. It's important to be aware of how you feel when you're exercising, how quickly you recover and what happens then. The heart is a bad-tempered organ that soon tells you when it's had enough...!!!! You can be given all the recovery programs in the world but you're the only one really tuned into your body. Yes, keep active and build up the activity, but how you do this will vary from person to person. If you have a 'thumpy' heart the next day you know you pushed yourself a bit too much. I can also do 5km on the treadmill, no probs, best post-op time so far has been 24minutes 30. So my On-X valve appears to be working OK. The only thing I find irritating right now is that my heart rate + rhythm are all normal except my heart beat still feels like a bit of a heart thump instead which is a bit uncomfortable but I guess this will fade with time (I hope!). Does anyone else get this? I'm on 1.25mg Bisoprolol beta-blocker to keep things calm whilst I recover fully. I'm approaching six months since surgery. All the best.
 
sensei Ade said:
my heart beat still feels like a bit of a heart thump instead which is a bit uncomfortable but I guess this will fade with time (I hope!). Does anyone else get this? I'm on 1.25mg Bisoprolol beta-blocker to keep things calm whilst I recover fully. I'm approaching six months since surgery. All the best.
Click to expand...

Yes. my heart often has an uncomfortable thump. I am hopeful that some of that is my heart getting used to a good valve. I feel it more at the end of the day.

You may be interested in my thread on low stamina http://www.valvereplacement.org/forums/showthread.php?37880-Low-stamina&referrerid=7522

I am assuming you are on Warfarin. That and karate must be a lethal combination. Will you be taking that up again?
 
Welcome! First, let me say that I don't think there is any evidence that active people wear out a tissue valve any faster. It is really based on your body and age. That being said, your 5k time is very good! Your recovery sounds like it is going really well. That BB will keep your heart rate down so that makes exercising that much more difficult. If you get a chance, stop over to cardiacathletes.org.
 
Hi Scott, thnx for your reply. I agree, I think the heart just takes a while to get used to a much better valve after being so used to working extra hard to compensate for the leaking. Before my second op my replacement aortic valve was absolutely shredded and I had a severe leak. I'll defo have a look at your thread. Re: karate, I am on warfarin but my INR is around 2.1. I keep it in this range because of my level of activity and because I have an On-X valve that is probably the most haemodynamicly friendly valve on the market at present. I should ideally be within the 2.5 to 3.0 range but that just increases the risk of bleeding, so I'm not going there. The current rate of thromboembolism events with this type of valve has been extremely low thus far. Iam indeed training again and I haven't had any injuries. Thankfully in our club it isn't full contact and you are required to use a lot of control because what you learn is pretty lethal stuff and we're not there to kill each other!! LOL!!
 
My heart seems to thump when I have been doing lots of training. The other week was walking up the local hill with some friends. Over the previous few days I had run up the hill about six times. When we stopped to let some of the slower ones catch up I asked them to listen as my heart seemed to be thumping (I was wondering whether it was just myself who could sense this). They said they could clearly hear it thump and joked that I needed the valve servicing. I took it a bit easier for the next few days and the thumping sound seemed to reduce.
Just over a week ago I did 4 days of big hill climbs, long runs and a race. My heart certainly let me know it did not like it - my chest/lungs became sore and I became very weak/tired with a head ache. A few days of easier training and I felt OK again. This has told me that I am still not OK to do all the things I used to.

PS my 5K times are similar to yours, i.e. 24 mins (used to do 19 mins just before the AVR) and I am on 1.25 mg of Bisoprolol. Have you found that you are a bit slower since surgery (with the Bisoprolol)?
 
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Hi tprice, good to hear from you :). You might be right actually, my body just doesn't like tissue valves...:). Re: my time, thanks, I'm trying to get below 24 mins but I have so way to go yet. That's a good point about the BBs, thankfully I'm only on 1.25mg of bisoprolol. They're pretty potent, I was on 2.5mg for a while and they just zonk you out. My heart rate was around 40bpms!! Nowadays it's around 45 to 50bpms. I'll take a look at that site you suggested. Thanks for your post and I like the doggy picture :). I hope you are keeping well. All the best
 
All the experts keep assuring me that activity level is NOT a risk factor for a tissue valve, although YOUTH (which is strongly correlated with activity level) is the strongest risk factor of all. Of course, if they understood the mechanisms perfectly, they'd have solved the problem of valve degradation by now.

How old were you when you got the tissue valve, and how long did it take you to shred it? My new tissue valve was making my heart thump for a few months, but I haven't noticed it for a while now, even without beta-blockers. I haven't started running, though, still just power-walking and bicycling (though fairly aggressively) so far, at ~5 months post-op.
 
Hi Martin, very much appreciate your feedback here. Yea, basically the heart thumping is defo worse when I've over-exerted myself, or even when I'm feeling generally tired and stressed. I work in a bank as a compliance officer and have a pretty demanding job, then there's always tonnes of stuff to do at home as I'm a family man. Life is so demanding! e.g. last week, I felt so uncomfortable for a couple of days with the continuous thumping that I upped by bisoprolol dose to 2.5mg, which helps a bit, but then this just zonks me out. The best cure of all here is just to get loads of rest and try not to over-exert yourself. This week however, I'm perfectly OK and I'm hardly noticing any thumping. Re: your running times, interesting one this: Prior to surgery I wasn't doing your sort of times, my best was around 23 mins 20 odd so since surgery I've lost about 1.5 mins, but in your case there's more of a difference. It could be that things are still settling down for you, I'm sure you'll get back to 19 mins or thereabouts. It all takes time and we all respond so differently to this type of treatment. You just have to keep training and focus on building things up slowly. What I find with the bisoprolol is that it takes a while for my heart to get going and respond to the exercise, so early on I can feel pretty knackered but then once the heart starts responding better then I'm off. e.g. last night i was at field hockey practice which involves a lot of sprinting round the pitch. The first 10 - 15 mins of this are always a bit tough, but then I'm OK. My advice is to just keep going, keep working at it. A lot of this is in the mind. The good thing is we've both got life-time mechanical valves so we don't need to worry about valve conk-out in 10 - 15 years time. Apparently my On-X valve is meant to last 200 years......!!!!!!
 
Hi Norm, good to hear from you. I actually got my tissue porcine tissue valve in February 2006, I was only 37. By the middle of last year following the echo, they told me that this valve now had a moderate leak. It was downhill from there and I had to have it replaced with my On-X valve in November 2010. My surgeon took a picture of the valve and it was obliterated basically. One of the leaflets was completely torn!!!! The basic rule of thumb in my view is that if you're younger, then it's mechanical valves all round, especially now that they've developed valves such as my On-X valve that appears to be OK with lower levels of anti-coagulation (they're testing this as I type in the US). Thanks for your feeedback about the thumping that is encouraging, I think it's likely that this will pass once my heart has adjusted fully to the new valve. It had to work pretty hard prior to surgery because I had a severe leak. Sounds like you're doing really well with the exercising, keep going, onwards and upwards!! All the best.
 
sensei Ade said:
Hi Martin, very much appreciate your feedback here. Yea, basically the heart thumping is defo worse when I've over-exerted myself, or even when I'm feeling generally tired and stressed. I work in a bank as a compliance officer and have a pretty demanding job, then there's always tonnes of stuff to do at home as I'm a family man. Life is so demanding! e.g. last week, I felt so uncomfortable for a couple of days with the continuous thumping that I upped by bisoprolol dose to 2.5mg, which helps a bit, but then this just zonks me out. The best cure of all here is just to get loads of rest and try not to over-exert yourself. This week however, I'm perfectly OK and I'm hardly noticing any thumping. Re: your running times, interesting one this: Prior to surgery I wasn't doing your sort of times, my best was around 23 mins 20 odd so since surgery I've lost about 1.5 mins, but in your case there's more of a difference. It could be that things are still settling down for you, I'm sure you'll get back to 19 mins or thereabouts. It all takes time and we all respond so differently to this type of treatment. You just have to keep training and focus on building things up slowly. What I find with the bisoprolol is that it takes a while for my heart to get going and respond to the exercise, so early on I can feel pretty knackered but then once the heart starts responding better then I'm off. e.g. last night i was at field hockey practice which involves a lot of sprinting round the pitch. The first 10 - 15 mins of this are always a bit tough, but then I'm OK. My advice is to just keep going, keep working at it. A lot of this is in the mind. The good thing is we've both got life-time mechanical valves so we don't need to worry about valve conk-out in 10 - 15 years time. Apparently my On-X valve is meant to last 200 years......!!!!!!
Click to expand...
I too have sometimes found it difficult when setting off running. I have just started again running with other people and last night I joined in club training with a slower group than I used to run with before surgery. There was a short hill at the start and I struggled all the way to the top. Breathing was very difficult and the legs hurt - it was very uncomfortable. After a little more difficult running over less steep ground and a short rest I finally came to and felt a bit more comfortable and started to run a bit quicker.
I have not thought of upping the Bisoprolol to 2.5 when the heart is thumping. I was originally prescribed 2.5mg but I complained that my heart rate was too low - down to 36 at times so it was reduced to 1.25mg by my GP. The heart rate is now about 42 bpm (which I still think is too low).

I do not think I have improved my speed over the past 8 months or so but I can run for longer periods. I get the feeling that I am stuck with my present speed so it is a case of getting used to it.
I have also found that if I train on my own for a few weeks I start getting used to running at a slower speed and it almost feels normal again. It is only when I run with others that I realise how slow I have become and how much effort I need to put in to what used to be a very gentle jog.

Also I ran last week with a heart rate monitor for the first time in months. When I was pushing it the heart would not go above 150bpm.

Good luck with your training

Martin
 
Just a quick note that I have found amongst our running memebers that our running improves in fits and starts, it is not a linear thing. Some days, weeks we are lucky to stay at the same pace, maybe even a little slower, then suddenly a jump in pace, then settle back again.
 
Not sure where you are in the recovery process, but I strongly suggest 2 things:

1. Stress test - this is a very controlled test with 12 leads. 1-2 cardiologists watch as they get your heart as high as you can possible tolerate. They will take your blood pressure, wathc your vitals, and most importantly watch your EKG as you push yourself to the max.

2. Cardiac Rehab. - This is a longer process, but you will be monitored over a longer period of time. Depending on the Rehab people, they might be willing to push you just as hard as what you might be doing on your own.

Both will give you and your doctors a fairly detailed look at what your heart is actually doing. I personally found the Rehab to be good because you can get a good idea of how your heart is healing after surgery over a longer period. I also found Rehab good because, in my case, they took in the fact that I was a life-long athlete, and seem quite comfortable giving me a good workout. The guy that runs the workouts is basically a personal trainer and tells me to pick up the pace me if he catches me going too slow on the machines. My shirt is soaked after 30 minutes.
 
Hi Tom, absolutely. In fact this is a characteristic of our recovery as a whole where you can have periods of a few days where you really feel crap then after that you feel great. It's a constant up and down wave like the FTSE100 index. Last week I found hockey practice a bit of a struggle and just couldn't keep the pace with my legs feeling like blocks of lead. Last night however, I charged around the pitch and managed to score 3 goals!!! Keep going.
 
Hi John, thanks for your suggestion, it's a good one. Given my level of activity you would think that my cardiologist would suggest this. I'm coming up to the 6 month mark now, and I had my echo and ECG last week. The readings were good, all the valves are in order, good heart function, no perivalvular leaks. All they found was a slight leak on my mitral valve which is benign, common and won't cause me any problems. I've also been fitted with a holter device a couple of times. All is normal with a few ectopic beats thrown in. I'll run this past my surgeon and see what he says. Best regards.
 
Hi sensei

I checked your profile and found your On-X was implanted in the aortic position. I also have an On-X in the aortic position. The clinic maintains my INR in the range of 2.0-3.0. I keep it in the lower range, like close to 2.0 as I also am a jock boy. The good news on the On-X proact study maintaining INR from 1.5-2.0, is that to this point it is successful! Monitor the On-X website for updates. I'm sure you spar with protective head gear. That should help protect you.

As for the thumping, some of that from my experience is the BB. My On-X also thumps during the rigors of sport. I also am on BB, presently 200 mg daily. I'm into my 7th week post op.
 
For what it's worth, in terms of fitness running and cycling and such, it took me easily 18 months to feel normal again physically in terms of my ability to improve performance. You're still well within that range so be patient with yourself, too (it does seem you're being very thoughtful with your care). Your body's coming back from quite an adventure--and getting started on an excellent new one.
 
Hi bdryer,
Thanks for your reply, I also keep the INR around 2.0 because of the On-X valve and all the studies going on. This is bloody good news for us, I'm hoping that when the full results of the PROACT study come out, we'll only need an asprin a day or something. That would be great!!! Re: the thumping, it's gradually going down. Over the past couple of days I've halved my dose of BB Bisoprolo down to 62mg and I'm coping really well. Last night I had a game of field hockey whilst being on the halved dose and my heart didn't over-react during or after all the running around. The only symptom I have is really stiff legs today LOL! So you are in your 7th week, take it easy and I wish you a smooth recovery. Slowly slowly you get there, keep persevering, keep as active as you can and get that heart going, it needs the exercise. If you overdo it, your heart will tell you straight away as it is such a grumpy bad-tempered organ!! Great to see that you're in the On-X club. Take care.
 
Hi spartangator,
Thanks for your note, I totally agree. Also, in my case, it's the second op I've had in 5.5 years as my previous tissue valve failed miserably. They say 6 months recovery but it defo takes much longer to feel normal again. After 6 months I've only just reached the stage where I've stopped getting uncomfortable light headedness, especially when standing in a queue - so uncomfortable. At the end of the day the heart has to remodel itslef to the new valve and that takes a long time. I admit I'm not the most patient of people but I'm being very careful at the same time not to overdo things. All the best.
 
Sensei

After I saw the surgeon last week he halved the BB to 50mg 2x daily. He also >the BP med to 5mg 2x daily. After being on a BB dosage of 100 mg 2x daily, I felt like I was getting back to being myself. Now I'm into week 8. Had a great wt lifting work out with zero sternum pain. Amazing how the body heals.

Got a 1500 mt swim and a 2 plus hour ride planned for today with a bud. Got to love cardiac rehab when the Doc named me to be the developer and manager of my own personal program. Believe me, I'm listening to my body. I'm a ways from stomping up hills on my bikes, just ticking the pedals over. Running is progressing nicely. I've worked back up to 5 km. My times to cover the distance are up but at least I'm covering the ground.

My progress must be the nightly couple of beers which are part of my self managed cardiac rehab program, prescribed by me and the INR clinic. Prior to release from the hospital, I met with a rep from the INR clinic. She said what's it going to be boy, 1 or 2 brewskies a day or none. Was their ever any question!? 1 or 2 of course!

My INR has been about 1.7-1.8 for the last couple of weeks. The clinic is not freaking, they slowly > the dose of warfarin. With my On-X AV in situ and the fantastic results from the 1.5 to 2.0 proact study I'm totally cool at 1.7-1.8! I know in a short while I'll be at 2.0 plus. Got a blood draw tomorrow.

Take care and have fun!
 
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