Valve *thump* vs valve *click*

[chaconne]

After 6 weeks of having a large On-X valve in me, the most noticeable effect is the way it *thumps* on my chest. The *click* is very soft, high pitched and can only be heard by me or others in the quietest room or one that's got a lot of tiles or mirrors. I can feel the thumping, however, most of the time and it's like someone is taping on my chest with two fingers. When I breath deeply, it's the strongest. When I hunch over and exhale, it's the weakest.

I use this "feature" when I walk, to calculate my HR when I don't have my HR monitor attached. I was wondering how many others have a strong thumping, vs clicking, with their valve (mech or tissue). Does this tend to reduce with time?

 

[Lynlw]

Do you have a graft or just valve?

 

[chaconne]

Do you have a graft or just valve?

I have a full prosthetic valve + root + ascending aorta. When I asked him, my surgeon insisted that the graft did not increase the sound of the valve clicking/thumping. My tendency is to believe him, given he's done and heard thousands of these.

 

[yotphix]

I know that in the first weeks I had a significant 'thump, which felt like a knocking, especially in the sort of circumstances you describe. I also couldn't lie on my left side because it was too freaky to feel and hear it as loudly as it appeared if I did. It diminished over time and I don't think it lasted much more than three months.

 

[bradvo]

I think I know what your describing and have felt the thump when walking up hills or incline in my neighborhood, so when the heart rate goes up it is more prevalent.

Since were talking about valve sounds , what surprised me the most was when I went in for my baseline echo scan, compared to my echo scan before valve surgery.
Holy mokes what a difference there was in sound when blood could move out of the heart. Before I had a higher pitch almost Alien sound with the blood trying to get thru a small orifice. After replacement it was more of a knocking clack sound, very noticeable difference.

 

[Jason]

I have a dacron graft, and have read that it does indeed increase the noise. I guess everyone's mileage may vary, but I do have the same effect you mention in that it thumps much louder when taking in a big breath and holding it.

 

[Julian]

Muhahaha! The curse of the thump knock! I'm 5 months post op and get the thump/knock on the daily. It is most noticeable when taking in a breath, especially a deep breath. Brother Chaconne for me its not always a constant when taking in a deep breath, sometimes I can take in a deep breath and all I hear is a quite ticking of the valve, btw love when that happens other times I take a deep breath and it feels like someone is hitting the inside of my upper chest with a rubber hammer, I picture what's happening on the inside like the graft is being contorted from the pressure release of the valve when it opens and closes, like a water hammer effect. Weather or not this visual is the case, which I hope it's not; that's what it feels like is happening. It is most noticeable when sitting and lying down, usually relieved by standing but not always. Doesn't seem to be caused by exertion either, just seems random but happens throughout the day everyday. I think it may be a combination of how things are situated in the chest and touching each other as well as "how" your heart is pumping, what kind of rhythm its in and how "hard" it's pumping rather then how fast. I was hoping this would calm down with time but after 5 months I think it may be a new normal for me. It really is freaking annoying and can even be depressing at times but it "beats" how I was feeling about 6 months ago that's for sure, heart failure is no fun.

 

[Julian]

I have a dacron graft, and have read that it does indeed increase the noise. I guess everyone's mileage may vary, but I do have the same effect you mention in that it thumps much louder when taking in a big breath and holding it.

I agree, doctors are amazing creatures but they don't know everything and probably never will because they haven't or can't live or lived "it". That's why this forum is so valuable because its an accounting of people who have lived and are living it. From the consensus on this forum, YES graft will make your tick/thump/knock worse. How, much worse?... Well that's the fun part everyone is different. If I could have it my way I would get rid of this graft and pacemaker and I think just having the valve replaced only would of been a lot better/easier recovery wise and quality of life wise than getting a graft and pacemaker to boot, now I have a bunch of things to blame when things just don't feel right and I don't know who to blame.

 

[Lynlw]

I have a full prosthetic valve + root + ascending aorta. When I asked him, my surgeon insisted that the graft did not increase the sound of the valve clicking/thumping. My tendency is to believe him, given he's done and heard thousands of these.

He may be right, but the reason I asked if you also had a graft was there have been a few threads, about what you see to be describing, many by a member Seth, http://www.valvereplacement.org/forums/member.php?6269-seth who seems to have it pretty bad. From what i remember different people had different brands of mech valves but all or most also had a dacron graft here are some of the threads http://www.valvereplacement.org/forums/showthread.php?28944-Valve-pounding-against-sternum and http://www.valvereplacement.org/forums/showthread.php?29590-Sternum-thumping-update


BTW julian, many agree it is a water hammer effect.

 

[chaconne]

Lyn,

Thanks for pointing me to Seth's thread. I think that was the best thread I've ever seen on VR.org. It was long but interesting, lots of people chipped into help, and some very interesting and useful conclusions were drawn.

I think I now better understand the issue of the graft contributing to noise. It's not the *click* but the *thump* that the graft may be contributing to. The water hammer analogy makes a lot of sense to me. I've done plumbing in my house and I get this effect at one place under my house at a bend in the copper plumbing whenever the automatic sprinklers come on. I can easily see this happening, to some small degree, in my heart.

I feel bad for Seth. Unlike him, I haven't lost one minute of sleep over my thump.

 

[Julian]

Lyn,

Thanks for pointing me to Seth's thread. I think that was the best thread I've ever seen on VR.org. It was long but interesting, lots of people chipped into help, and some very interesting and useful conclusions were drawn.

I think I now better understand the issue of the graft contributing to noise. It's not the *click* but the *thump* that the graft may be contributing to. The water hammer analogy makes a lot of sense to me. I've done plumbing in my house and I get this effect at one place under my house at a bend in the copper plumbing whenever the automatic sprinklers come on. I can easily see this happening, to some small degree, in my heart.

I feel bad for Seth. Unlike him, I haven't lost one minute of sleep over my thump.

I talked to Seth about 2 weeks ago, he is doing okay and moving along with life, even though he is still dealing with the thump. Super cool guy BTW lives semi close to me.

 

[D.C.]

I also have the thump. When busy doing things I never notice it, but even while sitting here typing I can feel-hear it. Also if I put my fingers just under my collar bone towards the center of my chest I and other people can feel it. When I first lay down at night it bothers me a little. Just keep saying to myself thumping is gooooood!!

 

[Bill B]

I have grafted SJM valve that produces a "thump" that I find comforting. It's like a normal heart beat amplified. The only time it bothered me was when my heart rate was 90-95 post-op. Now it is 60 or less and not irritating at all.

It is quite normal for the thump to be MUCH stronger when you take a deep breath. The negative pressure created in the chest cavity by your expanding rib cage and falling diaphragm causes a pressure drop around the heart and vena cava so they expand and stroke volume increases dramatically. This will only slightly recede over time and the healing tissues around the heart provide some insulation.

I can "hear" my pulse in my ears, transmitted internally, all the time, if I pay attention to it. I don't recall that before the operation. Whether that is simply produced by the snap of the mechanical valve leaflets or is further amplified by the Dacron graft is not clear to me. I sure prefer the thump to the click I was expecting.

 

[Fundy]

Since reading this thread, I experimented with deep breaths. Without a deep breath I hear and feel nothing. With a deep breath I feel my heart thump quite noticably with each beat for as long as I hold the deep breath. I have a Trifecta tissue valve.

 

[chaconne]

Since reading this thread, I experimented with deep breaths. Without a deep breath I hear and feel nothing. With a deep breath I feel my heart thump quite noticeably with each beat for as long as I hold the deep breath. I have a Trifecta tissue valve.

Interesting. It seems the effect is not limited to mechanical valves. I suppose it may have to do with us being only weeks from OHS.

 

[Mentu]

My valve is a tissue valve without anything else. I, too, experienced the very strong thumping for weeks after surgery but it has subsided. My surgeon said that the strong thumping is common after many valve replacements and indicates that the heart is responding to the new valve. Normally, as the left ventricle "remodles" itself, the thumping fades. This "thumping" is different from the palpitations that many of us experienced before surgery because it does not leave one feel ill.

Larry

 

[Bina]

Mine is a Regent from SJM, no graft, and a real "thumper". Immediately post op I was ready to rip that sucker out !!
These days, 6 years later, the thump is still there but has diminished considerably. I've stayed on a BB to help the
situation remain stable and I guess it doesn't help that I am thin and easily anxious.
What is worse is the PVC/PAC, SVT episodes.

 

[Bill B]

Interesting. It seems the effect is not limited to mechanical valves. I suppose it may have to do with us being only weeks from OHS.

It is a normal physiologic response in the normal heart as well, just not as detectable. There's no way around it - when you breathe in, the stroke volume of the heart increases. Maybe this will help :

"Pressures in the right atrium and thoracic vena cava are very dependent on intrapleural pressure (Ppl ), which is the pressure within the thoracic space between the organs (lungs, heart, vena cava) and the chest wall. During inspiration, the chest wall expands and the diaphragm descends (see animated figure). This makes the Ppl become more negative, which leads to expansion of the lungs, cardiac chambers (right atrium [RA] and right ventricle [RV]), and the thoracic superior and inferior vena cava (SVC and IVC, respectively). This expansion causes the intravascular and intracardiac pressures (e.g., right atrial pressure) to fall. Because the pressure inside the cardiac chambers falls less than the Ppl, the transmural pressure (pressure inside the heart chamber minus the Ppl) increases, which leads to cardiac chamber expansion and an increase in cardiac preload and stroke volume through the Frank-Starling mechanism."

http://www.cvphysiology.com/Cardiac Function/CF018.htm

 

[Cooker]

Thumper here .... never heard a click ... others have but not me....

 

[sensei Ade]

Hi Chaconne,
I've just gone past my 1 year mark with my aortic On-X valve. I feel the thumping alsoin the middle/top of my chest but it isn't as bad as it used to be. Things do settle down over time as your heart readjusts itself. You'll probably find you feel a bit dizzy at times, especially after prolonged standing, or that your blood pressure may be a bit high. Don't worry, this is all part of the heart remodelling process and things will improve over time. Take care

Sensei

After 6 weeks of having a large On-X valve in me, the most noticeable effect is the way it *thumps* on my chest. The *click* is very soft, high pitched and can only be heard by me or others in the quietest room or one that's got a lot of tiles or mirrors. I can feel the thumping, however, most of the time and it's like someone is taping on my chest with two fingers. When I breath deeply, it's the strongest. When I hunch over and exhale, it's the weakest.

I use this "feature" when I walk, to calculate my HR when I don't have my HR monitor attached. I was wondering how many others have a strong thumping, vs clicking, with their valve (mech or tissue). Does this tend to reduce with time?