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Old 09-25-2007, 08:15 PM   #1
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Unhappy Now what?

After learning I have 4 incompetent heart valves, I have been on 1 Ace Inhibitor and 1 Angiotensin Reuptake Inhibitor. Both have given a dry hacking cough and the last one caused hair loss. Now I am back to square one.

I have called the Cardiologist and awaiting further instructions. I see no need to continue with a scheduled echo in November if I have not been on meds to try to take the stress off the heart. I wonder what options I have as I am super sensitive to medications (long history)
Any ideas? Now I am afraid surgery will be more of a necessity. I really am not up to open heart surgery as I have other health issues and feel I won't be a good risk.
Thanks for letting me vent.

 
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Old 09-26-2007, 08:39 AM   #2
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Re: Now what?

What does "4 incompetent heart valves" mean in more detail?

I have three valves that leak, is that the same thing? How bad do they have to be to consider cutting you open?

 
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Old 09-26-2007, 10:41 AM   #3
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Re: Now what?

Quote:
Originally Posted by goldyfm View Post
After learning I have 4 incompetent heart valves, I have been on 1 Ace Inhibitor and 1 Angiotensin Reuptake Inhibitor. Both have given a dry hacking cough and the last one caused hair loss. Now I am back to square one.

I have called the Cardiologist and awaiting further instructions. I see no need to continue with a scheduled echo in November if I have not been on meds to try to take the stress off the heart. I wonder what options I have as I am super sensitive to medications (long history)
Any ideas? Now I am afraid surgery will be more of a necessity. I really am not up to open heart surgery as I have other health issues and feel I won't be a good risk.
Thanks for letting me vent.
Hi goldyfm,

You will need an echo to help determine the extent of valve non-compliance. Also, the echo will establish a referrence for later examinations to determine any progression. You may never need an operation! Many people go through life with a valve problem without a need to operate.

Just curious, how, what was the procedure to diagnose your condition?

 
Old 09-26-2007, 07:23 PM   #4
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Exclamation Re: Now what?

Thanks for your replies. I had posted earlier when diagnosed with the valve problems. I had an echo and was referred to a Cardiologist who did a Transesophageal Echocardiogram about 6 weeks ago. It showed mild to moderate regurgitation in the pulmonic, tricuspid and mitral valves and moderate to severe regurgitation in the aortic valve. Seems the report showed a left ventricular diastolic dysfunction although the EF was in the 55-65%.

The cardiologist was trying on ACE Inhibitor and the Angiotensin Reuptake Inhibitor to prevent preogression of damage. It was not a vegetative or structural defect. No stenosis was noted and the heart was not enlarged at that time.

I also had a negative echo in 2002 so all these problems have occurred over the last 5 years.

 
Old 09-26-2007, 09:33 PM   #5
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Re: Now what?

Quote:
Originally Posted by goldyfm View Post
Thanks for your replies. I had posted earlier when diagnosed with the valve problems. I had an echo and was referred to a Cardiologist who did a Transesophageal Echocardiogram about 6 weeks ago. It showed mild to moderate regurgitation in the pulmonic, tricuspid and mitral valves and moderate to severe regurgitation in the aortic valve. Seems the report showed a left ventricular diastolic dysfunction although the EF was in the 55-65%.

The cardiologist was trying on ACE Inhibitor and the Angiotensin Reuptake Inhibitor to prevent preogression of damage. It was not a vegetative or structural defect. No stenosis was noted and the heart was not enlarged at that time.

I also had a negative echo in 2002 so all these problems have occurred over the last 5 years.

I'm curious as to what ace inhibitor you were prescribed? Was it Lisinopril? I had a horrid cough, gagging and vomiting several times daily and worse at night from lisinopril. My doctor put me on Atacand and the cough was gone completely within two weeks.

 
Old 09-27-2007, 06:50 AM   #6
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Re: Now what?

I was first given Benazepril. The nurse said doctor will do nothing (after I informed I just had a Thyroid test in July) until my next echo in November. I wondered if it was deemed necessary to prescribe a med for the valve problem and now as I was tried on two with side effects by both, they seem to think it was "unnecessary."

I do want the best care possible for this condition. I am puzzled as to why do a followup echo if they are not going to treat.

 
Old 09-27-2007, 04:29 PM   #7
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Re: Now what?

Quote:
Originally Posted by goldyfm View Post
I was first given Benazepril. The nurse said doctor will do nothing (after I informed I just had a Thyroid test in July) until my next echo in November. I wondered if it was deemed necessary to prescribe a med for the valve problem and now as I was tried on two with side effects by both, they seem to think it was "unnecessary."

I do want the best care possible for this condition. I am puzzled as to why do a followup echo if they are not going to treat.

When I first read your original post I got the impression you were taking an ACE inhibitor AND an angiotensin Reuptake.

For a perspective, the ACE inhibitor blocks the production of angiotensin. Angiotensin enzyme contracts and narrows vessels.

Angiotensin Reuptake doesn't block angiotensin but relaxes vessels and both perscriptions treat high blood pressure by lowering the resistance the heart pumps blood against and lowers internal heart pressure as well. The reduced pressure provides some relief to the valves and regurgitation. Medication slows the process of valve non-compliance!

If your bp is normal, the medication may not be of much benefit.

Last edited by started04; 09-27-2007 at 04:30 PM.

 
Old 09-30-2007, 09:39 AM   #8
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Re: Now what?

Goldyfm

The medicines you are taking are given to almost everyone with heart disease, especially those that have had a heart attack. Statistics show they help improve survival. They are not specific for heart valve disease at all. I am being brutally honest here.

Are you sure the Angiotensin Reuptake Inhibitor is not an Angiotension Receptor Blocker? No big deal, I just am looking for a new drug in this class myself, and have never heard of the medicine you mentioned.

Goldy, I know you are struggling with Fibromyalgia, same as myself, along with heart disease. It is a very nasty trick for you to determine which condition is effecting you. Here is why; the FM causes aches and fatigue, while a leaking aortic valve causes tremendous fatigue and possibly chest pain, fainting, etc proportional to the valve leakage.

At this point you must concentrate on the valve leakage. If it is moderate to severe, you cannot work or carry on normal activities. If you do so, you risk enlarging your left ventricle and suffering left side heart failure, which leads to right side heart failure.

These echocardiograms or TEE tests, are the gold standard for evaluating your valve leakage/condition, and will signify to your doctor when repair or replacement of your aortic valve is necessary. There is a "window of opportunity" that the cardiologist/surgeons look at to "fix" a heart valve.

Your EF or left ventricle ejection fraction is good, but what is the left ventricle end diastolic fill pressure? I would think that it is very high. You mentioned LV diastolic dysfunction in your post. That means your left ventricle end diastolic fill pressure (LVEDP) is >20mmhg already. I have diastolic dysfunction also.

Diastolic dysfunction can lead to pulmonary hypertension, pulmonary edema and pulmonary embolism.

When your heart rests after a contraction (diastolic phase), the aortic valve should close securely, and allow the LV to fill with fresh oxygenated blood from the lungs via the left atrium and through the mitral valve.

Instead when your heart rest the LV is flooded with blood leaking through the aortic valve. Consider what is above the aortic valve. It is the beginning of the aorta which leads to the aortic arch with a huge amount or volume of blood This blood, due to its volume and height above the aortic valve, exerts a lot of pressure on the aortic valve and when it leaks the force is exerted on the left ventricle that is trying to fill and pump blood from the lungs. The efficiency of the over all heart is greatly reduced.

So, your good EF really doesn't mean a lot at this time, except that your heart is still fairly strong and can be rescued with valve repair.

Have you seen your actual echo report? If not ask for it and give us your heart chamber dimensions. I would say that your LV is already approaching enlargement due to being so over worked by the leaking aortic valve.

Get ready to get that valve fixed and start feeling 200% better

G-d bless you

 
Old 09-30-2007, 02:14 PM   #9
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Re: Now what?

I stand corrected. Cozaar is an Angiotension Receptor Blocker.

I don't really know what the measurements on the original echo mean, there were no measurements on the TEE other than est. LVEF of 55-60.

On the original echo:

LVD was 3.9 cm
LVS was 2.6 cm
Aortic valve area 1.9
aortic root 2.9
LVOT of 1.9
LV post wall and LV septal wall were 0.8
L atrium was 2.7
mitral valve area 3.1
First echo showed LVEF of 55-65 and stated LV diastolic filling pattern shows impairment of relaxation to suggest mild diastolic dysfunction.

No other values are included on either the echo or TEE reports.

The Cozaar is made by Merck, you can search by name and they have patient info and prescribing info.

Now it is hard for me to know whether I am so fatigued because of the heart or the fibromyalgia. I sleep more than I am awake. I guess my body needs the rest. But I can't slow down much more than I am at this time. I wouldn't be living if I slowed down anymore.

I know I don't really understand all that this entails but wouldn't all the valves need repair or at least the aortic and mitral for the left ventricle to pump efficiently?

Yes, Huck you and I are neighbors of sort, maybe there is something contagious about these maladies.

 
Old 10-01-2007, 09:18 AM   #10
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Re: Now what?

Goldy,

I am quoting you here, "It showed mild to moderate regurgitation in the pulmonic, tricuspid and mitral valves and moderate to severe regurgitation in the aortic valve." Except I made the most important part bold

Yes in a perfect heart all 4 valves need to open fully and close tight in the correct rhythm, in order for the heart to pump efficiently. Really all the left ventricle needs is the mitral and aortic valve to pump efficiently, BUT if the other 2 valves fail, it will lead to right sided heart failure which will lead to left side and total heart failure.

The heart is really 2 pumps side by side, the left, which consist of the LV and LA, the aortic and mitral valve, which pump fresh blood from the lungs to all parts, or cells and organs of the body, and back to the pulmonary valve, where the right pump circulates the blood through our lungs.

The right side, which consist of the RV, RA, tricuspid and pulmonary valve take suction on spent blood that has traveled through all of our cells and is returning through our veins back to the pulmonary valve, RA, RV and through our lungs to exchange CO2 for O2.

Many people our age have mild to moderate valve leakage in all but the aortic valve. This is the valve that can put an end to us quickest. I am sorry to say this. The aortic and pulmonary valve are totally different from the other 2 valves. They are exposed to the "system", and must be more tough and efficient.

Why does Goldy need to lay down a lot?

You know what a water tank is? You know, the huge ones we climbed and wrote whatever on (when our hearts were the last thing on our minds, lol)? They pressurize a cities water system. Pumps pump water up into them and keep them full. This is kinetic energy at work. 1 gallon of water weighs 8 pounds. Imagine what 250,000 gallons weigh? 2 million lbs.
The higher the tank, the higher the kinetic energy due to the force of gravity. This kinetic energy is converted to pressure and is felt in every pipe connected to the system. Every kitchen, bathroom etc. We have valves to stop the water flow.

Now lay this tank on it's side and see the effect on the system pressure (and in your case) the valves. The valves have much less pressure on them.

As you stand, your water tank is above your aortic valve......Exerting force as pressure and causing increased leakage, and most importantly, increased work load on your already over worked heart.

Have your doctors told you not to exercise until this valve is repaired? Are you seeing the dominant group of cardiologist in North Alabama? I have been to almost everyone of them. I think that is my problem. Instead of sticking with one, I have tried them all. I thought my care as far as my medical history would be the same, but boy it is not.

I will compare your echo readings to mine and the norms when I get the chance. Gee Goldy, my body has been aching all over for about 4 weeks, worse than ever. It is hard to take. Sometimes I wonder.... I know you understand.

My heart probs are different than yours. I have coronary artery disease or CAD. I have 5 stents. 4 are side by side in what is termed as a "kiss me" arrangement in my LAD.

I just got back from the Cleveland Clinic for an evaluation for minimally invasive coronary artery bypass surgery, MID-CAB. I was turned down and really do not know why. I was "under the influence" the last time I talked to my cardiologist, immediately after my TENTH CARDIAC CATHETERIZATION. This is against all medical standards, but I am supposed to receive all data in the mail. It was supposed to be here 6 days ago...I was a perfect candidate for this surgery. Politics are involved I am afraid.

I can't wait until UAB can do this type of surgery. I have been there guinea pig before.

Be well young LADY until we meet again ,

FMAndy

 
Old 10-01-2007, 10:36 AM   #11
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Re: Now what?

For a different perspective, I had severe MVR, enlarged LV and an MI going on 4 years. With medication there has been reverse remodeling (normal size). The normal size LV has reduced MVR to moderate. Tomorrow another echo.

My ischemic LV led to an MI, dropped EF to below 29%. Left ventricle non-compliance (inadequate cardiac output) caused pulmonary edema and was hospitalize for several days. If cardiac output is compromised by a weak contractions of the LV, oxygenated blood from the lungs back up and leak fluids into the lungs (edema). That appears to be my experience.

If the right side fails, there is system edema for the same reason... reduced output causing an imbalance in output and supply. Right-side failure lacks sufficient blood flow to the left side and the left side chamber for lack of blood will compensate by enlarging the chamber thereby increasing contractional strength consistant with the Frank Startling phenomonom. There comes a time when the oversize chamber loses (over compensates) its contractional strength and as a result the heart fails to pump sufficient oxygenated blood to meet demand.
The mechanism for Frank/Starling can be compared to the expansion of a hand spring. There are specific cardiac cells that have this property. As it is stretched it springs back with more force. Over stretch and recoil is flaccid and heart failure. If and when the heart is compensating by remodeling, EF can be abnormally high!

Last edited by started04; 10-01-2007 at 10:41 AM.

 
Old 10-01-2007, 12:04 PM   #12
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I am seeing a group at Birmingham Heart Clinic at what used to be Med Ctr East. The cardiologist had only seen me briefly for an initial visit post 1st echo, so there was not a lot of history with him. Although he advised after the TEE that I could resume my normal routine the following day; my normal routine is anything but normal due to the fibromyalgia and some other issues. So basically he was telling me to do what I felt like which isn't much even on a "good" day. Huck, I am sure you can identify with that.

I don't see him again until November, for a repeat echo and consultation following. I am in a holding pattern as far as the heart goes until my next visit. After trying me on two meds (I have long history of medication allergies) that failed to be tolerable to me, I was told to wait til the next evaluation. In the meantime, I am trying to arm myself with any info so I can go in prepared this next time.

I have researched the Cleveland Clinic and definitely would seek a second opinion before any surgical suggestion. I also would like to know if you required a referral for the evaluation there or if they take patients without referral. I am lucky in that my health insurance allows me to pick my own physicians, so that is a plus for me that I am not limited to a certain hospital or doctor's group for treatment and possible surgery.

I have also been investigating the types of replacements available, and though the literature suggests that mechanical valves are used in younger patients, I find no definition of age criteria. I think if I had to have a replacement I don't want to think that I would have to undergo another one in a matter of x number of years. I am 55, so I should have a few years left.

Also Huck, on one website it was listed that connective tissue disorders can damage the heart valves. I wondered if you had seen that info and what your take is on the possibility it may be fibro related. Makes one wonder if there has been a study of how many with fibro have valve disorders of undeterminable origin. I know I never had rheumatic fever as a child, there was no evidence of stenosis or vegetation, and as far as I know there is no Marfan's in my background. Hmmm, maybe there is a relation between the two.

I know that all the symptoms for the two started about the same time. The thing is they only did some stress EKG's and Cardiolite studies in the beginning of my symptoms. And I was told those were normal. Your thoughts?

 
Old 10-01-2007, 04:22 PM   #13
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Re: Now what?

Huckfinn,

After answering OP you may want to enlighten readers regarding your comments:

Quote:
The right side, which consist of the RV, RA, tricuspid and pulmonary valve take suction on spent blood that has traveled through all of our cells and is returning through our veins back to the pulmonary valve, RA, RV and through our lungs to exchange CO2 for O2.
I find your description of the system's cardio/vascular anatomy interesting but where does "suction of spent blood" arise?

My information after reading about EECP the systematic venous system return consists of pressures and bicuspid valves to prevent back flow due to gravity, etc. as it relates to venous blood flow below the heart. As it goes blood flow to the heart involves the muscles. When muscles contract blood is sqeezed at the vessel cite pushing blood toward the heart; when muscle relaxes bicuspid valves closes. The muscle acts like a pump.

My friend, Lenin, stated suction was involved for venous return, but could not elaborate. So I put some validity to that comment, but I don't understand the mechanism involved? Do you have a source?

 
Old 10-02-2007, 01:13 PM   #14
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Re: Now what?

Goldy

I am reading like the devil for you, lol. I am not through with what all I would like to cover, to really answer your post, but I have a few answers and questions.

I do not understand the question you ask here " I know that all the symptoms for the two started about the same time. The thing is they only did some stress EKG's and Cardiolite studies in the beginning of my symptoms. And I was told those were normal. Your thoughts?"

What do you mean by "symptoms of the two" (I am confused as to what the two are). Please forgive my foggy mind. I know that you understand. If I assume it is FM and aortic valve leakage, I am probably wrong

I have totally read the Birmingham Heart Clinic web site. I looked at each doctor's credentials. I don't think that any do valve repair? This is very important; have you asked them if you have a bicuspid or tricuspid aortic valve?

So glad to hear that your insurance is good. BCBS allows you to go to any state that has BCBS, and if that state's doctors/hospitals are in the preferred network, your coverage is exactly the same as if you were at home.

I just received my cath and other lab reports from the CC. I am very disappointed with an obvious mistake they made. I am going to fax them later.

I wanted to say that I know that you have been to many doctors for fibromyalgia, and any answers are often vague. Cardiology is different. You must demand and keep all of your medical records and test results. I surely hope that doesn't sound condescending

You don't need a referral to get an appointment at the CC. Just make sure you get it pre-certified with your insurance company.

There is no doubt to me that Fibromyalgia and connective tissue disorders could cause valve and other heart conditions. Remember the myofacial tissue or whatever. I have about forgotten about it but.....

Don't be worrying about valve replacements yet! Let's study valve repair the easy way....No open heart surgery I believe. That is what I wanted to cover before I answered your post. I have felt the worst that I ever have in my life for the last month or so. I think I am repeating myself here, lol.

I think I may have figured out that I have/or had drug induced lupus from a very potent heart medicine that I have taken for many years. I changed last night and some of the muscle pain has gone away already. (I was taking a beta blocker, atenolol (6 or 7 years) and switched to Coreg last night.)

Cross your fingers for me.

My best to you,

Huck

 
Old 10-02-2007, 01:50 PM   #15
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Re: Now what?

Yes Ken, I really over simplified the function of the right heart when I said it "takes suction on spent blood".

I am using one of the basic laws of physics, which must take place in order for our blood to circulate. It is call delta p, or differential pressure.

You are most correct about the venous pump:

When you are in the upright position, the blood in your leg veins must go against gravity to return to your heart. To accomplish this, your leg muscles squeeze the deep veins of your legs and feet to help move blood back to your heart. One-way flaps, called valves, in your veins keep blood flowing in the right direction. When your leg muscles relax, the valves inside your veins close. This prevents blood from flowing in reverse, back down the legs. The entire process of sending blood back to the heart is called the venous pump.

I do not feel like putting my explanation of "taking suction" into my own words, so let me paste some info that I cannot supply references for, due to board rules. I will say that on an echocardiogram, it will note that in a healthy individual, the inferior vena cava collapses with each heart beat. This is due to negative pressure.
----------------------------------------------------------------------
Abstract

To investigate the effect of a sustained fall in intrathoracic pressure (Mueller manoeuvre) on blood flow through the right heart and on systemic venous dynamics, 16 patients were studied using thermodilution, cinevenograms and simultaneous pressure recordings with two micromanometric transducers. The reductions in airway pressure (median [rangeI) during two graded Mueller manoeuvres were 25 (20–30) and 42 (22–52) mmHg. Right atrial mean pressure decreased by 17 (2–25) mmHg during the former and 38 (0–49) mmHg during the latter, and simultaneously, pressure gradients of 23 (1–32) and 45 (1–82) mmHg developed between the inferior vena cava and right atrium (P<0.003 for all). Internal jugular venous pressure decreased by 16 (4–25) and 24 (4–43) mmHg (P<0.03 for both), respectively, and no pressure gradient developed between internal jugular and superior caval veins. The minimum diameter of the proximal inferior vena cava decreased by 69 (–49–84)% (P = 0.002) during the greater manoeuvre. Cardiac index tended to increase by 26 (–17–40)% (P<0.066) during the lesser manoeuvre but did not change statistically significantly during the greater.

In conclusion, during negative intrathoracic pressure caused acutely by the Mueller manoeuvre, right atrial pressure decreases and the inferior vena cava collapses partially at or below the diaphragm. Despite a significant venous obstruction between the lower body and right atrium, blood flow through the right heart increases or remains constant.


Abstract

Pressure in the right ventricle (RV) as well as the right atrium (RA) and pulmonary artery (PA) were measured in 80 patients with catheter-tip mlcromanometere and evaluated to determine If the pressures are compatible with the concept of RV diastollc suction. In 40 patients with normal PA pressure, minimal RV diastollc pressure that occurred during early filling, was negative (-2 ± 0.3 mm Hg) (mean ± SEM). In 29 patients with PA hypertension, minimal RV dlastolic pressure during expiration also was negative (-2 ± 0.7 mm Hg). In 11 patients with right ventricular failure, however, minimal RV diastolic pressure was positive (9 ± 2 mm Hg). These results indicate that the human right ventricle, in the absence of failure, has a negative early diastollc pressure, which may reflect RV diastollc suction.



Excerpt: "Blood flows through the blood vessels, including the veins, primarily because of the pumping action of the heart. However, venous flow is aided by the heartbeat, the increase in the negative intrathoracic pressure during each inspiration, and contractions of skeletal muscles that compress the veins (muscle pump).The pressure in the venules is 12–18 mm Hg. It falls steadily in the larger veins to about 5.5 mm Hg in the great veins outside the thorax. The pressure in the great veins at their entrance into the right atrium (central venous pressure) averages 4.6 mm Hg but fluctuates with respiration and heart action...."

 
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