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Subject: Aortic Root Dilation
Forum: The Heart Forum
Topic Area: Heart Disease
Posted by Jay on August 31, 1998 at 00:48:01:

I am a 50 year old male.Five years ago,as a result of a congenital bicuspid
aortic valve,which was stenotic and regurgitative,it was replaced with a S.J.mechanical aortic valve.
reSubsequently,I was told that during the course of the operation
problems arose as a result of an enlarged aorta.Apparently the surgeon had a
difficult time "reseating" the aorta.I am told that at the time,the surgeon
contemplated using a vein,and/or some sort of "brace" to properly seat the aorta.
However,the surgeon was ultimately able to "reseat" the aorta using the "normal" procedure.

I was out of the hospital at day 4.5,and back to work in 6 weeks.I have also
diligently taken "coumadin",and monitored my PT.

Over the past number of months I haven't been feeling well.My symptoms include
lethargy,sore legs,slight pain in my back,chest discomfort similar to what I felt prior to the original surgery,
frequent yawning,occassional nausea and dizzy spells.This has come as a surprise,since I
have been active almost from the time of the operation.

After recently having a whole slew of tests performed,including an "echo",and CT Scan,I am informed that I have
"moderate"(whatever that means) dilation of the aortic root.I am also informed that I "may" need surgery
to fix this.(I had been told that I "may" need aortic valve replacement too!)
My primary care physician and cardiologist have advised me to see the surgeon who performed the original operation.
I am informed that since he has the "operation notes",he is more qualified to assess the extent of the dilation.
This of course sounds fishy to me,since the cardiologist was there during the operation,and certainly could
ask for,and receive copies of the "notes" for his evaluation from the surgeon.
Needless to say,I am a more than upset about this.

Is this normal?
Why didn't the surgeon do it the first time?
What caused this?Did I cause it from vigorous physical activity?
What is the mortality rate for this re-surgery?
Are there typical complications from this type of re-surgery?
If I make it through this re-surgery,how will it affect my quality of life?
Is there anything I can do to prepare myself for this surgery that "might" happen?
Should I get a second opinion?
Should I use a different surgeon,or is there some advantage to using the same surgeon?
Any other insights would be appreciated too.

Thanks in advance!

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There are two different things going on here. The first, skipped beats, is a common symptom and is generally benign. These are usually caused by PVCs and PACs and you can read the many postings concerning these topics.

Your second set of symptoms may be something else. I suspect you are experiencing what is called 'supraventricular tachycardia' or SVT. The only way to confirm or excluded this diagnosis is to have a recording of the heart rhythm during an episode. If you had an episode during the heart recordings that you had and it only showed sinus arrhythmia then there is probably not much more to do at this point. If however you did not have an episode during the recording periods I would recommend obtaining a longer term recording (e.g 2-3 months). If you are having an SVT these can usually be cured with a procedure called an ablation. Your doctor can tell you more about this if the need arises.

 

 

Topic: Arrhythmia

Posted By: nina on Saturday, September 29, 2001

I have posted here and just want to thank you guys for the great web site. I have been experiencing "skipped beats" since 18 years of age and I am now 23. I was wondering if this will lead to greater complications in the future for me. Also, I sometimes experience a sudden fast heart beat. It is very scary and alarming. When it happens, my heart feels like it is going to beat out of my chest. I was diagnosed with a benign sinus arrhythmia and ectopic beats originating in my atrium. I was wondering what could actually cause this sudden pounding of the heart. It happens out of the blue. I dont feel like I am going to faint but it is more of a scary feeling. I do not get any symptoms before this happens. It only happens 2-3 times a year. I told my specialist and she could not find anything other than the mentioned above. She even said that my heart is in really good condition-via a 48 and 1 month heart monitor. I did have an echocardiogram done when I was 18 and it was perfect. I just want to know the different things that may cause what I am experiencing-thanks a bunch

Answered By: CCF-M.D.-CRC on Monday, October 01, 2001

Dear Nina,
There are two different things going on here. The first, skipped beats, is a common symptom and is generally benign. These are usually caused by PVCs and PACs and you can read the many postings concerning these topics.

Your second set of symptoms may be something else. I suspect you are experiencing what is called 'supraventricular tachycardia' or SVT. The only way to confirm or excluded this diagnosis is to have a recording of the heart rhythm during an episode. If you had an episode during the heart recordings that you had and it only showed sinus arrhythmia then there is probably not much more to do at this point. If however you did not have an episode during the recording periods I would recommend obtaining a longer term recording (e.g 2-3 months). If you are having an SVT these can usually be cured with a procedure called an ablation. Your doctor can tell you more about this if the need arises.

Comment By: Richard on Saturday, September 29, 2001


When I was in college and about your age I was under a lot of stress. That was when I had my first episode of the kind of rapid heartbeat that you are describing. My heart would suddenly beat very hard and very fast for only a few seconds. Taking a few deep breaths would seem to restore the normal heart rhythm. My doctor told me that my problem was caused by anxiety and that I shouldn't worry about it.

Now 35 years later I still have these episodes if I become very anxious about something but they don't bother me because I know what causes them and they have never been a problem.

Good luck with your problem. I suspect that yours is also caused by anxiety.

Comment By: nina to Richard on Saturday, September 29, 2001


Richard,

Hopefully that is all that is causing these episodes. When you experience these, is it like you were suddenly frightened? Mine are not like that...they are more of a pounding beat that is very fast. No matter how many times I go to the Drs. I keep thinking there is something wrong!!

Comment By: Richard on Saturday, September 29, 2001


I believe that my episodes are just like yours. They start without warning when I am very stressed. The heart pounding is very hard and fast and lasts only a few seconds. Afterward I feel more relaxed as though the episode has relieved some of the tension.

Comment By: dejan on Saturday, September 29, 2001


I am a 30 year old male. I had several episodes of sinus tachycardia since I was 18. But recently my problem got worse.
EVERY morning my heart starts racing with minimal exertion.
Even if I walk for only 20 meters my heart rate is 120-130 per minute. I go to normal phase late in the evening. Then, I can walk, even run without problems. If I get stressed during my "morning" phase I get tachycardia of about 150-160 beats per minute.
Does anyone know why this is happening only in the morning.
I usually get stressed when I feel a PVC beat (I have them 10-20 per day) or I anticipate tachycardia. Since there is always something to upset you in the morning, I could not function any more. I am scared to go to my work place since last time
I had an episode while driving. This was a week ago and I am at home since then. I started taking ATENOL. It works fine but I do not know how long I can use them without problems. Does anyone know how long should I be on ATENOL? I actually think that ATNENOL makes my PVCs worse. I have heard that beta blockers can have severe side effects like heart failure and cardiac arrest.

Thanks,

Dejan

Comment By: J. W. on Sunday, September 30, 2001


Nina,

As I read your complaint. I wonder. I am a healthcare professional that works in cardiac diagnostics. Sounds like time has passed. Have you talked to your physician about a complete cardiac work up? You put that you was diagnosed with a SA. Was the SA present all day or when you were just asleep? The thing about halter monitors must function on a 5 lead wire system. Which most the time are fairly accurate but a 12 lead works best. SA is related to respirations while SD being related to ectopy or abberent beats. Sounds like your doc is saying you are having premature atrial contractions. Some people it is common in though. Do you drink coffee? I suggest follow up with a cardiologist at a school of medicine learning hospital.

Comment By: J. W. on Sunday, September 30, 2001


Dejan,

The medication is safe.

Have you had a dobutamine stress test lately?

10 - 20 PVC's a day is great and not uncommon. If they remain from the same foci and are not multifocal.

Do you have a diet high in caffiene?

Try vitamins high in magnesium for the premature ventricular contractions.

Comment By: nina to J.W. on Sunday, September 30, 2001


J.W.,
I do not drink coffee or any other caffine for that matter. I have seen two different doctors about my symptoms and I finally got somewhere with the specialist. I did have the queen of hearts monitor for a month and that is how she diagnosed me with Pac's and a sinus arrhythmia. However, I never capture this fast beat on a monitor because it only happens 2-3 times a year or even once a year. When it happens I get NO symptoms before hand and it literally feels like my heart is going to come out of my chest. It does not feel like I just got done exercising or being scared, it is totally different.

Comment By: dejan on Sunday, September 30, 2001



Thanks J.W.,

I had a standard treadmill stress test done.
Everything was OK except that my resting heart
rate was 112 and jumped to 170 with very moderate
exertion. Echo-cardiogram is OK, blood pressure also OK. I repeat that this (tachycardia) happens only in the morning
and gradually vanishes towards evening. By 10 PM I
am in normal state, until next morning. My doctor says
that I am hypersensitive to adrenaline.

I avoid caffeine and alcohol and even meat since
any kind of meat is full of a killed animal adrenaline.
But nothing helps, except ATENOL. Does it mean that
I will be on ATENOL to the rest of my life?

I will definitely try magnesium for PVCs.

Thanks,

Dejan

Comment By: Wondering about symptoms on Monday, October 01, 2001


I apologize for posting a question here, but I'm a little worried about some symptoms I've had since a couple of months ago that are happening almost daily now. I will try to find a good cardiologist in the near future, but am wondering if anyone else has experienced THESE symptoms. I'm a 58 year old woman:

I've had occasional palpitations (?PVC's?) off & on over many years, but more frequently lately. For the past several nights, when I've gone to bed & was LYING ON MY BACK, after a while (several minutes) I would (all of a sudden) feel a scary feeling, plus a "heaviness" in BOTH arms, from the biceps down to the wrists. I also would feel almost a pins & needles sensation (or a ?flush?) in the arms, and from waist up to neck. When there would be a little light coming in from outside, I would look up and notice that MY VISION WAS GETTING DIMMER and seemed to become REDDISH in color. At that point I would feel that I better do something, to live!

When this has happened, I would shift to a different position, like on my side, and try pressing on an acupressure point on each wrist, in line with the little (5th) finger, which is on the "heart" meridian.

I had this type "episode" happen last night, while I was SITTING at dinner in a restaurant. I had drunk a margarita & was finished with dinner, and was chatting with friends when the weird feelings hit suddenly. I felt "something" like a cross between pressure & burning under my breastbone at the same time that both my arms felt "heavy" and felt like they were losing blood circulation.

I DIDN'T FEEL LIGHTHEADED, DIDN'T FEEL "DIZZY", and I didn't feel like I would faint, but it still was a weird, unsettling feeling. I wasn't feeling anxious. I know what anxiety attacks feel like, because I had several, over 30 years ago, and these episodes didn't feel at all like anxiety attacks.

I almost had an episode when I went to bed last night, but I think I "prevented" it by lying on my left side, instead of on my back. (I had read that lying on the left side can help prevent GER/Gastro-Esophageal Reflux).

Several weeks ago, I had been driving (which I do a lot), and suddenly had to jump up & rush out of my car to catch someone's attention that I needed to talk to. As soon as I came back to my car & SAT down, I had on of these "episodes". (? related to orthostatic hypotension??)

About a week ago, I was driving, and had just pulled into a gas station (using both arms on steering wheel to make the turn), and as I was SITTING QUIETLY, just getting ready to get out of the car, that weird feeling hit, with the "heavy" feeling in arms, again from biceps down to wrists, plus the flush (almost pins & needles) in arms and upper torso.

I've also found myself gripping the steering wheel very much, and leaning forward (?creating muscular back strain??) when driving. Also, I've been doing too much computer work, probably not in a good ergonomic position. So maybe poor posture & muscle strain could be factors?

Has anyone else had symptoms like these from palpitations or from Gastro Esophageal Reflux (I believe I have a little GER)? I also wonder if there might have been some MSG (Monosodium glutamate) &/or some Aspartame (Equal, Nutrasweet) in the restaurant food that I frequently eat, that could have precipitated some of these "?palpitations".

I also wonder if any of my vitamin (& etc.) supplements might have additives (excipients) that could have irritated my heart or esophagus.

My husband thinks driving posture is somehow connected to these "episodes". The "episodes" have not (yet) happened while I was standing up, just when sitting or lying down.

I appreciate the helpfulness of you folks on this forum. I'm a bit embarassed to ask for help, because I usually give help to others in health matters, but you all seem so nice, I figured I'd reach out this time. (If anyone knows any really good cardiologists in Colorado, I'd appreciate some references. My email is vcdcjs@hotmail.com)

Thanks for any responses, in advance!
Sincerely, Wondering about symptoms

P.S. I wish the best for all the others on this forum!


Comment By: J. W. on Monday, October 01, 2001


Dejan,

To no surprise the decision to discontinue the use of Atenol is between you and your doctor. I do not recall your age but it is used for lifetime with some patients with no problems. Stick with what works. I think your treating the effect and not the cause though.

J. W.

Comment By: dejan on Monday, October 01, 2001



Thanks again J.W.,

I think you have got the essence of my problem.
I do not know what causes my hypersensitivity
to adrenaline (if this is what triggers my tachycardia).
ATENOL keeps my heartrate down but all the other
symptoms are still present (mildly elevated temperature,
tiredness, loss of breath when I talk too fast...).
My cardiologist says she does not know what the
cause is. That is why I hope someone from the list
could help me.

Thank you very much,

Dejan

Comment By: My name is Sheila on Monday, October 01, 2001


I have ATRIAL FIBRILLATION, I was diagnosed over 18 years ago and was put on Inderal and then on to Tenormin, Quinidex, and lonoxin..later on my cardiologist diagnosed me with Brady cardia asnd said if I didnt get a pacemaker I could die, I got my pacemaker and was still on meds but was changed to Amioderone and Atenolol. I was told about the side effecs and was very scared to take it, but was ssured everything would be okay and that I would be monitored very closely. NOT! My cardiologist after 9 months has decided that I am having liver and lung problems due to this med. Has anyone else had any similar probs with this?

Comment By: Wondering about symptoms on Tuesday, October 02, 2001


I looked in the "archives" for my symptoms of "heavy arms", and found a man in 1998 who also asked about this symptom. The doc thought it was neurological, rather than cardiac.

I will see a cardiologist soon about the palpitations I've been having, but now I'm thinking I might also have Thoracic Outlet Syndrome (TOS). I will also check on the possibility of "degenerative disc and arthritis in cervical spine".

I have some risk factors for TOS: I drive for a living, and overuse my computer, and probably am not "ergonomic" either (slumped posture)!

In case anyone else can benefit from this, check out a good neurological website I recently discovered, at www.braintalk.org and click on "M-Z", and then choose "Thoracic Outlet Syndrome".

Good luck to all!

vcdcjs@hotmail.com
http://cantbreathesuspectvcd.com

Comment By: cn to Sheila on Tuesday, October 02, 2001


Sheila,
I also have atrial fibrillation, and was told that without a pacemaker I would die. I am also taking amiodarone for the last 9 months, and was told they would check things closely. Now I am told that my liver enzymes are too high and that because (I believe) I have too many drs. that don't communicate it was left too long without checking and now I may be in trouble. They are doing blood tests every week to determine the levels. I was told I had to stay on the amiodarone, and that if I started having jaundice or bad pain in my upper right side I would have to stop taking it. They said they usually let it go up to 2x the normal level, mine is more than three. I am hoping it stabilizes.

What is your situation? Will you have to stop taking it? Have they given you any ideas what the next step might be? I'd love to hear back, so keep me posted. Thanks. My email is tim-chris1@msn.com.