Getting to the heart of the matter

A few years ago, I happened to have completed a vigorous workout at the JCC just before visiting my doctor for a routine checkup. When he listened to my heartbeat, he heard a murmur, and referred me to a cardiologist. She had me do a stress echocardiogram, decided that there was nothing to worry about, and asked me to come back in a year. I did; that time, she only did a stress EKG, and sent me on my merry way.

A few weeks ago, I was at the JCC for Body Sculpting class, where we had a new instructor, who added quite a bit of cardio to the mix. One of the additions was a quick run around the room; I was surprised to feel some tightness in my chest while I was running. But if I slowed down a bit, all was well. And it didn’t happen every time. But I did make a point of mentioning it to my doctor at this year’s routine checkup. He decided that it needed to be investigated; a chest X-ray showed nothing (whew!), but something about my EKG didn’t look quite right, so he sent me back to the cardiologist for another stress echocardiogram, which happened yesterday.

They started by wiring me up, then doing some baseline measurements and getting a baseline echocardiogram before putting me on the treadmill. It seemed like the process took longer than it did on my first visit, so I wondered what was going on. When the cardiologist came in, she and the tech conferred for a bit, and then she told me that she wasn’t sure I should take even the test — that my aortic valve was clearly not opening fully. But then she decided she’d get more data by putting me on the treadmill, so away I went.

Taking the stress test is a lot like playing a coin-operated video game — the machine is going to win, it’s just a question of how long you’ll last. This time around, I made it to the fourth level (16% grade, about 4 mph) before the doctor stopped the test; my heart rate was up around 150, and I was starting to feel a little tightness in my chest. Right after the test, they took another echocardiogram, and that confirmed the diagnosis: I have symptomatic aortic valve stenosis, which means I have surgery in my future. Not, fortunately, the immediate future, but probably within a year or two.

In the meantime, I’m excused from the classes I’ve been taking at the JCC and from giving blood; I also need antibiotics before I visit the dentist. But I can continue to do aerobic exercise (as long as I stay below the point of discomfort), and I’m cleared to try yoga (but not pilates) and to continue to frustrate myself with golf. What could be better?

Needless to say, I have lots of research to do before making any decisions, including where I want to be treated (and making sure that my insurance plan offers choices). I am very glad to have time to make decisions on this one!

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12 Responses to Getting to the heart of the matter

  1. Wow…. that’s a scarier diagnosis than the one I had last year, after my doc noticed something funky on my EKG and had me do a stress test and an echocardiogram. I did fine on the stress test (although I thought I was going to go flying off the treadmill by the end, like Adam did in that Mythbusters episode), but the echo showed “mitral regurgitation”. Apparently, I’m OK as long as I don’t have shortness of breath or chest pain…

  2. epc says:

    Ugh, sorry to hear this but glad you can have some control over when to have the surgery. I keep having arrhythmia issues (apropos of nothing my heart will go into overdrive for a couple of hours, then settle down). Other than a yearly echocardiogram my doctor has held off doing anything because, so far at least, it’s not a serious issue (it’s been diminishing in occurrence since the first apparently medication induced bout two years ago). My doctor’s initial advice would have been more useful ten-fifteen years ago: avoid drinking caffeine and alcohol in the same 24 hour period.

  3. Peter Andrews says:

    Well, it is good that you know it and have the time to work through the options. (Of course, it would be better not to have any problems at all, but this is the real world.) You’ve inspired me to get my own ticker checked, and I bet I’m not the only one!

  4. Scott S-M says:

    David, I’m so sorry to hear that you may have to go under the knife! When our son had heart surgery (sub-aortic stenosis), I was amazed that what was so foreign and scary to us was so ordinary and matter of fact to the surgeon. It was quite reassuring to know that they weren’t breaking new ground. Here’s hoping your treatment and recovery is as successful as his was!

  5. David says:

    Hi, Sherry — That is a funny scene! Last time I did the stress EKG, I lasted longer (into round 5, as I recall), but I never felt that I was going to fly off. Of course, I was sober and didn’t have to run!

    If you have to pick a valve to malfunction, the mitral valve is a better choice than the aortic valve! Good work.

  6. David says:

    Ed, I’m not sure how much control I have — some of it depends on what IBM’s insurance thinks, and how they change it for next year.

    How well do you adhere to your doctor’s initial advice? I’m glad my doctor didn’t give me that prescription, because I’m usually non-compliant.

  7. David says:

    Peter, as you suspect, one of the reasons I wrote this was to encourage others not to ignore symptoms. (And, of course, I’m looking for advice from those who have gone before.)

  8. David says:

    Scott, thanks for the encouragement. Expertise is a wonderful thing — I intend to find a surgeon with lots of it. (Assuming the diagnosis is confirmed, that is — next steps for me include a consultation and an angiogram.)

  9. Barbara says:

    David, I am really sorry that you have this one as a “to do.” In case you are still looking for
    more professional input, I have heard that Dr. Gaudiani (Sequoia Hosp) is a very good cardio
    surgeon; a phone chat w/him may be useful.

    Vincent A. Gaudiani, M.D.
    Specialty: Cardiac Surgery
    Gender: Male
    Accepting new patients: Yes
    Practice Information: 2900 Whipple Ave. #210
    Redwood City, CA 94062
    Phone: 650-366-0225
    Sequoia Hospital

    Barbara

  10. David says:

    Thanks, Barbara — I expect to be doing a LOT of research over the next few weeks!

  11. epc says:

    Sorry for the late reply — I’m actually pretty good at separating the caffeine & alcohol now. Am now trying a month-long caffeine fast (for a variety of reasons).

    The triggers for my arrhythmia are any combination stimulants and depressants, so it’s not just caffeine / alcohol but any of the typical decongestants (which made last year’s sinus ordeal all the more “fun”).

    My only other advice is not very helpful: but figure out what you need to do and then do it, let the insurance guide you but don’t let it misguide you. Given my personal family history of early onset cardiac problems (early = 50s, something else I wish I’d known about ten years ago), I made the call to go to a cardiologist who isn’t on our plan, but is basically the top in our area and that has helped with other non-cardiac issues (like the sinus ordeal).

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