wolff
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wolff, July 12,  2020  1:11pm EST
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Mitral valve prolapse and Afib

Hi, I'm male, 60 in pretty good shape and never had any health issues, I dont even wear glasses or contacts.

Back in Feb I had a dental cleaning and about 3 days later I got sick with what the doctor said was bronchitis, and given antibiotics, it seemed to get better but then it got worse and I was coughing a lot, and then felt faint at one point, went back to the doctor, they did a chest xray and Ct scan and said I had pneumonia in one lower lobe and put me on iv antibiotics.

While I was there earlier and then this time the doctor said I had an extremely high heart rate that concerned her, 158 bpm, on day 3 of the outpatient IV antibiotics she gave me a small pill to try to lower the heart rate, no idea what drug it was but 20 minutes later I started feeling bad, vision filling in, faint, so I rang for the nurse and they found my bpm was 37 and bp was if I remember right  60 over something, they wheeled me to the ER and flushed out the drug with IV's then said they were transferring me to another hospital, which I objected to like before when the doctor was going to admit me for the IV antibiotics, I  told the ER doctor that I have 4 big dogs at home with nobody to care for them, my back door was unlocked, lights and computer all on expecting to return after the IV, and nobody I could call.

So he said they think I might have a blood clot in the heart causing the tachycardia, eventually I agreed to go in the ambulance to another hospital where I was in the ICU for 4 days, they did ECG's and more, IV antibiotics and respiratory therapy,  plus a cardioversion one time with 200 joules and that fixed the tachycardia and the EF went from around 35% to 55%

They put me on several meds, including Eliquis, Amiodarone, Metaprol succinate and others like spironolactone.

A follow up  echocardiogram in June shows the attached results, after talking with my cousin who is an RN and consulting with the cardiologist, I felt it best to have this mitral valve prolapse repaired sooner than later, so I asked the cardiologist to put that on the table to look into, that she did and I have a consultation Aug 10 with a surgeon.

I still don't know which came first, I knew for 25-30 years I had a mitral "click/murmur" which the doctor said just get antibiotics for dental work. Obviously it's gotten worse since then, but Ive never had pneumonia in my life so I dont know if the Afib caused it or vice versa, or if I caught something at the dentist,  or if all 3 things are coincidental.

I guess my questions would be, how bad is the attached report, will mitral valve repair pretty well take care of everything since that seemed to maybe  have caused the Afib, maybe that caused pneumonia to develop from bronchitis, and will the repair pretty much take care of this issue "permanently" or am I looking at having to have another surgery in a few years?

Since I work, I would need to have a better idea of how long I might be in the ICU, and what the recovery process/time frame is to return to work?

I'm in a woodworking related field working indoors in a wood shop, there's some lifting involved and a lot of  on my feet time, but the shop is air conditioned nicely and there's no going out in the field, climbing ladders type heavy work like electrical lineman or construction.

I say Id rather get it repaired sooner than later because right now theres no big changes in the heart due to damage beyond atrial dilation,  my insurance at work covered everything after my deductable but it wont be available to me 5-6 years from now and as this all tends to get worse over time, why LET it get worse and causing other damage.

 

 

  • AHAASAKatie
    AHAASAKatie, July 13,  2020  9:35am EST

    Thank you so much for sharing your story with us. We have quite a few heart valve survivors who can share their experiences over the next few days.  However, one piece of this we can not do is provide medical advice. However, we have a vast amount of Heart Valve Disease treatment information including details on surgeries, recovery, and life after. 

    I look forward to reading what our members share with you about their experiences. And please know, whatever you decide, we are here for you. 

    Best Katie

  • wolff
    wolff, July 13,  2020  8:41pm EST

    Thanks Katie, this is all new to me, Ive never even been in an ambulance or actually admitted to a hospital in my adult life, and all the time I was worrying about how much I was going to have to pay past the deductable and if insurance was actually going to cover everything 100%, I really wanted to get out of that ICU room, the bed was terrible, the pillow was worse and the battery in my Iphone was going bad and I had to keep asking the nurses to charge it for me. Then I had to figure out how I was going to get home from 40 miles away!

  • AHAASAKatie
    AHAASAKatie, July 14,  2020  9:07am EST

    Hospital stays are rough. I have been in the ICU once and it was not pleasant at all. I am sorry you are having to manage this. Oh, and your dog is adorable. Is he/she a St. Bernard?

    Best Katie

  • TomBroussard
    TomBroussard, July 14,  2020  1:10pm EST

    Hi, Wow!  Thanks, that is quite a series of stories...I am glad you are working your way through all of this!  I can't even imagine...it is difficult enough to have the health issues and then have to go to the hospital for a number of trips... I have been to hospitals plenty of times but I have NEVER experienced what you are experiencing...best wishes for your continued health improvement...and the next big step ahead.  Take care!  Tom B

  • AmbassadorDN
    AmbassadorDN, July 14,  2020  4:21pm EST

    Welcome, Wolff!

    You have come to the right place--we Heart Valve Ambassadors are here to offer you insight and support, and I'm sure others will be along soon to offer their perspectives.

    Like you, I had MVP all my life which for me was actually part of a structural congenital heart defect (CHD). I knew early on that I would need surgery in my 60s, but here I am, almost 45 and have three heart valve surgeries under my belt. It's a long story, but for the most part I am healthy as can be and as active as I can be.

    While we can't offer medical advice, we can tell you that it's always best to have any questions or concerns addressed with your medical team. You seem to be your own best advocate, and that's great that you are taking charge of your health! Talk with your surgeon at your upcoming consult to determine what might be best for you regarding repair versus replacement. Obviously, surgeons can't tell the severity of valve disease until they get in to perform the actual operation. The best bet always is to try to preserve the native valve; if that can't be done, then make sure you are comfortable with receiving either a tissue or a mechanical valve.

    Regarding recovery, everyone recovers diferently. Some will stay in the ICU longer than others, and some will be able to resume working within a couple short weeks. It all depends on the type of valve surgery (repair or replacement), if there were any "bumps in the road" in recovery, and how your body heals. My surgeon's nurse was quite candid with me after my second valve surgery and said to me, "Your body has been through a tremendous trauma, so don't push yourself too hard and do be sure to listen to your body." Rest, walking, breathing exercises, and a good diet post-op are key. Allow your surgeon and/or cardiologist to take the lead in determining when it is appropriate for you to return to work, since you don't want to have a setback. Generally, full recovery can take about 4-8 weeks. Since you have to do some lifting, you want to make sure that you're appropriately healed before resuming your duties.

    You are right--why let the valve further degenerate and cause damage? Surgeons like to get in and do the valve surgery before further damage happens, so be sure to have all your questions ready to ask when you go in.

    We are all here for you, so keep us posted and let us know if you have any other questions or concerns as you move forward!

    To Heart and Soul Health,

    Ambassador DN

  • AmbassadorDN
    AmbassadorDN, July 14,  2020  4:46pm EST

    One more thing to add: Like you, I had myxomatous MVP which was initially repaired; however, my valve continued to degenerate after the repair which led me to have a replacement almost 10 years later. You may want to speak with your surgeon candidly about possibly just replacing the valve in order to prevent degeneration of your native valve and possibly having to go through another surgery down the line. It's just my two cents. I'm attaching a research article regarding the reoccurence of regurgitation in degenerative mitral valves from the AHA for your perusal. You might want to discuss the findings of the research with your surgeon to determine the best method of valve surgery for you. Take care!

    https://www.ahajournals.org/doi/10.1161/01.CIR.0000058703.26715.9D

  • wolff
    wolff, July 14,  2020  9:35pm EST

    Great responses everyone thank you!

    Here is a more complete part of the recent echo and what's happening, I'm trying to correlate this to real world meanings and implications;

    ---

    Left ventricular end diastolic dimensions appeared normal. Overall left ventricular systolic performance appeared to be in the lower limits of normal. Physician estimated ejection fraction was 55%. Left ventricular wall thickness appeared normal. Left ventricular filling pressure could not be meaningfully estimated. LV diastolic function could not be definitively evaluated.

    Left atrial dimensions appeared markedly increased. The study was technically inadequate for meaningful estimation of the left atrial pressure.

    Right ventricular dimensions appeared to be within normal limits. Right ventricular systolic performance appeared normal. PASP was 32 mmHg. Doppler estimated peak RV and pulmonary artery systolic pressures were within normal limits.

    Right atrial dimensions appeared normal. Inferior vena cava dimensions appeared normal with normal respirophasic reactivity. Features were consistent with normal right atrial pressure. The estimated mean right atrial pressure was 5 mmHg.

    The aortic valve appeared to be trileaflet. There was no Doppler evidence for significant aortic stenosis or regurgitation.

    The mitral valve leaflets appeared redundant and thickened consistent with myxomatous degeneration. There was mild prolapse of the anterior leaflet. There was mild prolapse of the posterior leaflet. There was Doppler evidence for moderate mitral regurgitation (grade 3+).

    The tricuspid valve appeared structurally normal. There was Doppler evidence for mild to moderate tricuspid regurgitation (grade 2+). Doppler estimated peak RV and pulmonary artery systolic pressures were within normal limits.

    The issue is, how to extrapolate and compare; "markedly increased" and "Grade 3+"

    I also read about the L atrium remodelling and LARR after valve repair in the journals;

     

    "...aimed to establish whether LA diameter, a simple measure of LA ***********, is predictive of mortality under medical treatment and after mitral surgery in patients with organic MR due to flail leaflets. The relation between LA diameter and mortality was studied in 788 patients in sinus rhythm followed for 6.2- 3.9 years. LA diameter was independently associated with survival after diagnosis (HR, 1.08 [1.04 to 1.12] per 1-mm increment). The optimal cutoff value for prediction of mortality identified by receiver operating characteristic curveanalysis was 55 mm. LA diameter 55 mm was associated with more than 3-fold increase in the risk of overall and cardiacmortality under medical treatment."

     

    I don't know what that measurement is, I didn't see it in my report, unless I missed it.

    I also don't know if I have flail leaflet, or if  the atrium dilation is causing the prolapse and regurgitation  because the leaflets have moved apart.

    It would appear that with the dilation and the apparent degeneration (leaflets appeared redundant and thickened consistent with myxomatous degeneration)  that I might have to have the valve replaced because even with repair it would continue degenerating. In which case it appears that a tissue valve is indicated for patients >70 and mechanical for <70 because the tissue "wears out" and would need another surgery down the road.

    In any case as I'm finding out- this doesnt seem to be just a;  "simply repair, go home good as new and never worry about it again."

     

     

     

     

  • wolff
    wolff, July 14,  2020  9:43pm EST

    "Hospital stays are rough. I have been in the ICU once and it was not pleasant at all. I am sorry you are having to manage this. Oh, and your dog is adorable. Is he/she a St. Bernard?

    Best Katie"

    I found the ICU room was nice, the nurses were great, but the respiratory therapist would come at like 2 AM, the BP cuff inflating every 5 minutes all night long, I think I got an hour of sleep a night. The food was good but by day 3 I wanted OUT!

    Thank you! yes, , that's Mirela the St Bernard, I imported her from Romania about 3 weeks before this whole mess started in Feb.

  • AHAASAKatie
    AHAASAKatie, July 15,  2020  8:56am EST

    Mirela is beautiful. I have a Great Pryense and a husky/shepherd mix and now that my kids are grown and out of the house (mostly) they are my kids.

    It is frustrating when the medical staff comes in at all hours to do their work. It never fails to feel like you just fell asleep when they tip toe in.

    I am so glad you found such great support with our community. Please continue to share your journey with us. Best Katie

  • wolff
    wolff, July 24,  2020  10:21pm EST

    I got my Eliquis refilled today, glad I have insurance since I read the stuff costs $600 for a 30 day supply because the sole maker has an exclusive FDA and patent on it, that brings up another question- it would appear my mitral valve is likely to need to be replaced rather than a repair, I read that in that case you have to be on blood thinners, so is that 2 pill a day thing and what options are there besides $600/mo Eliquis, and side effects?

    Jan 1 my deductable resets, so I would be paying $2500 before the insurance takes over, hate the idea of giving these people $600 for 60 little pills for 4 refills  just because they have an exclusive on it! That insurance won't be available to me when I retire from this job in maybe 6 years.

    A hospital video I watched said after this surgery you cant drive for like 6-8 weeks! there's no way I can not drive that long, what's the reasoning behind that kind of restriction after being out of the hospital a few days and walking around?

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