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Forum Name: Diseases of the Aorta

Question: Aneurysm repair and chest pain


 Geordie97 - Sat Jan 17, 2009 1:34 am

Quick history...53 year old male, firefighter and law enforcment officer.

Bicuspid aortic valve diagnosis at age 4 in 1959.
Aortic commisurotomy in 1967
Aortic valve replacement (Bjork-Shiley) in 1975
Congestive heart failure diagnosis in 2005, symptoms relieved with medications
Ascending aortic aneurysm diagnosed in 2008 (5.4cm)
Ascending aortic aneurysm repair and aortic valve replacement on 9/11/2008

I had no symptoms before or after the discovery but due to the size of the aneurysm, we decided to have the surgery and get it repaired. I returned to work on 12/14/2008 but had two minor cases of staph infection on/around the incision in late October/early November. Since the surgery, I have had some trouble getting used to the new sound of my heart. My resting heart rate prior to the surgery was around 68 and is currently around 80, plus my heart seems to be pounding all the time to the point that I can feel it beating, especially if I take a deep breath, and you can actually see my chest (beneath the collarbone) moving.

For the last couple of days, I have had some pain on the left side of my chest, under my breast. I don't believe it's heart related though I think it may be surgical. Is it possible that adhesions are causing the pain? The area on my left side of the incision next to my breast is slightly sensitive to touch also. I can provide a complete listing of my medications but I'm currently at work and don't have a complete list with me.

All in all, I feel pretty lucky to have found the aneurysm. I was surfing the web and found the Bicuspid Foundation (http://www.bicuspidfoundation.com) website where it mentioned the possibility of BAV patients developing aneurysms in their early 50's. I requested my cardiologist to do a CAT and we discovered it. Otherwise, I probably would never have known. Due to the size at the time of the discovery, we decided not to wait and see if it was growing or how fast.
 John Kenyon, CNA - Sat Jan 17, 2009 9:44 pm

User avatar Hello -

This definitely warrants an evaluation. While it is most likely due to something related to the surgery (adhesions are one possibility), there are other post surgical problems which are rare but do occur, including scar tissue complicating the seating of the replacement valve (very rare) and sometimes a progression of the dilation from the aortic arch into one of the takeoff branch arteries such as the left common carotid artery or the left subclavian. This should be visualized for possible dilation; the visible pulsing beneath the collar bone concerns me just a little.

As for the sound and feel of the new valve, this is very common and usually becomes tuned out by the patient, but it can take some time. They can be rather noisy (to the owner at least) and I've had the odd experience of listening, without stethescope, to a co-worker's titanium aortic valve, both via close proximity and by standing with the person in a small, tile-walled room. It was startling to say the least, so I can well understand how it must sound to you. They work incredibly well, however.

You were extremely fortunate to have discovered the aneurysm and had it repaired. Not everyone with BAV is aware of the additional risk (which is something of a mystery) of ascending aortic aneurysm linked to this defect.

I hope you'll have this discomfort and visible pulsing checked. It may well be nothing at all, or may even be indicative of how effectively the new valve is working, but it also is a little odd. The sound and the increased rate are normal.

Hope this is helpful and that you'll follow up with us here as needed. Best of luck to you.
 Geordie97 - Sat Jan 17, 2009 9:59 pm

Thanks John,

Actually, this valve (St Jude) is much quieter than my old Bjork-Shiley, which was titanium and stainless (it happens to be sitting on my desk...I had it for 33 years and wanted to keep it..just have to figure out what I am going to do with it) but it's not the valve noise as much as the louder, stronger heart beat. And, since I didn't have any blockage, I can't understand why it would be any different than before, other than the fact that the fat around the heart has been moved and maybe that's why I hear it so much louder.

As far as the pain, it's not a constant pain. I usually feel it more as I get tired and/or when I take a deeeeeep breath.

Will the faster heart rate eventually go back to "normal"?? I realize that the muscle has been stretched/pulled/etc during the surgery and, like any muscle, it takes time to heal but I would think that my heart rate would resume it's "normal" speed soon.
 John Kenyon, CNA - Sun Jan 18, 2009 12:01 pm

User avatar That Bjork-Shiley is an antique by now! And you're probably right about the actual heart sounds being audible due to loss of fat. Fat is a remarkable audio insulator, and many of us have quite a lot accumulated on the outside of our hearts (where it does no harm and does keep things quiet). I'd expect that will eventually either become background noise (tuned out) or will accumulate some more fat insulation.

The reflex increase in sinus-dictated rate post-surgery can last for weeks or months. Sometimes it becomes reset as the baseline rate (which still wouldn't be a bad one) but in your case I feel fairly certain it will start to slow over time, depending, to a great extent, on the fitness level you manage to achieve.

The pain, since it seems related to fatigue and breathing, is probably inflammatory in origin. Again,this sort of thing is fairly common post thoracic surgery in particular, since so much has to be forcefully moved around (even in minimally invasive operations). You might ask your doctor what would be an acceptable anti-inflammatory to use in combination with your anticoagulant therapy.

Good luck and stay in touch.
 Geordie97 - Sun Jan 18, 2009 1:31 pm

Thanks John. Actually, I'm already on Celebrex, among my many prescriptions that I take. As far as fitness, I do need to work on that. I'm a volunteer firefighter and a Federal LEO so I need to be in shape. I've noticed that my fatigue level is much lower than before. I am back to bowling, walking a lot (and relatively quickly...I do about a 12 minute mile) and riding the motorcycle (don't say it...you are an EMT and I work rescue and should know better, especially on coumadin but...!!). I will update my profile with my meds so you can see what I'm on.
 John Kenyon, CNA - Mon Jan 19, 2009 5:42 pm

User avatar You're welcome!

The Celebrex should be fairly effective where this is concerned. If it's not, then this may be worth a second look. Then again, if you were already on that med when this started, it could be that it would be worse had you not been taking Celebrex. Still worth a second look.

I don't see anything else in the updated meds info that might be affecting this one way or the other.

As for the motorcycle, one of the great pleasures in life for a lot of people, and your riding would at least fall under the heading of informed consent. You know what you're doing. Otherwise you seem to be doing very well with your fitness program. A 12-minute mile is pretty brisk.

All in all, other than this intermittent pain, it sounds as though you're doing great. Keep up the good work and keep us updated as well.
 Geordie97 - Sat Aug 22, 2009 2:39 am

Hi John,

Well, it's a number of months later and, all in all, I'm doing great. I did get to read my surgical report and when they removed the aneurysm, it was at 5.7cm so it apparently was growing and it was a good thing we did the surgery when we did.

I do have another problem and though it's in my chest, I don't think it's cardiac related but wanted your opinion. I have a spot just at/under my 7th rib on my left that is quite painful. At times, if I move wrong or stretch, it's almost as if a knife is cutting in to me. That may last up to a minute (though it feels MUCH longer) and then goes back to a dull pain. It is tender to touch, causing a sharp knifing pain also. The spot is about 1.5" from my sternum. I thought about the possibility of costochondritis but it doesn't seem to be in the right place for that. I don't think it's any of my organs as I'm not having any other symptoms. It almost feels like a cracked rib but doesn't really hurt any more with a deep breath. Any suggestions????

THanks
 John Kenyon, CNA - Fri Aug 28, 2009 8:21 pm

User avatar Your new pain is definitely not cardiac-related, although my be indirecty related to the surgery or at least is musculoskeletal in origin. Because it is highly localized, lasts only a brief amount of time and is tender to the touch, it only qualifies for this classification of aggravation. Could still be costochondritis, but also could be either a cracked or stressed rib or could be inflamed muscle. It in no way resembles cardiac problem or even any internal organic problem. If it doesn't go away shortly it will probably respond to something like ibuprofin or naproxyn, although because of your history you probably would be wise to ask your doctor about use of either of these before buying some. It would likely be fine, but there are some considerations that make them less than ideal. Still, if it's not too bothersome it can probably just be left to run its course.

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