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Forum Name: Valvular Heart Diseases

Question: aortic valve stenosis symptoms inexplicable


 Robbyha - Wed Nov 04, 2009 2:14 pm

Hi everyone,

I am 50 years old and i have a calcified aortic valve stenosis, bicuspid by birth, LVH, slightly insufficiency and slightly ST segment abnormalities.
AVA 1,1 cm2 and gradient 68mmHg.

I still can run and cycle for a couple of hours without any trouble.
Sometimes (weekly) there are symptoms like chestpain, on the left side, tight in the chest, shortness of breath and fatigue.

These symptoms appears mostly the time a couple of hours later AFTER an exertion when lying down and/or one day later.

Very typically and cardiologists can't explain, because they can't measure any kind of heart troubles like ischemia, cardiac arythmia and palpitations during a ECG, Echo or bicycletest. No valve leakage, no left ventrical fibrilation etc.

They told me that it's seems to be impossible that a heart can gets pain like musclepain when ischemia can't be measured.
Oke but i'am very sure it's not psychical.

Can anyone help me to find an answer?

Robby
 John Kenyon, CNA - Wed Nov 11, 2009 12:14 am

User avatar Hi Robby -- The symptoms you mention are actually pretty well-recognized in cases of aortic stenosis, especially where the outflow tract is compromised. Patients often tolerate exercise well but have some angina-like pain after the fact, and cooldown is extremely important for these patients at the end of exercise sessions. However, the pains you describe really doesn't sound especially heart-related, but rather maybe musculoskeletal. The other stuff does sound heart-related, though, and I don't know why this would be especially surprising since it's established you do have some abnormality of the aotic valve. You also have biscupid phenomenon, so need to be checked annually for possible dilation of the ascending aorta, but again this doesn't sound like its causing your problems.

This doesn't have to be psychogenic to be present. You may be having either orthopedic chest symptoms, delayed aortic outflow tract problems (which could be caught be echocardiogram but only if it were done while the symptoms are being experienced, which is pretty difficult to arrange.

I'd suggest you continue to follow this with your cardiologist, make sure your exercise is followed by adequate cooldown, and on days when you feel the discomfort, fatigue and shortness of breath, take it easy and maybe try to arrange to make it possible to be seen during one of these periods. It's not easy to get a STAT walk-in with a specialist, but I can think of no other way (other than going directly to an emergency room) to get this evaluated while it's going on. This latter may actually be appropriate and could be the simplest way of determining what's causing this and if it's a reason for concern or just part of your natural up-and-down.

Hope this is helpful. Good luck to you and please follow up with us here as needed.

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