Totally OT: My echocardiogram

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For those who have been following my open-heart surgery saga…

I had a surgical arterial valve and ascending aorta replacement almost a year ago – in November 2024, age 70. It was a bear of a surgery (compared with my previous splenectomy, hysterectomy and bilateral mastectomy). I was on oxygen 24/7 in the hospital for 9 days due to a pleural effusion and partially collapsed lung that cut my lung capacity to 500 cc. I was terribly weak for months afterward. (According to Google Gemini, this weakness is due to the heart-lung machine destroying blood cells that take months to be replaced.)

I pushed exercise as far as I was able. I did cardiac rehab from June to July 2025.

I had an echocardiogram last week. Here’s the result.

Conclusion

Normal left ventricular ejection fraction calculated at 59%. [Normal is 50% - 70%]

Mildly increased septal wall thickness. [That’s probably age-related and causes a little heart stiffness.]

Grade I diastolic dysfunction, normal left atrial pressure.

Well seated bioprosthetic aortic valve (25mm Bioprosthetic AVR - 11/2024).
No regurgitation or paravalvular leak. [That’s the key good news!]

Upper normal transprosthetic gradients (peak aortic valve velocity is
2.3 m/s, EOA 1.5cm2. DVI 0.46. AT < 100 ms).

Normal right ventricular size and systolic function.

Normal estimated right-sided pressures. [end quote]

Basically, it’s normal except for a little age-related heart stiffness.
But I will have to dial back my exercise intensity because my heart is
filling with blood a little slowly and the flow rate through the prosthetic
valve is on the high side even at rest.

But overall the news is good. :slight_smile: I don’t expect to see my cardiologist for another year. I’m taking metoprolol, aspirin, a statin and Co-Q10. Plus d-ribose for energy. I’m beginning to feel more like myself again.

This was a huge investment that will hopefully pay off with 15 years of life (according to my cardiologist). Assuming I don’t get cancer or another fatal illness, of course.

Bottom line: don’t have open-heart surgery unless your life depends on it.

Wendy

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All good news, especially that.
Here’ s to at least 15 years!

Spot

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Wendy,

Congratulations on the good results!

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Grand news, Wendy!

Like, dh, you’ve got an aortic valve that’s younger than the rest of the chassis. Those regular follow ups are important, though, as stuff can still trend south even with the best self care…..as in dh’s development of HALT just in time for what should’ve been his last echo prior to “no more appointments necessary unless there’s a problem” (the irony of that statement doesn’t escape me given our collective experiences with late diagnoses because we appeared to have no problems)

About that exercise, though….the “cutting back” doesn’t mean low value exercise but rather weaning yourself off the high intensities/higher heart rate stuff and embracing Z2/MAF/low lactate training for its value rather than seeing it as something that’s “too easy”. It’s still too much of a challenge for me right now with my FPTTD (I’ll leave the F to your imagination) but getting fitter, stronger, and faster at that 110-120bpm heart rate range is my goal for the future.

PS:…..the intervention cardiologist’s aim for both of us is to help keep us in shape for the oncologists

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Getting fitter, stronger, and faster at a 120-130 bpm heart rate range is my goal for the future. But I will stop doing the stuff over 130. Not to mention up to 150. Though a momentary excursion now and then probably won’t kill me. :wink:

I really have to do the fancy fast footwork in Zumba to push away Parkinson’s. I have a gene that causes Parkinson’s and at least 3 of my cousins had it…but lived to their late 80s. Studies show that complex exercise can delay the onset of Parkinson’s symptoms. So I really need to push this.

I’m sorry that you are suffering from FPTTD. What does “F” stand for?

Wendy

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The adjective I use to describe it most days still. The word that would get the post pulled😉 "

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It’s a verb.

:hugs:
ralph

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Hmm.
I have my CV issues - CT score greater than 500. Ejection fraction is north of 75% though.
I went hiking yesterday. Climbed up to around 11,200 feet. Total gain 3,300 feet. 11.5 miles round trip. On the steep parts my heart rate was 140-150 bpm. Maybe more? Not sure. I was wondering if I was flirting with disaster. Hope not. Cardio appointment Dec 1, I’ll ask then. It does make one nervous. Why is it necessary to stay below 130bpm?

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Every one of us is individual.

I would not have been able to do the hike you did yesterday. Especially since you were hiking at high altitude.

Question: Did you have any cardiac-type symptoms? Chest pain, shortness of breath (taking the thin air into account at high altitude), unusual fatigue (more than your would expect given your age and current fitness), swelling in your legs?

Optimum heart rate depends on many factors, including age. I’m 71 years old with a prosthetic aortic valve and aorta which might potentially have a problem with a heart rate of 140 - 150. For example, Perplexity said that the prosthetic aorta isn’t as elastic as a natural aorta so there might be a back-pressure during a high heart rate that could potentially damage the left ventricle.

My cardiologist told me to keep my heart rate at 70% of my age-adjusted max which works out to 109 bpm. That’s not even a warm-up for me, much less a workout. A “Zumba Gold” type workout with moderate-paced music gets me 120-130 which is what I think I need to stay fit. But I did a HIIT workout with weights today and got up to 150. OOPS! I felt fine, not even tired. But that’s clearly way outside the recommended parameters.

Listen to your cardiologist. Your parameters will be different than mine.

Wendy

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Thanks for the reply Wendy. No to all of those. I feel the same as as I always did. Well, probably not as in good of condition as my 20-30’s, but not bad at all. I’m 62 now. My worry is my heart is thumping away and one of those calcifications breaks off in my LAD and pffffft - game over. Especially in the middle of nowhere.

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If (God forbid) that happened it would be game over no matter where you are.

My secretary’s husband dropped dead of a heart attack right outside my office. I heard his head hit the floor and he was gone in less than 10 seconds.

If your cardiac arteries are that close to being blocked you should be getting a stent(s) or bypass surgery. But blocked arteries can cause all kinds of problems, not just sudden death.

First stop, cardiologist. Next stop, echocardiogram and/ or CT scan. Then angiogram. You will also want a scan of your carotid arteries (don’t forget your brain!).

Blocked arteries can also cause gradual heart failure. Don’t want that.

Please follow up and take care. It’s a drag but you can’t solve a problem if you don’t know what it is.

Wendy

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@Volucris….. I think you have the wrong idea of cardiovascular physiology. You are not alone, so…..

Coronary calcification doesn’t mean that your coronary arteries are lined with calcium deposits…..like, say, the buildup on the inside of a kettle in hard water areas. The calcium giving you that high CAC score is “calcified” plaque……i.e. the scar tissue that forms to stabilize the soft plaque that forms early on in the ASCVD process. This (the soft vulnerable stuff), is the plaque that’s prone to rupture and that you need to be concerned about WRT sudden cardiac death. This is the plaque that a CAC scan does not detect

if you’re on an aggressive lipid lowering regimen, the rationale is that you’re halting the formation of soft plaque at its root cause. Possibly causing regression (apparently with sturdy evidence that this does happen) but, even if not, allowing time for any soft deposits that may still remain to stabilize. Absent tell tale signs of chest pain….at rest or exercise…..enlightened thinking suggests that stent placement is usually contraindicated.

I’ve posted my own shock horror moment of getting a very scary result following my CT angiogram on a Sunday evening (CTA on the previous Friday morning) and imagining at least stent placement or coronary bypass surgery……to be followed by a phone call from my intervention cardiologist next morning to apologize (he has no control over this foolish practice of sending out unvetted results without expert insight)….and to reassure me that my perfectly reasonable fears were unfounded. This was in addition to the already scheduled visit the next day. Apparently it’s a frequent occurrence. The radiology department is very efficient :roll_eyes:

I’ve posted links to articles and podcasts on this very topic…..starting at the early pathogenesis of ASCVD…..complete with photos of electronmicrographs of the process. So many times, in fact that I am willing to bet that one or two have done an eyeroll (and they know who they are). You shouldn’t have missed them.

I was going to respond to correct your idea of what your heart rate means (or, rather, doesn’t) I thought this was more important.

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I have a 163 CAC score. Two cardiologists have looked at the imaging and said I have no plaque. My calcium is spread out. It is very thin, might as well be just staining in the arteries. Like staining on teeth with age.

The 75% number mentioned paints a different picture. It tells cardiologists that plaque is forming. The CAC imaging has some insight into that typically but it is rudimentary.

I have looked at my imaging. The cardiologist said, “There is no plaque as you can see”. I had no clue what I was looking at, but he certainly did.

I have backed my trigylcerides down from 380 to 80. I do not have sugar problems. I no longer have a BP problem. I am continuing to improve those numbers and working on the weight.

Other than that I am getting older.

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If those cardiologists were looking at a CAC scan result, of course they saw no evidence of uncalcified, “soft” plaque, since a Coronary Artery Calcium scan is powered to detect calcified plaque. With modern equipment, it’s certainly possible to spot the newly forming stuff if it happens to be obvious but the adage of “Absence of evidence is not evidence of absence” still holds here.

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You must be my third cardiologist.

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For anyone interested….or who ought to be….. a longish read. Especially if you follow up on the hyperlinks. I’ve followed this page for a few years (before I realised that the reassurances being given to me about my cardiovascular health had an increasingly shaky foundation) and it was one of a few drivers to my decision to request more advanced testing…..including, but not limited to, a CAC scan

The Skeptical Cardiologist’s Guide To The Coronary Artery Calcium Scan Updated for 2023 – The Skeptical Cardiologist https://share.google/BRzdNhuczCVbGVYOS

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As this article should emphasize, although ASCVD tends to show clinical features with advancing age (I was diagnosed shortly before my 70th birthday) it’s a disease process that has its origins years….decades, even….before.

Much like other disease processes that build along a trajectory with a departure from healthy homeostasis beginning in the teens…..or earlier.

From my own field, for example. Periodontal disease. By the time someone (dentist, hygienist, you……or anyone within sniffing distance) actually notices the clinical signs and symptoms, you’ve got a preventable disease that’s already well established.

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@WendyBG @VeeEnn Thank you. I have seen a cardiologist. He didn’t seem to concerned. Definitely did not see the need for an angiogram. But we did lower my LDL to <20 mg/dl. It was less than 100, then <60, now less than 20. I see the cardiologist every 6 months. Due again in December.

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@Volucris…..well, if he’s going for this level of lipid reduction, it seems to me that he’s concerned enough. The thing with a CT angiogram (and note the CT…..it’s not the more invasive catheterization, although you get a hefty dose of radiation and the “risk” of the contrast medium) is that it seems to be a logical next step in disease risk stratification. Mine also included an eFFR….estimated Fractional Flow Reserve measurement. Evaluates the flow rate through the coronary arteries and how well the cardiac tissue is being perfused. It strikes me that this is something worth knowing….possibly more valuable than ejection fraction?? Although, I guess, if you ignore the first for long enough, you’ll have cause to be concerned about the second.

Mine was actually low enough that in Olden Times (6 or 7 years ago) your averagely hungry intervention cardiologist would’ve had me lined up for a stent. But, with no symptoms (probably developed a decent collateral microcirculation with all that exercise) a nuclear stress test showing healthy functioning myocardium, and an LDL-C almost as low as yours, it’s “carry on doing what I’m doing”

FWIW, there’s a degree of having to trust the process too, apparently. I did ask a couple of appointments ago if repeat CTAs are would be a good idea (thinking it might be an objective measurement of all this pill taking and injection stabbing was “working”) Apparently not as, the degree of prediction for MACE isn’t clear enough to warrant frequent exposure to the higher dose of radiation.

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Additionally….and before you ask (because I asked this too)…..there doesn’t seem to be any sort of evidence based exercise regimen that can be shown to promote optimal collateral circulation production. You’d think there’d be something more than historical references to Heberden’s wood sawing patient to go by….

The Health Benefits of Exercise – A Critical Reappraisal | New England Journal of Medicine https://share.google/3lcpmLGKpIwcZ1eSS

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