Heart enlargement -

[Christina L]

As most of you know, my (post heart surgery) world was sent into a spin last November 1 with an echo showing "mild right atrial and right ventricular dilatation."

Okay, many second opinions later of "there is no enlargement, the chambers are upper limits of normal, etc.," I saw my PCP this afternoon and read some of the letters that were sent to him from the cardiologists about my heart.

They all pretty much say there is upper limits of normal size of the left atrium, right atrium and right ventricle - also that the "left and right atrial chambers appear to be between 40% and 50% of the volume of the ventricles." (this last statement sounds really scary to me - any interpretations?) I was told by another second opinion cardio that my heart has always been this size and it is subjective how a cardiologist wants to interpret things. This same cardiologist told me the heart was enlarged from all the years of moderate regurg (which it was moderate all through my 30s and into my 40s (had the surgery at age 44) and that is might shrink down some and may not - but it took years to get it that way and may take years to revert in size.

I am wondering if this is common in valvers - the heart size overall being enlarged. I always thought it was just the left atrium that enlarged from MVP or eventually the left ventricle. BTW, my left ventricle is fine.

My take on all of this is that I can't do a darned thing about this - just watch and wait - my heart will continue to enlarge, stay where it is (which is what one of the docs said - that it has been this way for years) or maybe even shrink down in size a bit. AND basically I shouldn't worry because it is going to get me nowhere.

I see the pulmonologist this Friday regarding my desaturating at night. My PCP told me today that who knows, the pulmonologist may think it is nothing to be concerned about.

Also, to add insult to injury, I am having more frequent flutters and arrhythmias of my heart. Are they from nerves or is it a self-fulfilling prophecy being that my cardio asked me if I was in a-fib as my heart was enlarged, I think implying that it was inevitable that I will go into a-fib.

Any comments or experiences (on heart enlargement pre and post surgery) would be most helpful to me right now - and prayers that I will be strong and accepting of whatever I'm told on Friday.

P.S. Both letters that I read today state there is NO pulmonary hypertension. I hope to get an x-ray on Friday and a definitive no from the pulmonologist on that issue.

Thanks everyone.

P.S. Ever since going on the oxygen while sleeping, I am having lightheadedness (not dizziness) during the day when I turn my head a certain direction. The PCP had no clue what this is from, nor did the cardio. Someone suggested stress. Any thoughts?

Christina L

[Karlynn]

Christine, I'm wondering if your light-headedness maybe do to sinus irritation from the oxygen. I have sinus issues and will sometimes get dizzy or light-headed when they are irritated. Since the whole sinus/inner ear can go hand in hand, that my best guess.

[Christina L]

that is a thought. I know I have constant postnasal drip from allergies to our cats. That could very well be the culprit.

Any thoughts on my upper limits of normal heart size?? :) I hope someone on VR.com can reassure me about this.

Christina L

[Phyllis]

that is a thought. I know I have constant postnasal drip from allergies to our cats. That could very well be the culprit.

Any thoughts on my upper limits of normal heart size?? :) I hope someone on VR.com can reassure me about this.

Christina L
Christina,
I think "upper limits of normal heart size" are the operative words here. Concentrate on the fact that it is still in the normal size range, always has been and probably will stay that way or get smaller.
All in all, it sounds like a great report. :)

[tommy]

Christine,

Don't know about the enlargement issue - wish you well. Phyllis makes a good point.

I started nasal irrigation a couple of weeks ago. Light saline solution. It's a little "uncomfortable" in the beginning but seems to help. My post nasal drip kept turning into something bigger. So far so good with the irrigation.

[Natanni]

Hi Christine

Nathan has "Cardiomegally" on his post-op discharge papers. It was known to us that his left ventricle had continued to enlarge over the last 5 years. About a year and a half ago, he had some changes that sent warning flags up that he was heading down the same path as his father, a transplant recipiant for an unspecific cardiomyopathy, with cardiomegally. I don't have Nathan's specific numbers on me at the moment, but would be more than happy to look them up for you. They Mayo felt that Nathan's overall enlargement was simply due to his aortic valve regurg which was moderate-severe, and that they had all hopes that all could be reversed with surgery. At his 3 month post op visit, his ejection fraction was worse following surgery, but he had been in atrial fib three times, and they were very specific about not wanting him to go back into a fib, feeling this was also related to the decreased ef. Nathan has 29 mm Carbomedics valve, which is definately on the larger end of the spectrum, and I am thinking this was relative to his heart size as well.

I will have his paperwork here on hand if there is anything specific you want to know. Ann

[OldManEmu]

Christine my heart was "huge" and this is my cardio’s description before surgery and the surgeon report described it as "grossly" enlarged. My LV especially was grossly enlarged internal dimension was 80mm; normal upper limit is 58mm. AVR Surgery was 11/2004 and my heart size and function has now returned to normal and the LV internal measurement is 46mm. The cardio was most surprised that my heart had been able to remodel back to normal after being so enlarged. :)

[Christina L]

and giving me some idea of what others on VR.com have had in the way of heart enlargement. I was beginning to think I was the only one. Ann, I'm sorry to hear about your husband, but maybe things won't progress any further.

Old Man Emu, congratulations on your heart going back down to a normal size! That is so great for you.

I have been told over and over that my heart has always been somewhat enlarged (the left ventricle is fine as far as I know) due to the years of moderate to severe regurgitation and the heart working so hard. I never held back on exercise or hiking mountain trails in all those years - I would pant and pant with exertion but would trudge on. So....my poor old heart had to compensate somehow.

I just hope I will be as lucky as you, OME (mind if I call you that? - hee) and my heart will start to at least shrink down a bit.

Right now it is all about mind over matter for me. I can't continue to worry about things that haven't even happened, as I am missing out on today.

Guess this is just all so much more scary as we are in the midst of the adoption process from China and I want to enjoy raising a little child, not be a burden to her OR to Wayne. At the doctor's office yesterday, I picked up a Working Mothers magazine (thought I should get an idea of what I am in for - ha) and just opened the magazine randomly to the middle and there was a story on a gal with cerebral palsy who had adopted a little girl from China. I think God was trying to tell me something. :)

Thanks all.

Christina L

[Christina L]

Are there any herbal or vitamin supplements that you take for your heart - have you been regularly exercising since your surgery and if so, what kind?

Thanks.

Christina L

[mmarshall]

wow oldmaneu....i thought i was one of the few/rare huge hearts out there. when they opened me up my lv was at 83mm and went down to 71mm by the time they closed me up. they were not sure if my heart would ever get back to it's normal size. i had my six month check up about 3 months ago and my lv was 58mm. the lv is in the normal range but there is still some restructing we are hoping for....ejection fraction, etc. i just figure that even if it never gets back to "normal"...i will just have a big heart...literally....i guess we all will. :)

[Emma]

Christina,
I know its different cos shes only small but Chloes heart was enormous at VR time - it was beating down in her abdomen and there were thoughts that it might not get back to normal even after VR. Luckily, after a couple of years it was back down to the 'upper end of normal', as yours. She started taking enalapril and a year later, its down to normal. She remains on enalapril to prevent it enlarging any more due to her two leaks.
Just sharing and empathising!
Love Emma
xxx

[Christina L]

atrium are the two chambers that tend to enlarge with valve disease, but what about the rest of the heart?? Is there anyone with an enlarged overall heart also? Like I said, all of my chambers are upper limits of normal size, except for the left ventricle.

Christina L

[Emma]

yep, Chloes was enlarged overall

xxx

[Christina L]

I have asked the cardios if there is any med that I can take that would take the stress off of my heart and they adamantly refuse to put me on any meds until absolutely necessary. Besides we tried calcium channel blockers, etc. for my PACs and they didn't work at all - just insanely lowered my blood pressure and my heart rate which is too low the way it is.

So glad to hear about Chloe - bless her heart! :)

Christina L

[mmarshall]

just a little fyi...not sure if this applies to everyone...but my cardio informed me that it usually takes about a year after surgery to see the full results. it takes about a year for the heart to "restructure"...get back to normal...if it is going to. did not rule out that there may be small improvements over time after a year...but for the most part...12 months post op was the time frame i was given.

[Emma]

We were told that too - and Chloes heart was down quite a bit within the year but did take 2 years to come right back down to normal size - it was massive though!
xxx

[mmarshall]

christina....my cardio has me on 25mg of coreg and 20mg of lisinopril for that exact reason...wants to take the stress off of my heart and help it get back to normal. it does do a number on your blood pressure so i'm not sure if that is an option. according to him....coreg is the wonder drug for the heart...but i think it is in the "wonder" category because it is not cheap..lol but seriously...it does appear to be helping me in my case.

[Christina L]

on her side. I pray that her heart will rejuvenate 100% and just be as good as new and serve her well for the rest of her LONG life!

Now my "old" heart may be a different story, but I am praying and hoping that if it can shrink back down a little, that it will, even if it takes a while. I just don't want it to keep going the other way. :(

Christina L

[Christina L]

I'm so glad for you also - that the meds are helping to calm your heart down so it won't work so hard, and the heart size is becoming normal again.

Isn't it interesting how all cardiology groups are different in what they prescribe or want done for a patient?

I will ask my cardio again about meds and see what he says. Right now I am being tested for hypothyroidism. Oh goodie. ;) BUT, hey, if it is a reason for the arrhythmias, the sleep apnea, the "possible" heart enlargement, then maybe we can do something about all of these things.

Thanks again for the posts everyone.

Christina L

[Christina L]

and my heart isn't really budging in size at all. I know they can shrink back and they may not. My cardio also told me that many, many older folks die with a moderately enlarged heart that wasn't affecting them at all.

I think it is wild how Lance Armstrong's heart is 30% above the normal size of a heart. That just doesn't seem healthy, but for him, I guess it is.

Christina L

[Rain]

Girlfriend you gotta not let stuff stress you out so much! :eek: I know stress definitely makes my a-fib worse. I also know it's easier said than done (the stress stuff) .... but I worry about you worrying too much. :eek: That’s sort of a weird statement, isn’t it? :confused: :D But it’s true.

My heart was enlarged before surgery and still is. My cardio says it’s because my heart was screwed up for so long before we put in the mechanical valve. It always will be. I think there are alot of people with enlarged hearts.... and it sounds like yours is still within the 'high-normal'. I know how you worry.... try not to. :)

Congrats on getting a baby from China!! I bet you’re excited. I’m gonna be a Grandma soon!! I can’t wait!

[Karlynn]

It would be interesting to do a poll on heart enlargement. I would guess that a good portion of us have some enlargement.

Mine is slightly enlarged (past upper normal limits), but like Rain, it's because I went along time w/out the surgery fix. It hasnt stopped me from working out and leading a rather busy life.

[Christina L]

now I am worrying about you worrying about me. ;)

Thanks for sharing your experiences. I think what has shocked me is that I NEVER heard this before - that my right atrium and right ventricle were upper limits of normal size. It was never mentioned before just that my left atrium was upper limits of normal size. So, I am just kind of unsure if it is starting to enlarge or if it has been that way all along and no one bothered to mention it because they didn't think it was a big deal.

I think it is pretty clear from what you all have said that MY enlargement was probably there all along - as most of us on this thread had mitral valve problems and I would guess most people have the same things happen with their heart who have the same valve abnormality.

Anyway, I will try not to worry Rain!! Yes, we are excited about having a child, but very, very scared (and worried) :eek: - too. You know, I just have to have something to worry about all the time, otherwise I am bored. Ha. As it stands right now, we will be going to China to get "Emma" next February - God willing - and if all goes smoothly with the dossier and the Chinese Consulate side of things.

Congratulations Rain on expecting your first grandchild. I hear that is the BEST - you will be getting that bumper sticker that says "If I had known grandchildren were so much fun, I would have had them first." :) Post photos and an announcement as soon as the little bundle of joy arrives. I am really happy for you.

Thanks, again, everyone for your answers to my questions on this thread.

I know having an enlarged heart is not unusual even for a lot of healthy people and like my cardio said, there are 85-year-olds with moderately enlarged hearts who do just fine and have lived that way for years and years. So, we're all gonna be okay - we just have more love (larger hearts) to share with others.

Christina L

[Natanni]

Nathan's entire heart was enlarged. He was also put on the generic Coreg and Toprol, to minimize any further enlargement. Toprol was also for his atrial fib, but his cardio also said the combo of these two would give maximum effectiveness in reversing this damage, or preventing any further....as mmarshel mentioned.

Congrats on your upcoming adoption!! How exciting!!! You will have to keep us posted on all of the exciting dates to come!!!

[Harrybaby666]

I have "Hypertrophic Cardiomyopathy" which means that my heart muscle is growing "extra fibers" due to genetics and therefore stiffening the heart muscle, and the SPH (Secondary Pulmonary Hypertension) and Sleep Apnea in my case, have caused my ventrical (left side) and atrium (again, left side) to enlarge, now as for the right side, I still have to find that out after I see the Pulmonary Hypertension Specialist next week and hopefully, he will do a right heart cath and let me know if things have progressed....This is just what has happened to me personally...just wanted to share this in hopes that it might help you in some small way....God knows that I hope that this isn't the case with you, and that you are doing terrific, and I am routing and praying hard that you get some solid answers and soon. Harrybaby:D :D :D

[Harrybaby666]

Girlfriend you gotta not let stuff stress you out so much! :eek: I know stress definitely makes my a-fib worse. I also know it's easier said than done (the stress stuff) .... but I worry about you worrying too much. :eek: That’s sort of a weird statement, isn’t it? :confused: :D But it’s true.

My heart was enlarged before surgery and still is. My cardio says it’s because my heart was screwed up for so long before we put in the mechanical valve. It always will be. I think there are alot of people with enlarged hearts.... and it sounds like yours is still within the 'high-normal'. I know how you worry.... try not to. :)

Congrats on getting a baby from China!! I bet you’re excited. I’m gonna be a Grandma soon!! I can’t wait!


When is your grandbaby due? I am going to be an "Uncle Harrybaby" for the first time in May, and like you, I CAN'T WAIT!!!!!:D :D :D :D My prayers and best wishes for a BEAUTIFUL new grandbaby for ya!!! Harrybaby:D :D :D :D :D :D :D :D :D :D

[MelissaM]

Hmm... sounds like your Worry Gland is way more enlarged than your heart - keep an eye on it before it gets into the danger zone! ;)

[Christina L]

You are too ornery, but you are probably also too right!!

I will have the doc check my worry gland next time I'm in the office. Come to think of it, you know (I) probably REALLY have such a thing. Hee. :p

I hope all is well with the new doggie that you adopted from the Humane Society - you are a good person for doing that, you know!

And Harry Baby thanks for the advice and telling me about your condition. Also congrats on soon to become a new uncle! There is nothing like that either!! I have been told over and over that I don't have pulmonary hypertension. I am now honing in on hypothyroidism as a possibility. We will see. The pulmonologist's visit is this Friday. I will let you know ASAP what was found.

Christina L

[distances]

I know the worry reflex lies very close to the surface, but try not to worry any more than you absolutely have to. I think "high normal" is really not so bad. When it comes to health, I love anything with the word "normal" in it. I know it's difficult, but try to focus on the fact that your 2nd opinions are not talking about another surgery. When is "good enough," good enough? To me, it's anytime a dr. uses the word "normal."

Your recent encouraging words when I was panicing after my cardio told me I had leaky valves (2 yrs. post-surgery) really helped to put my situation in perspective. You were correct, of course. I ended up not needing a second surgery, and so what if my valves are a little "leaky." It may not all be perfect, but for me it's good enough.

Lightheadedness experiences: I got lightheaded when I first went on beta blockers, but it went away after a short time. One doctor told me most meds have some kind of lightheadness or dizziness as a side effect. I also get lightheaded from lying in one position too long and my eustastian tube fills up and causes inner ear problems. In any event, if it were me, I'd continue to press the dr. about the problem or consider getting a second opinion. You deserve to know the cause.

My prayers are with you on Friday. Congrats on the adoption process in China!

[OldManEmu]

Christina don’t worry about calling me OME I have been called a lot worse. :D I was in Left and Right side heart failure before surgery. The Left side performance was so bad things were banking up through the lungs to the Right side of the heart causing that to fail. I was a mess; I couldn't have the Ross procedure that had been planned for because my heart function was so bad and the operation had to be delayed a week while the CHF was treated. After treatment for the CHF started and the AVR was done my Right side heart function had returned to normal 6 weeks post AVR. It took a further 12 months for the Left side to return to normal. On admittance to hospital the LV was 80mm, three days post operation it was 75mm, 6weeks post op it was 65mm and at 14 months it was 46mm. As I said the cardio and surgeon were amazed that it returned to normal. You should see the greatest improvement in heart function and remodelling in the first 12 months, it can continue to go on after this. I do not take any vitamins or herbal supplements specifically for the heart. I have taken a number of heart drugs over the period post operation; these have been reduced as my heart has improved. The only drug I now take is 4 mg Peridopril an ACE inhibitor and 100mg Aspirin. I do exercise; I started walking everyday after I got home from hospital. At 6 months post operation I started lap swimming several times a week (I was a lap swimmer before this whole heart mess started) and at 9 months I started at the gym. Since I started at the gym my training routine has consisted of 4 gym session a week and 1 swim. The gym is cardio work and moderate weights. As for Lance Armstrong he would have athletes heart this is a recognised by product of his extreme aerobic training, it is common in elite athletes in these types of sports. As far as your heart size goes I think the important thing to focus on; seeing it is still within normal size is if it is getting larger over time. If the size is stable and the function is good I wouldn't be overly concerned. Given you live in Colorado at high altitude your heart does have to work harder. I would ask the cardio how much this high altitude is impacting your heart. :)

[Christina L]

Wow you really had a miracle happen with your heart! That is fantastic. I would say, though, that your consistent exercise really helped. I have to admit that after a certain point after my surgery, I was exercising maybe 1-2 times a week, if that, feeling that I was home free. I don't know if the lack of exercise has anything to do with things or not.

I do worry about the altitude we live at - we live in the mountains at 7700 feet. I have asked the cardio and he says it makes no difference - he only sends people with lung problems to sea level. I deliver Meals on Wheels here in Estes and practically 100% of the people I deliver to are wearing nasal cannula oxygen - some are smokers but most are not - of course they are very elderly people. When I look at them, I see myself in 10 years, and I will only be 56 then.

I want to move to a lower elevation, but at 4700 feet there is just 10-15% more oxygen - I am wondering if that would make a difference or not.

I know another couple - he had aortic valve repair (they were in their 70s) who moved down to a lower elevation here in Colorado right after his surgery as she said, "It's a no brainer that living up here is hard on the heart."

Unfortunately my husband is really making things hard - he does not want to move - that is a personal issue, but it really bothers me that he is putting his precious mountains before his new wife's health. Again, another issue, and one that is not good for my heart either. :(

From what I gather, the cardio has said the size has stayed stable over the years, but I am just confused as my echo reports read "normal" right atrium and right ventricle two years ago before my surgery. Now the report reads "mildly dilated." I guess maybe upper limits of normal is a real subjective thing.

Thanks OME!!

Christina L

[Karlynn]

Christine, don't forget that, to a point, echo interpretation is subjective. This is why there are small discrepancies in your echos. I would consider a heart size of "upper limits of normal" a victory if your doctor is saying it hasn't really changed over the years.

[Christina L]

Good things to remember and I will try. I just feel I am in a tailspin right now - after two years of smooth sailing after my surgery, I was blindsided by that darned echo report last November. The tailspin is slowing down a bit, but I am still left wondering what the heck is going on, especially as I am now wearing oxygen at night.

Your words are always comforting and I appreciate them very much.

Have a great day!

Christina L

[Rain]

I’ll be worried about you worrying about me worrying about you!! :D

I do see your point about not knowing if it was always enlarged or if this is something new. Can you call the cardio and ask him?

I’ve been meaning to make a spreadsheet to track my echo results. Didn’t we talk about that one time in the forum a long time ago? I wonder if anyone ever made one?

Wow... so you already know the child you will get?? That's really neat!

Harrybaby.... I’m due to be ‘Grandma Rain’ on May 17th ..... scooooot over Granbonnie! :p :D We can celebrate together, Harrybaby!