Mechanical Valve Cavitation

[Bill719]

Hi all, I'm new to this forum and hope to gain ongoing insights from each others' experiences.

Following an unsuccessful MV repair in 1997 I had it replaced at Cleveland Clinic in 1998. Recovery went well, and I've resumed a very active lifestyle, including a 3mi/day running regimen. However, after 3 years I still haven't gotten back to my old form, and run out of breath prematurely. Stress echo shows that the valve is performing as it should, with no leakage. However, there is quite a bit of "cavitation"...a phenomena which creates water vapor in the blood due to the valve closing rapidly and creating a pressure drop on the entry side. I'm told this cavitation is probably what's affecting my running performance.

Furthermore and of even greater concern, is that even though I'm on a high coumadin dose with typical PT levels of around 5, I still experience occasional "splinters" in my thumb fingernails.... these are small clots. Cardiologist seems clueless, but thinks the cavitation may be contributing, and recommends I moderate exercise. What I mainly want to understand is the clinical cause of these splinters, and what risk level I'm at, and recommendations on lifestyle changes that are based on fact rather than speculation.

Any one have any ideas or similar experiences?

Thanks

[Hank]

Hey Bill - Could you elaborate on what exactly "splinters" are? I may or may not have them because I don't have the foggiest idea what they are.

[Bill719]

Hank-- the "splinters" are actually little blood clot flecks which appear under the fingernail along the capillary. They look just like you jammed a splinter under your nail, only they begin to appear farther back along the capillaries. As my fingernail grows out, the splinter follows until it disappears.

I also have tiny blood clot "flecks" on the inside of my upper arms. Apparently, something is causing these micro-clots to form, flow through the blood stream, and filter out in the capillaries. The only place I've noticed them is under my thumb fingernails (both hands) and both uper arms.

Thanks for the interest... if you have any thoughts our leads, let me know.

Bill

[Hank]

That's wierd stuff Bill, I have not experienced any of that.

I'll keep my eyes out though.

[Caroline]

My mother Bridie, had AVR on 30 May 2001, made great progress until 27 June, when she had palpitations, She was admitted to hospital on the 29 June. But all of the doctors, were sure that she had a stroke (she didn't) and were very interested in the tiny 'splinter' found on her right tumb nail. They did not elaborate why, and weren't very keen to discuss it!

She's now out of hospital, 7 days later, very weak, and lacking the confidence that she had before this 'hiccup'. She's still got the 'splinter' and now suffers from aterial fibrillation every now and again - when I see her tonight I'm going to check for more of these 'splinters' and start some research into them..

Thanks for posting, Bill, if I find anything I'll be in touch

[Gillian (in UK)]

Caroline - I'm so sorry to hear your mother has had this setback. I do hope her A fib will go away and that you can sort out the splinter mystery. I had the fast irregular heart a little while after my AVR, but I am hoping it is now a thing of the past. I thought I was going to just sail through everything and it can be very unsettling when you have a setback. Sending you both my best wishes.

[Rain]

Bill,

I’ve never had ‘splinters’, but I do have little red spots on my legs & chest sometimes. The first time I noticed them my INR was 7.9! The doctor said the high INR caused the spots. Since then I see them even when my INR is only around 3 or 3.5 The higher my INR the more spots I have.

I also exercise three days a week for 45 min. non stop with my heart rate at 145 - 155 .... then I lift weights. What is strange about that is I have no problem with my three day a week exercises, but occasionally (not always) just walking to the mail box can make me feel tired and a little short of breath. I kinda think it’s the atrial fib. causing that... I’m gonna ask my cardio about it on Monday.

Rain

[Bill719]

Thanks to those who posted a reply... a couple of additional loose ends that may be of interest..

Gillian-- splinter hemorrhages are among the telltale symptoms of endocarditis. I'm sure thats why they took such an interest when your mom developed one. In my case, I have no other symptoms (high fever, red spots, extreme fatigue, etc.) so I know (and blood tests have confirmed) that this is not the cause in my case. Its still spooky though, since I don't really know whether they mean I'm at risk for stroke or other neuro-events. So far the only other symptom I have is occasional optical migraines, where an glimmering aura/blindspot develops in my vision for several minutes. These are still relatively infrequent though, and not all that bothersome.

Rain-- I read your reply with interest. I experience the same effect... I run 3 mi/day vigorously and religiously, but then a flight of stairs will leave me breathless for a moment or two. At one time I thought it was the Lopressor (blood pressure meds taken in low dose following surgery as a precaution against rhythm problems), but I've been off of that and still experience the same effect. I'm beginning to think that the mechanics of the valve just can't respond sudden changes in body demand for blood flow, and requires a warmup period. However, thats just a theory.

[Bill719]

OOps .... sorry.... just realized it was Caroline, not Gillian who's mom I was referring to in the last post.

Bill

[Susan in FL]

Hi Bill,

I had AVR almost 3 years ago and still get the optical migraines which I have had for years before. Never knew before, and am still not sure how they were related to the valve problem (congenital bicuspid). When I mention it, neither of my doctors seems too concerned. What kind of reaction do you get? It is not bothersome and doesn't happen often, but I've not specifically related it to the valve.

I can't speak to the splinters as I have not had that problem.

Hope all continues to improve! Good luck, Susan:cool:

[Caroline]

Bill719

Another thing about these splinters, is that I get them! On Sunday, noticed one on my left forefinger, and thumb. I get psoriasis, one of the classic symptoms is lifting of the nails. The nails thicken and lift away from the nail bed, not very pretty, but hardly anyone notices.
I knew I'd seen them before, but forgot it was on me! Just goes to prove, you don't need to go through an AVR to forget things!