new member question about dizziness

[Sheila]

Hi everyone. I am a new member and glad to have found this wonderful forum. I am 60 years old and been aware for a few years that I have a bicuspid aortic valve. We moved 2 years ago from Cleveland to Marietta, Georgia and had to find all new doctors here.
I did not have any symptoms as such that could be clearly related to the valve. However, last December, I experienced a wave of dizziness while seated in church,- the best way I can describe it is that it felt as if my system was shutting down starting with my head! But in a matter of 10 seconds or so I felt powered up again and I did not blackout!
I saw my cardiologist who repeated my echo which showed no change from an earlier echo, in the aortic valve area, which has stayed stable for a couple of years at 1.0cm2. Since this dizziness did not appear to be a symptom of the valve we decided to wait and see.
I was fine and had no further dizziness till the end of last month and again it happened while I was seated and at rest. I thought it might be from some other cause so I went last week to see my new primary care physician who wanted me to have an echo right away and not wait till October when it was scheduled. On the way home from the doctor's office I experienced another brief dizzy spell.
I had the echo done this week on Monday and I was pretty shocked to find out that this echo showed a valve area of .7cm2 I will be seeing my cardiologist on Monday to discuss this change. I understand that different techs and equipment and even dehydration may cause variations in the readings. I will wait to see what my cardiologist says and if he wants more tests done before deciding what next.
I was wondering if anyone else had experienced a similar dizziness with no exertion at all, and if that was seen as a symptom of the valve getting worse?.
Thank you for all the useful information you have posted on this site.
Sheila

[ALCapshaw2]

Dizzyness is one of those vague symptoms that can have MANY possible causes. You may want to do a Search to see what other members have had to say about dizzyness and heart issues.

Can you give a more detailed description of the Dizzyness?
Does the Room Spin? Do you feel like YOU are spinning? Or is it more a sensation that you are just not feeling stable / steady?

The Spinning Sensations can be a sign of an Inner Ear issue which is best diagnosed by an Otolaryngologist (Ear, Nose, and Throat Doctor).

If you haven't talked with your Cardiologist yet, I'm wondering how you learned that your Effective Valve Area is 0.7 sq cm...

FWIW, my Cardiology Group schedules their Echo checkups to occur just before the appointment with the Cardio so that he can review it and give his impressions during the same office visit.

FYI, many Cardiologists (and Surgeons) use 0.8 sq cm as their 'trigger' for recommending surgery so it may be time to interview surgeon(s). Atlanta has many good Heart Surgeons. Peachtree Cardiovascular and Emory University Hospital come to mind.

'AL Capshaw'

[dick0236]

Originally Posted by ALCapshaw2

Dizzyness is one of those vague symptoms that can have MANY possible causes. You may want to do a Search to see what other members have had to say about dizzyness and heart issues.

Sheila, I agree with Al. Ever so often, I have experienced dizzy spells that have turned out to mean nothing. I think it is a natural reaction for us to say "uh-oh, must be heart related". But, I have also learned here that....."when in doubt, check it out".

[Ross]

I encountered what I describe as periodic dizziness. I'd get double vision, feel like I was going to pass out and sweat profusely during those few moments of terror. It was because of my aortic valve. Since I had surgery, I've never had those again.

[Tbone]

Are you a diabetic or hypoglycemic? If so test your numbers right when you have a dizzy spell.

[Sheila]

Thank you all very much for your responses. It is so comforting to know you are all out there...
Ross,
I don't have the sweating or double vision with the dizziness.
What I experience is just an extreme sudden lightheadedness when I feel I will blackout but I have never actually blacked out.
I am not diabetic or hypoglycemic. I do suffer from migraines and wonder if it might be related to that rather than the valve.
As you said Dick the dizziness may turn out to be nothing.
But the otherthing ofcourse is the change in the valve area.
Al,
you were wondering who read the echo... it was a cardiologist. My cardiologist will be back next week and is being sent the film.

I have an appointment on Monday with him and will know then what comes next.
Will keep you posted.
Thanks again

[Eva]

Sheila,

I used to feel lightheaded on and off and my GP did not care for them since I did not black out and they were momentarily. I disregarded them too and related them to some tension, not having had breakfast, etc. etc., which we all do. WRONG! NO MORE lightheadedness since my surgery and I do believe now they were related to lack of oxygen being pumped properly from my heart to the rest of my body!!

Good luck, welcome to VR.com, and keep us posted

[JeffM]

Sheila,

Ever have migraines? Another possible cause.

[Sheila]

I do suffer from migraines and have wondered if that could be the cause.
But at the same time, I also have this feeling as in Eva's case that it could be related to "lack of oxygenated blood being pumped properly from my heart to the rest of my body"

Al mentioned that .8 sq cm was the trigger for surgery--With a valve area of .7 sq cm, I now have to accept that surgery may be soon, regardless of symptoms.

Is it routine procedure to have a cath prior to surgery?

[ALCapshaw2]

Originally Posted by Sheila

I do suffer from migraines and have wondered if that could be the cause.
But at the same time, I also have this feeling as in Eva's case that it could be related to "lack of oxygenated blood being pumped properly from my heart to the rest of my body"

Al mentioned that .8 sq cm was the trigger for surgery--With a valve area of .7 sq cm, I now have to accept that surgery may be soon, regardless of symptoms.

Is it routine procedure to have a cath prior to surgery?

Most Surgeons like to see a Left AND Right Heart Cath before surgery to look for signs of Coronary Artery Disease (i.e. blockages that may need bypassing) and to assess the Pulmonary Function (right heart).

They want to address ALL Heart Issues "while they are in there".

[delvalle6]

I agree with TBone. Glucose and insulin resistance issues can go hand in hand with cardiac issues. I've heard both that the blood sugar issues can irritate the heart condition and that the heart condition can mess with the blood sugar issues. I'm not sure which is the correct answer, but either way--after surgery the team keeps a close monitor on insulin and blood sugars to facilitate a smooth recovery.
Another thing that can cause dizzy spells and be more severe when combined with a heart condition is anemia.
So- if you are having dizzy spells- regardless as to whether you believe it is heart related or not, you should see a physician and get to the bottom of it.

[pamela]

I was told prior to both my heart surgeries to rise slowly, breathe deeply and sit down until dizziness passes. Are your nail beds blue-tinted, does the perimeter of your lips turn bluish, too? Do you see spots or other aura-like vision vagaries? Cyanosis is an indication that your heart isn't moving oxygen around efficiently so yeah, your dizziness could certainly be valve related...

Murmur the heart patients' mnemonic with me...

"If in doubt, check it out. If in doubt, check it out. If in d..."

[va66]

I too started having "lightheaded spells" which were a sign to me to schedule surgery soon. As you described, it seemed as though my system was closing down. On two to three occasions, however, I needed to hold on to a table for support. Fortunately, I was in a seated position at the time. In checking my notes, I see that I had five lightheaded spells in 2007. When I went in for my six-month echo, I discovered that I was in the "severe" stage at which time I scheduled my surgery, which I had in Febuary of 2008.
I'll be checking this board to see how you are doing.
You're in the right place to get information and support.

Good luck!

[TXWildflower]

Am I ill-informed? I thought that dizziness and lighteheadedness were known symptoms of aortic stenosis? I have had a few episodes myself, but I'm usually not seated, but walking briskly down a hallway or something. Very mild and they end quickly.

[Lorimacm]

Hi Sheila,

I too have experienced the same dizziness at rest as you. Usually it feels like I'm falling to the right and the room is moving left just when I am sitting. That's when it happens most. But it does happen sometimes after walking (not far) where I stumble a bit cause I feel like the room starts to spin. My valve area is not quite as small as yours, (.97) and I have been experiencing this dizziness for about 9 months now along with other symptoms. When described it to my cardio he isn't sure it is related to my heart. It may or may not be but I think it is since nothing else has really changed with my body as far as I know except the valve. When I was very anemic (which I am not anymore) I didn't experience this dizziness.

Definitely best to get on board with a good surgeon at this point. Even if it's not related you will need the valve taken care of.

Best wishes to you and God bless,
Lori

[JeffM]

I think there's dizziness and then there's lightheadedness. When you're dizzy, you lose your balance; when you're lightheaded, you feel like you are about to black out. I have gotten dizziness in association with migraines. My lightheadedness started after my AVR and persists. Some days it's not there but others, like today, I'll have to bend over or stoop to let the blood get up to my head when standing quickly. I plan to talk to my cardio again about it. It's not a major problem but it gets a little old.

[COLLEEN S]

Meniere's?

[deck1434]

Hi,
First time poster here. I had my latest Echo last week and my aortic valve area is now only .8 cm. I do experience occasional dizziness but my cardiologist wasn't concerned about it. His concern is if I actually faint, if my ankles swell or if I experience chest pain.

I also have Avascular Necrosis in 4 joints, so I take pain meds. Because of this I also wondered if the dizziness might be caused by something else, in this case my pain meds. Regardless, the concerns above are what my cardio wants to know about asap.

Best,
Dianne

[drivetopless]

Welcome, Sheila-
I'm in Lawrenceville, GA and am at a similar status-- .7cm2 BAV--Doc says surgery within 1 year. I have my next follow up in January.

I have noticed dizziness when resting--usually when I'm laying on my left side--so I just don't do that. I also have shortness of breath when I lay down if I don't lay with my shoulders back and chest in an "open" position. The dizziness I experience is more of spinning/falling --sort of like you feel right before you fall asleep.

I haven't noticed any dizziness on exercise-- just occassional palpitations and quick onset of breathlessness. I can still do everything, but I do notice I take a slower pace to manage the breathlessness. I should say that I'm overweight, so I usually attribute some to that.

I have also noticed some vision changes--more spots/floaters.

Let me know who you choose as a surgeon. I'm thinking 2010 is my year. I was dreading it, but now as I'e noticed more phyicals symptoms I'm looking forward to feeling more energized and less breathless.

[tobagotwo]

Just my opinion...

The AMA/ACC guidelines still say that any valve area under 1 cm² with symptoms is acceptable for surgery. Symptoms + Size = Surgery.

There has recently been a move by some cardiologists to move that down to .6 cm². While this might be acceptable for the very much older and sedentary patients in their waiting rooms, it defies reality when it refers to a younger or more active patient, or if symptoms have advanced to a state of concern.

A state of concern could be, for example, if you felt dizzy for just a few moments and swerved into oncoming traffic. What about if it turned out that the dizziness were caused by bits of calcified material from your valve breaking off and causing TIAs, possibly threatening a stroke, would that be concerning?

SOB (dyspnea) and dizziness are both symptoms of severe aortic stenosis. So are palpitations and angina (which you may not realize you have - mine was just a sort of tight feeling in my throat, women often get jaw pain).

Don't forget, in many cases of older patients (esp. 80+), the cardiologists are concerned with managing their heart conditions until their patients succumb to something else, not with fixing them. A surgery for much older patients is a higher risk, with less potential payback in many cases. So cardiologists tend to view surgery as a dangerous thing, a last resort. Their view is often that collateral damage from valve problems can be managed for someone who is sedentary and non-demanding.

However, younger patients (certainly including those in their 70's - and even 80s - who are active, with mostly good health otherwise) can't really afford to have the possibility of permanent damage to their hearts. They still have physically active lives to lead. They still have to carry their own suitcases. Heart damage means a damaged quality of life, a loss of the ability to do some of the things one loves.

And there are normal variations in echo read results. So, is your .7 cm² really a .7 cm², or is it actually a .4 cm²? There is a tacit understanding that echo results can vary. But when they do, they don't always show the valve opening smaller. They just as often can show it as bigger than it is.

Waiting for the mythical .6 cm² in a younger patient particularly provides a possibility of permanent damage that must be monitored carefully. I fired my last cardiologist for doing just that (waiting, despite signs of collateral heart damage), and presented my case to a surgeon, who agreed with my analysis (which turned out to be a good thing, based on the state of the removed valve). My valve was a .74 cm² according to my last echo. I had the surgery before more damage could be done.

You may not want to do what I did, but you should seriously discuss the issue of your entire heart's condition and your quality of life (and future life) with your cardiologist. It's understandable to want to leave the issue with the cardiologist, especially if he or she isn't pushing surgery. It's comfortable for it to be entirely in the doctor's hands. No one really wants surgery, if they feel they can avoid it. But it can be foolish to not take responsibility and at least partnership for your own heart's health. And it may be a mistake to assume that the doctor knows what risks you may or may not be willing to take in order to wait a bit longer for surgery.

Nothing in your heart will improve until the main valve issue is corrected, but things that are going bad can get worse, and they can become permanent.

Best wishes,

[Mentu]

Sheila, welcome to the VR community. I think it is only normal to worry that every possible symptom is related to ones heart valve but we are complex creatures and there can be other causes for any given symptom. Bob makes an excellent point that you need to talk with your cardiologist to find out what he is looking for before he recommends surgery. You need to have a voice in that decision making process. As my valve began to really deteriorate, my Cardio said that he would expect to see several symptoms normally but that tests to measure valve area and pressure gradient were equally important. There are after all some people who never really display overt symptoms. When he discussed a priority of symptoms with me a couple of years before surgery, he explained that dizziness could possibly be an indicator but that it is usually a minor issue unless one actually passes out. More serious is swelling of the legs as it can indicate congestive heart failure. Chest pain can be an indicator that one’s condition is becoming even more severe.

My cardio emphasized that it was really important that I be aware of what to expect and to report any changes promptly. Shortly after an echocardiogram measured my
- valve area at .74 cm2
- Peak gradient 127.5 mmHg
- Mean gradient 61.4 mmHg
I began experiencing chest pain. My Cardio immediately scheduled me for a heart cath and referred me to a surgeon on the same day.

A simplified view of how this diagnosis business works is that cardiologists tend to be conservative and look for a definitive combination of multiple symptoms along with the measurements. Surgeons, on the other hand, seem to rely more on the measurements and are focused on operating while the patient is still healthy and can realize the maximum benefit from surgery. By becoming well informed about your condition and what the different test mean, you can become an active part of the decision making process.

[ALCapshaw2]

Old School Cardiologists like to wait for symptoms (which are signs of DAMAGE to the Heart).

Most Surgeons like to get in there and FIX the problem BEFORE there is Permanent Damage to the Heart Muscles and Walls.

With the Extremely High Success Rates for First Time Surgeries (1% morbidity, 1% mortality, nationally...even less at Major Heart Hospitals) I see Little or NO Benefit in postponing the inevitable.

Valve Disease Will NOT cure itself.
Surgery is the only way to FIX valve problems.

IMO, Sooner is Better for most patients.

'AL Capshaw'

[cp172]

Hi Sheila,

Prior to my MVR I was having eye issues such as double vision and distorted vision. Surgery cleared up all the issues. Best of luck to you.

[vhmoriarty]

My cardiologist always wanted to know about my dizzy spells or fatigue which is severe now. For about three months however I have been expierencing eye twitches in my left eye. Could this be because of my aortic stenosis as well? I noticed some of you talking about vision changes.

[Sheila]

Thanks to all of you for your responses. I just wanted to give you an update on what is happening now with me. About 3weeks ago, I had another echo and saw my cardiologist afterwards. This time he felt it would be a good time to have a preliminary consultation with a surgeon to talk about timing of surgery.

Many of you have pointed out the difference in approach between the cardiologists and surgeons. It was like night and day!.

When I met with the surgeon it seemed to me it did not take him more than a couple of minutes to come to a decision. All he focused on was the valve area being .7cm2 and the fact that I had had dizziness with 2 near blackouts earlier in the year. It was the dizziness with near blackouts that he said could on another occasion become an actual blackout from which I may not recover. He said I was at high risk for sudden death and needed to have the valve replaced before Thanksgiving.

I told him that I felt well and could do the treadmill for 30mns at a speed of 2.5 with an incline at 2, I could watch my 2 grandchildren 5 and 2yr olds for 4-5 hours plus many other activities. He said that did not count.!! He said I was in a dangerous place.

He then said I should have a cath done in preparation for surgery, which I did this past Wednesday. The good news is that I did not have any blockages but Unfortunately, I had a rough time with the heart cath procedure .

I had some discomfort during the procedure itself and needed more of the Versed. Then I had a lot of pain from internal bleeding of the artery right after the procedure. I was told it was because they had to make several attempts to get to the femoral artery due to scar tissue. The nurse applied pressure and it did feel better after a while. 2 Hours later I was sent home.

That night around 1:30 I woke up with severe lower backpain which lasted close to 3 hours. I found out the next day that the pain was caused by more internal bleeding. It was actually a lifethreatening situation but I did not know and did not call the number they gave me at the outpatient cath lab. I just rested in bed most of the time the first 2 days and took it easy over the weekend. By the Grace of God I am feeling better today.

I thought the cath would be the easy part... I am a bit shaken by this whole experience.
The surgeon's office is ready to set the wheels in motion for surgery in 2 weeks, but I don't feel I am ready for that just yet. The surgeon may be right but I am still considering getting a second opinion before proceeding.
Sheila