concerning echocardiogram results FINAL UPDATE 3/12/2024

[jcs7282]

Originally Posted by teleguy57

For those suggesting sports-specific cardiologists, how does one identify them? Is there a specific certification, training or designation to look for? Or is it more asking questions, and if so, what to ask about? When I review the bios on the cardiologists in our local group there are some comments about them individually being runners, rowers, etc. but none of them specifically state anything about athletic focus of their study or practice....

In the case of the Mass General program, they state it pretty explicitly on their website: "The Cardiovascular Performance Program offers specialized cardiac care for athletes, including leading treatments for suspected or confirmed heart disease, detailed pre-participation safety screenings and exercise assessments."

Short of that, I would guess a doctor who is active/an athlete themselves is a better filter than nothing...

Link: https://www.massgeneral.org/heart-ce...rmance-program

[flying]

Originally Posted by OtayBW

You can have them outfit you with a Holter monitor which collects (and records) data in real time as you wear it over a ~day or two.

I actually did have that for two week before the stress test
It caught many spikes but (I could be wrong) wireless stick on type monitor I dont think shows that kind of data meaning where upper/lower chambers etc originates from in heart

In any case they tried very hard during stress test to recreate but could not

[flying]

Originally Posted by DHallerman

Dave, who couldn’t get an appointment with Chinitz until the end of March which maybe says something about the prevalence of heart rhythm problems like afib and the American medical “system”

Exactly ^

[teleguy57]

Time for an update. Without going into tons of detail, after a series of further exams/tests (including CCS which led to a nuclear stress test,Duke score of 9 so low risk there although the inferred VO2 max sucked) we've confirmed I have a aneurysm of the root/ascending aorta as well as a failing aortic valve. At first it appears surgery would be imminent but after a CT angiogram last week my cardiologist said those results were "reassuring" that we're in a monitor vs react phase and we'll take another look at things in August.

In terms of activity, I am supposed to avoid activities which are considered a "strain." That means no heavy stuff with valsalva or holding my breath, and I pushed to understand about CV type stuff beyond general admonitions so we landed on aerobic stuff is ok, but avoid going beyond 15 RPE on the Borg scale. I'm going to have to continue to get smarter on "harder isn't better -- or necessary..."

Now I have to give more thought to the ebike world....

Thanks again to all who contributed here and through DMs. Lots to sort through yet on next steps and implications.

[gasman]

Originally Posted by teleguy57

Well, my recent echocardiogram came up with some concerning results. I got some helpful insights from folks here when approaching my TKA in 2020, so searched here and found several threads including posts from @bocaarider, @classtimesailer, and @cyclisticliff with great contributions from medical professionals such as @gasman and @slinkywizard. I'm smart enough to know not to ask for diagnostics from the interwebs, but I am interested in any counsel people have about how to think about what I may be facing.

I won't go into all the details, but several months shy of 69. Issues include aortic root and ascending aorta echo measurements which seem to approach or be at the dimensions leading to surgical actions per the Nov 2022 updated ACC/AHA guidelines, aortic valve issues and atrial enlargements (both L&R). My personal physician referred me to a cardiology group; I'm scheduled for a consult late Feb (their first opening since my MD said he didn't feel it was super urgent given his assessment of my high function). I will admit to being overwhelmed by the significance of what I'm seeing online, and having a great deal of trepidation about permanent lifestyle changes for someone who enjoys picking up and putting down heavy things and likes the discipline of structured intervals/intensity.

My big question is how to think about qualifying the professionals with whom I will be consulting -- and who I would choose for whatever potential procedures may be in my future. Already thinking after local consult here in WI I may look to Mayo and Cleveland Clinics as well. Also wondering about waiting 5 weeks for a first consult...

I'm probably thinking too far ahead, but thinking an e-bike may be one part of my future -- wish there was an equivalent in the nordic skiing world.

Any experiences or insights appreciated!

Talk to the cardiologist but I would go to the Mayo or the Clevland Clinic-go to the best if you can.You may or may not need surgeryI have a biking buddy with similar issues-was told he was going to need surgery until he got a consult atStanford Medical center He is now just being followed and no surgery see the best people you can and they explain it allot you
Just slow down your skiing-you'll be fine Good luck

[teleguy57]

@Gasman, so appreciate your comments here, especially in light of your recent post about some you own challenges. Your patience and positive outlook are inspiring.

I'm only 5 hours from Mayo, so they are on my radar screen. Right now my cardio has me set for a follow up in August, so he's anticipating no interventions in the short/med term. Thinking through if a second opinion would make sense now or perhaps when we have an update if the root aneurysm and aortic insufficiency are stable or continuing to progress.

[ERK55]

Gasman is The Man.

[gasman]

Originally Posted by dr50470

As a PCP practicing in CT Yale New Haven has a CV surgeon that we used throughout the years for aortic root repairs/replacements.....https://medicine.yale.edu/surgery/ca...-elefteriades/
Patients loved him and his results were excellent.
Good luck and stay fit if you are anticipating surgical intervention.

I've known John since 1988when I was doing my anesthesia fellowship(pediatric cardiac) He's a great guy and an excellent surgeon

[teleguy57]

So, time to provide an update on this thread. Bottom line is that in two weeks I’m going in for open heart surgery. The procedure includes an aortic graft to address my severely dilated aortic root and either repair (more likely replacement) of my severely regurgitating aortic valve via a Bentall procedure.

I have a great deal of confidence in my surgeon, who heads up the aortic program at St. Luke’s hospital in Milwaukee. It’s a top-50 cardiac center in the country and he does more heart procedures than anyone in the state. Another cyclist who had two procedures done at Mayo and a third at St. Luke’s said he’d easily choose them over Mayo for a number of reasons. With our two sons local in the Milwaukee area and the quality team at this team at this heart center was a relatively easy choice.

His team says 80% recovery in 1 month with full recovery in 3 months. My experience with my total knee replacement in 2020 tells me that with a full sternotomy true full recovery will take longer, but the good news is when we’re done I should be without limits on activities.

A friend retired several years ago as the head of PT at a local hospital and had the cardiac rehab unit under her (she’s also a cyclist/Nordic skier/multi-time Ironman and has qualified for Olympic distance worlds next fall in Spain). She’s shared lots of good information and helped both my wife and I have a better sense of what to expect overall. Bottom line is that recovery is the long game and trying too much too soon will only delay getting to where I want to get.

I’m not one of those guys who will do the daily social media video about it. I figure sometime by mid-late January I may circle around back here with a summary update.

Until then, clearing the decks here of all the in process stuff so I can concentrate on getting ready for surgery and plan for a productive recovery time to be back on the bike this spring.

[reuben]

Godspeed, teleguy57. I look forward to your return.

[robt57]

Best to you, we will await your update....

[NHAero]

Wishing you the best of all possible outcomes and will look forward to your circling back to the Tribe!

[hobbanero]

Good luck teleguy57!

For others reading, I'll echo what others have said about finding a cardiologist who is experienced with athletes. Hell, most group rides with old dudes probably have a cardiologist on them.

Always do the stress test on the bike unless you are also a good runner. For my test, they told me my max target was 167.....which is just above my threshold. I basically said "hold my beer" and did my best to wreck the bike and myself.

I also purchased a Fourth Frontier X2 HR monitor. I gives a full ECG of your workout and can be super helpful when your symptoms are happening on your rides, but not in the doctor's office.

[bheight1]

You’re in good hands Teleguy57. Your timetable is right and it’s a good time to have it done. Mine was 1/30 and I was on the club ride opening day 4/1. No one, family included, knows what you are feeling but you and others that have experienced OHS. I found great comfort and resources in the website Heart-Valve-Surgery.com. See you on the other side.

[teleguy57]

Thanks to all the well wishes and info. I guess I'm not done posting here quite yet

Originally Posted by hobbanero

...Always do the stress test on the bike unless you are also a good runner. For my test, they told me my max target was 167.....which is just above my threshold. I basically said "hold my beer" and did my best to wreck the bike and myself.

I also purchased a Fourth Frontier X2 HR monitor. I gives a full ECG of your workout and can be super helpful when your symptoms are happening on your rides, but not in the doctor's office.

On the stress test, my radionuclide stress test was limited by my BP due to the aortic aneurysm, although I was pretty close to maxing out effort running, albeit with one knee replacement and the other needing one. I agree I probably could have gone harder (had they let me) on a bike.

I've seen info on the Four Frontier device, and seemed like it had mixed reviews... Your experience with it sounds positive.

Originally Posted by bheight1

I found great comfort and resources in the website Heart-Valve-Surgery.com.

Interesting as the site was one that came up early and often in my research and which I now follow. I first learned of the MD who is my now surgeon when he was interviewed by the site host.