Cardiac related?

[DavesMom]

Thanks for taking my question!  Just a bit of background:  female, 50, aortic valve replacement and aneurysm repair in 1999, on coumadin, Tegretol (for complex partial seizures), Actonel and Crestor. (I recently switched to this from Lipitor).  Last echo fine except for mild mitral regrug and mild mitral annular calcification.  All blood work fine - bad cholesterol is 118 but good cholesterol is 105. Trigclyerides about 50. Fasting glucose fine. I walk for an hour or so every day and the only problem I seem to deal with is fairly frequent bouts of fatigue.

The past couple of mornings I've had a scary incident. When I get up I feel not so much dizzy as pretty off balance.  I start to feel lightheaded, woozy, and my vision become blurred.  I'm also a bit sweaty. It doesn't last long - maybe three or four minutes - and then I'm ok, though a bit weak for a few more minutes.

I know you can't diagnose over the Internet and I'm calling the doctor today. However, in your opinion does this sound like it could be cardiac related?  I do have problems with stuffed up sinuses - could that be the problem? Anyone have a similar experience?

Thanks in advance for any advice.

[CCF-M.D.-MJM]

Hello,

I am sorry to hear that you are feeling well.  If I understand correctly, this is happening every morning for a few mornings in a row.  If this is the case, this does not sounds like a heart arrhythmia related problem.  Usually dysequalibrium or lightheadedness after walking up is related to low blood pressure (from hypertensive medications) or just orthostatic hypotension (lightheadedness from standing too quickly).  This is sometimes a matter of dehydration, especially in the setting of an illness.

I agree that calling your doctor for evaluation is the right thing to do.  If you have a blood pressure cough, check your blood pressure in the morning.  Your doctor will probably check sitting, standing and lay flat blood pressures to check for significant differences.

I hope this answers your questions.  Good luck and thanks for posting.

[DavesMom]

Hello again!  Sorry to follow up to my own post but thought I'd mention that my blood pressure is fine.

[Avel]

I am wondering if you were born with a bicuspid aortic valve? Some of what you describe reminds me of some complex women I know who have bicuspid aortic valve disease (BAVD). You mention aortic valve replacement, aneurysm resection, and you also experience complex partial seizures. It is hard to know what the recent morning symptoms you are experiencing might mean - but I hope that you can be seen in a major center with a multi-disciplinary team that can check you thoroughly. It still may be difficult to come up with answers.

You may want to discuss having a TEE to determine whether or not any of your symptoms (blurred vision, balance problems) could be related to some sort of particles coming off your valve. (My husband suffered a stroke due to complications - valvular strands - from his mechanical aortic valve. A TEE is the only test that detected them.) What you describe seems reminiscent of something affecting the brain, but what? You are complex given your seizure history.

If you were born with a BAV, you are at greater risk of brain aneurysm than the general public. Regardless of anything else, if this were myself, I would want to be screened for that.

Again if you are bicuspid, you may want to visit the Bicuspid Aortic Foundation at www.bicuspidfoundation.com and read the story of a woman named Carrie. Her experience is described on the Memories and Hope page of the site.

Best wishes,
Avel

[DavesMom]

Hi Avel,

Thanks for your interesting comments and the link. I'll check it out.

Hmmm...if I remember correctly the cardio said I was actually born with a unicuspid valve. Had a repair done at the age of 20 and then the replacement (with a mechanical valve) at 42. At the same time they repaired an ascending aortic aneurysm. I wasn't diagnosed with seizures until about four or five years ago.

Speaking of aneurysms, since the one I had was repaired what are the chances of me developing a second one? I've often wondered whether I'd be free from that worry or not.

I haven't had any more of the episodes since I posted but you may be right that a TEE is in order just to be on the safe side. I haven't had one in about five years.  My regular echos are always fine but there's a lot they might not pick up. Some days I feel almost the same as I did prior to my surgery. I know I'm getting older and my diet isn't the best but there's no reason for me not to have more energy than I do!

Thanks again for the information.

Best wishes.