Last July, I went to the doctor to complete my job related bi-annual medical exam. While performing the ECG, my doctor noticed I had "left ventricular hypertrophy by voltage criteria". The doctor then had an echocardiogram completed which indicated the following: no murmur was heard, no cardiovascular symptoms, to wit: no shortness of breath, no ischemic symptoms, is normotensive, and not on any medications. Basically I was told by the doctor that I was born with two aortic leaflets fused together at birth, therefore, I have one big leaflet and one small leaflet for the aortic valve. Due to this situation, I have a small amount of regurgitation or "aortic insufficiency". Here is a little background on myself, I am a state trooper and a trooper pilot. Naturally I am concerned as how this situation will affect my job, my flying status, and my overall health. I have not attempted to seek a second opinion and frankly, I have been putting this off for a while. I am a 31 year old male who doesn't smoke or drink. Sometimes my heart makes "funny jumps" or "hurts", and I get some pretty bad migraine headaches in the temple area and behind my head at the base of the neck. I have always thought the headaches / pains were stress related or as my wife jokes, "a blood clot getting ready to launch". I really don't exercise unless it's job related such as running after bad guys or lifting heavy objects. I am in good atheletic shape, I am not overweight, I am 72" tall and weight 165 lbs. My heart doctor suggested that I come back in one year to redo my "stres test", i.e. shave my chest, place the elctrodes on, run and hold my breath, while they do an ultrasound. The heart doctor said this would show if my condition was remaining the same, improving, or degenerating. My origonal family doctor said I should do a follow-up a couple of times in the next year or two. As I said before, it has been 11 months since I have seen the doctors. I have not gone in for a followup. I have been putting off the doctor because I am afraid of what they may find and I really don't want to loose my pilot license. Here are my questions: How often should I see a doctor about my condition? Do I need to worry about this situation? Is this condition normal, serious, or have a potential to get worse? Should I seek a second opinion? Due to the high stress my job creates, am I placing myself more at risk? At what point does a person need to consider having the valve replaced? Am I making a big deal out of nothing? And last but not least, how will this affect my class 2 aviation medical? Basically I am worried that I am putting my coworkers at risk by "keeling over at when I am needed most", or something will happen when I am flying (obviously, others will be affected as well as I am always flying other troopers or prisioners). I also want to make sure I am around a long time for my family. Thanks for your time and I appreciate the service that you are providing. As you can tell, confidentiality is a great concern of mine.
I will have to check on the pilot limitations in the case of a bicuspid aortic valve diagnosis which is what you have; your cardiac risk (of "keeling over" doesn't come until the valve becomes very leaky and or stenotic (closing off.)
Your valve will eventually require repair and or replacement, meanwhile you will need to take antibiotic prophylaxis on visits to the dentist and for certain urologic and GI procedures should you undergo them (unlikely at your age.) Also you will need regular follow up with the cardiologist, about once a year (sooner if you develop any symptoms.)
I don't know that you need a second opinion so much as a follow up as suggested with the cardiologist you have already seen, which would be in the next few months since the initial eval was some 11months ago.
What you chose to tell or not tell your employer is up to you and your cardiologist; I've always found it best and easiest to be honest in life.
I hope this information is useful. Information provided in the heart forum is for
general purposes only. Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
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