Three months after a mitral valve repair an intermittant shortness of breath (SOB) condition occurred in November of 2007. The frequency of SOB has increased over the months. Now I am not able to walk 150 feet on level ground without having to stop. Recently I have begun taking my pulse when I walk. When I do anything that should increase my heart rate, my heart slows down. On a recent walk that included climbing a hill (40 feet elevation change over 100 yards) my heart rate steadly declined to a low 48 when I had to stop to catch my breath. This rate decline is typical of my SOB problem now. An angiogram and ultrasound show no blockages of the coronaries or the carotid artery. Echocardiograms show no heart valve problems.
My sole medication is 180 Varapamil three times each day. I have been in perfect health all my life until the mitral valve surgery. For three months after the surgery I had no health problems whatsoever. I am 70 years old. I still work in my small business doing finance work. Any ideas?
You may have developed worsening heart block following surgery, which has caused your symptoms. This may or may not be related to the mitral valve surgery, which depending on the type of repair may affect the conducting system. I recommend that you obtain a 24 to 48 hour holter to document any episodes of high grade AV block with symptoms ( dizziness, or lightheadedness mainly but also could be breathlessness).
If this test does not show any high grade block findings, then referral to a tertiary referral facility is probably in order as your case is not straightforward and requires the evaluation by a valve expert. You may have, for instance, have developed post repair mitral stenosis, which is something not easily seen on a surface echo by an inexperienced cardiologist.
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