Can a bad heart valve compromise brain function?

My husband has Lupus since he was a teenager and has been taking the steroid Prednisone for over 40 years.  He's in his mid-50's now.  He has incredible mood swings and strikes out at family members, but is able to keep a normal, calm exterior toward people at work.  

Recently he had congestive heart failure that resulted in a triple bypass and a Mitral valve repair.  The doctors told him he'd had this valve issue for years and just didn't know it ... and that it was a saving grace that he used to run about 40-50 miles a week for the year prior to him having the attack because it allowed the heart muscle the strength to pull him through the attack.  The cardiologist said he was "... absolutely amazed that he hasn't dropped dead of a massive heart attack before now."

That said, is it possible that for the years his valve wasn't functioning properly, that he wasn't getting enough oxygen to his brain and that THIS is the reason for his hostile mood swings?  During these episodes he's dark, quiet, wants to be alone, is surly, demeaning and rude - but only to either me or certain family members.  His moods last a few weeks and then leave almost as quickly as they appear.  

In the hospital I overheard a fleeting conversation about his oxygen saturation ... it was incredibly low.  I think the nurses were saying it should be in the 90's and it was down in the 30's somewhere.  I have no idea ... but wouldn't a decrease of oxygen saturation go hand-in-hand with a faulty valve not doing its job?  

We (the family) are at odds about my husband's moodiness.  Since his operation at the end of last year he was doing very well until just before Easter.  Then he sank into one of these funks again and although aware of it, hasn't been able to come out of it.  He's had some post-operation problems and had to wear a heart monitor for a couple of days, but the tests aren't back on that yet.  

Have you any suggestions?

[PaulMD]

Hi there.

I'm sorry to hear what all of you especially your husband are going through.  I can think of several causes for these but should be verified with your physician.

The lack of oxygen may not be the primary culprit and the heart valve problem may not contribute much to these mood swings.  As long as the blood pressure is normal, the brain will be perfused with oxygen rich blood.  Regarding the low Oxygen saturation during the post-operative status, this can be due to several things like fluid in the lungs or hydration problems, but if just transient, should not have caused damage.

Though rather unlikely but plausible, Lupus has a manifestation called "Neuropsychiatric Lupus" which means that the lupus activity is affecting the brain.  This can present with behavioral problems, maybe similar to what you are describing.

Depression can also contribute to these moodiness and untoward behaviors, and a psychologist consult may be warranted.

I suggest you discuss with your doctors regarding all of these possibilities, and hopefully come up with a convincing solution.  Regards and God bless...

[hopeshigh]

Thank you very much for your input.  I'll Google "neuropsychiatric Lupus" and read up on it.  We've talked about getting some psychological testing done and he's amenable to that ... it's just getting to getting to it!  

Thank you so much, Doctor.  I do appreciate the time you took to write such an informative reply.  

Best regards,
nancy ~