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septal thickness and high ef

I SAW MY DOCTOR YESTERDAY AND HE SAID I SHOULD NOT EXERCISE BECAUSE THE THICKNESS OF MY SEPTUM HAD INCREASED TO 22MM AND THAT MY GRADIENT APPROCHED 100 MM.  MY EJECTION FRACTIONN WAS 80%, BUT I HAD ONLY BEEN TAKING 20 MG CORGARD.  HE INCREASED IT TO 40 MG.
I AM A SEROIUS ATHLETE, 62 YEARS OLD, WHO HAS RUN , LIFTS WEIGHTS DO KICKBOXING. I AM IN VERY GOOD CONDITION AND CANNOT BELIEVE THAT NO EXERCISE WOULD BE A GOOD THING FOR ME. HE SUGGESTED ALCOHOL ABLATION WHICH I MIGHT CONSIDER OR OPEN HEART SURGERY WHICH I WILL NOT CONSIDER. I HAVE MILD AORTIC VALVE DISEASE AND I CAN SEE NO REASON TO HAVE A VALVE REPLACEMENT UNNECESSARILY. I HAVE A LITTLE SHORTNESS OF BREATH, A LITTLE ARRHYTHMIA, MY EXERCISE TOLERANCE IS GREAT.  IS THIS CARDIOLOGIST BEING OVERLY AGGRESSIVE? OTHERS IN THIS PRACTICE HAVE SAID I NEEDED NO EXERCISE RESTRICTION , TAKE THE BETA BLOCKER, AND DONT EXERCISE IN COMPETITION.
5 Responses
Avatar universal
22mm is a bit thick, mine is 10 mm, about the norm.
ALSO TURN OFF THE CAPS LOCK. In internet terms, its poor form, it means you are screaming.

Back to subject. Ejection fractions are meaniningless. They are bogus and it represents well-meaning booksmart people trying to quantify something that is not possible to quantify as part of their studies.
I have seen two cardiologists, one says the EF (ejection fraction) is 50%, the other say it is 75%. Ignoring whatever measurements a young tech makes.

So EF is useless. The best is to say normal, mildly reduced, moderately reduced or severely reduced. Or in your case, hyperdynamic.


Now, to your specific case, without seeing what your heart looks like and bear in mind I am not a doctor. You need a few opinions on your heart from different types of cardiologists.
At 22 mm, you will probably have an outflow tract obstruction, couple with or causing the aortic valve disease (which because of the turbulence of blood, maybe causing your aortic tissue to sort of, how you say, callous, like when you lift weights you get callouses) Same process with the heart.

So it is going to, as the disease progresses cause you problems. Its sort of a downward spiral with this. One thing leads to another. The turbulent flow causes your aortic valve to narrow. Thereby increasing the flow it need to push against it, making your heart tissue thicker, thereby making more turbulent flow, which makes your valve narrow further.

So the trick is, timing the intervention and what intervention to do. I leave that between you and your specialists. But, unless you want to die younger than you should. You will need to have it fixed. Its a downward spiral that is destroying your heart.
Family member test. Fiance, mum, dad etc... I'd make sure they had this fixed asap. This is contrary to most of family member test questions I use
367994 tn?1304953593
I would never tell someone not to use all caps as there individuals who like (may need) large print for eyesight reasons.  I don't consider it shouting unless in context it is used fore emphasis.

For an insight to your diagnosis: The normal dimension of the septal (wall separating heart chambers) is 0.6-1.1 mm.  An abnormal size can/will cause diastole dysfunction.  That is a condition that limits the filling capacity as the enlarged septum crowds out available space.  Also, the rigidity of the wall impairs effective contractions.  As a consequence cardiac output (amount of blood pumped into circulation in 1 minute) is reduced.

To achieve the same CO as a normal functioning heart, the heart compensates by increasing heart rate and dilate the left ventricle.  This will increase increase heart contractions (Frank/Serling law of physics) causing an increase in EF (normal 55-75), and untreated the dilatation will increase to a measurement that overcompensates and heart muscles will overstretch and  lose their contractility and EF will quickly drop into heart failure range <29%.

The thick septum causing diastolic dysfunction presents another problem.  When the heart beats very fast there isn't enough time to even completely or adequately filll the reduced chamber size.  And cardiac output is farther reduced. A beta-blocker slows the heart to help functionality.

Also a thick septum, can disorganize the electrical impulses' pathway that polarizes and repolarizes heart cells to contract and then relax and that can an arrhythmia.

Mild aortic valve insufficiency does not require open heart surgery or any treatment unless there is progression.  Beta blocker should keep your heartrate safe enough to exercise, but there is a risk for arrhythmia until the ablation procedure.  Alcohol is injected directly into the heart tissue with a cath and that kills the access cells.  You are correct that is better than open heart surgery that cuts out the heart tissues.

367994 tn?1304953593
Sorry for your pathetic, ill-advised misdirected feelings, but this is not the medical expert forum, and I have absolutely no idea what your are talking about, additionally,  I don't recall figuratively holding a person's hand, but if I or anyone else figuratively holds a person's hand, why would that disturb you?   You may want to exercise some self-control of your emotions and talk to your doctor for a release to your pent up hostility and not make a fool of yourself on an open forum.
159619 tn?1538180937
COMMUNITY LEADER
I hate to jump in where I'm not involved, but EVERYTHING (I used capitals because I was yelling) ken said is absolutely correct. I can't even follow what you're talking about let alone apply it to this discussion, it's goes in so many directions with information that is quite frankly not right or else I just can't follow what your point is. I been reading ken's posts on several forums for a long time and he has always given good sound, medically backed up advice from personal experience and research. I agree with your right to disagree but please don't take it to such a personal level. You last post was extremely inappropriate and not helpful to the original poster at all.

Now you can go off on me too I suppose.

Jon
367994 tn?1304953593
Enjon, I don't wnat to embarrass you, but it is people such as you that sustains  viable dialog with an informative input that helps relieve some poster's medical anxiety and in my case provides enlightment at various times as well.

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joyceraymer
Mar 28
HELLO! YOUR POST WAS HELPFUL TO ME. THANK YOU. COULD HIGHER DOSES OF BETA BLOCKERS GIVE ENOUGH RELIEVE TO STOP THE NEED FOR ALCOHOL ABLATION? DO YOU KNOW IF THIS CARDIAC CATHETERIZATION AND THE SUBSEQUENT CONTROLLED HEART ATTACK HURTS? ARE YOU AWAKE WHEN THEY DO THIS?

To answer your E-mail note,  beta blocker medication can meet a dosage level that will cause syncope (fainting), and a very low heart rate can cause blood clots as well.

Septal ablation injects pure alcohol into the the arteries that feed the intra ventricular septum that kills cells and thins the affected muscle.  It is done under local anesthesia and the individual is completely relaxed, no anxiety, no pain so the cath procedure can be done without the danger of the individual not laying still and have the ability to respond to instructions such as changing positions.  The procedure last takes about 90 minutes.

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