valve replacement or monitor changes

[lmfbrown]

Having chest pain with exertion, or increased stress x 5 months. Blood pressure running 150-180 over 85-105  with heart rate 100-142. sometimes palpitations, nausea. Was told couple years ago I had a left axis shift, but EKG essentially normal. Today had stress echo and couldn't complete the testing due to heart rate over 180 and chest pressure. Was advised I have a "leaking" aortic valve , likely left ventricle thickening and now I need a MIBI.  
Is it safe to "watch and see"" while trying to  decrease blood pressure-eliminate stress, versus having aortic valve surgery?  of note- also found out my LDH is 184 even though my remaining cholesterol numbers are normal.
Advise, opinions from others would be welcomed.....thanks

[skydnsr]

It may be time to consult a cardiothoracic surgeon.  Oftentimes, a surgeon will have a different opinion on the timing of valve replacement than a cardiologist.  In my opinion, it is the surgeon's opinion that counts more, because deciding whether and when you need an operation is his specialty.  Keeping you alive and functional with nonsurgical interventions, mainly medication, is the cardiologist's specialty.  So if you want to know about surgery, ask a surgeon.  Generally, surgeons will want to do surgery before your heart suffers irreversible damage from valve dysfunction.  A cardiologist may tend to want to postpone surgery for "as long as possible."  You do not need your cardiologist's "permission" to consult a surgeon, at least not in the US and not under most circumstances.  If you live elsewhere, things may be different.  But assuming you live in the US, you generally can schedule an appointment with any doctor whose opinion you want to ask.  If it were me, I might hold off on the MIBI until after consulting a surgeon.  If it should turn out that you are going to need aortic valve replacement in the near future, the surgeon may want you to just have a cath.  Also, if you happen to have aortic stenosis, there is a small but real possibility that a stress test could be dangerous.  The first step is to decide which surgeon you want to consult.  The next step is to call that surgeon's office to see what test results he will need to look at.  Generally, the main test the surgeon will want to see is a recent echocardiogram -- the actual images and not just a report.  It is important that the surgeon be someone who does a lot of aortic valve replacements, and this is definitely not true of all cardiothoracic surgeons.  The bread-and-butter operation for most heart surgeons is coronary artery bypass.  Even if it turns out that you also need a bypass graft done at the same time as your valve replacement, your primary need is for a surgeon who has exceptional skill at doing aortic valve replacement.  AVR is an operation for which a good outcome is highly dependent on the surgeon's expertise with that particular procedure.  The best practical measurement of expertise is the number of AVR's that the surgeon has done.  I would look for someone who has done in the hundreds, and at least a couple of dozen of them should have been done within the past year.  Any cardiothorac surgeon who is qualified to do your AVR will also be qualified to also do a bypass, if you need that.  You may have to go to a nationally reputed heart center, and it is best to go someplace that has a thoracic aortic surgery program.  Cleveland Clinic, which sponsors this site, is one such place, but there are others.  Good luck.

[ed34]

If you are diagnosed with aortic insufficiency then I would personally go for the surgery asap. This condition can get very serious. I would look at the stress after surgery, but my guess is that the BP may drop when the surgery is done.