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Welcome to my Gemini capsule. I am a Science and Physics teacher from Christchurch, New Zealand who writes code in his spare time, but would really rather be outside doing almost any type of sport! 🏔 🏃♂️ 🎿 🛶 🚴♂️ 🧗 🧘♂️
First things first: iamnotadoctorthispostdoesnotconstitudemedicaladvicepleaseseeaprofessionalifyouhaveconcerns. Ta.
In 2019 I found myself with a new partner -- Jen. She's pretty rad, if I do say so myself. She is also a doctor, which leads to many interesting conversations that I love. One evening we were having a bit of a snuggle (cute, I know), and she goes "You have a heart murmur!". I didn't know what to make of that and she told me to see "a real doctor", but I was probably just tachycardic[^1]. We both promptly forgot about it.
Tachycardia: An increased heart rate (e.g. over 100bpm). Not always a concern; for example during exercise.
Fast forward to 2022 and I'm seeing my GP for an unrelated issue and he asks "Can I listen to your heart?". So, he puts his stethoscope in his ears and what do you know "You've got a heart murmur". "Oh yeah! My partner picked that up in 2019 but we both forgot about it." Well, he wanted to investigate it. He referred me to the DHB and a few months later and I got an appointment for an echo-cardiogram[^2].
Heart Murmur: A change in the beat sound of the heart caused by atypical blood flow. See reference for a video.[^12]
My echo was performed by a lovely technician who let me ask lots of questions. I was mostly interested in the Doppler shift[^3] I could see on the ultrasound screen -- very interesting stuff! Turns out, it shows the flow of blood. Super cool. She told me that yep, that's definitely a "bicuspid aortic valve" and there's definitely "regurgitation". To explain:
- the aortic valve should have three leaflets not two[^4],
- and regurgitation means that some blood is flowing back into the left ventricle due to the malformed leaflets[^6].
In summary, not good.
<figure>
<img src="https://www.umcvc.org/sites/default/files/styles/large/public/bicuspid-aortic-valve.jpg" loading="lazy"/>
<figcaption>
<p>A bicuspid vs tricuspid aortic valve. [<a href="https://www.umcvc.org/conditions-treatments/bicuspid-aortic-valve-bav">Source</a>]</p>
</figcaption>
</figure>
Later that day I got a call from a very kind cardiologist who explained these things in more detail and also noted that my aorta is dilatated[^7].
Dilated: make or become wider, larger, or more open
Dilatated: make or become wider, larger or more open through active or artificial means, usually beyond natural sizes.
Hmm, what can cause that? In my case, a bicuspid aortic valve. Is it bad? Yes. How bad? Very, if its gets to the point where the aorta dissects.
Aortic dissection: where the inner layer of the aorta sustains a tear which fills with blood and can cause the aorta to split open (potentially fatal).[^8]
The cardiologist booked me an MRI before Christmas, but was not clear about why I needed it. Jen told me they can normally tell all they need about a valve from the echo-cardiogram. I figured that I would find out later!
People talk up the claustrophobia of being in an MRI, but I found it totally fine. It's quite a long process, though. Lots of breathing in, and holding your breath for certain amounts of time (to still the heart) before breathing out and repeating. I think I must have dozed off for a few seconds in the middle and missed an exercise, though, because the technician asked "Just checking you're still awake" over the headphones. Whoops!
I later found out that the MRI was to look specifically at my aorta. This was to better inform any potential surgery I might need.
The overall goal is to:
1. Reduce risk of aortic dissection
2. Reduce dilation of my left ventricle
To stop the aorta dilatating any further, pressure needs to be reduced. This can be achieved by replacing the aortic valve. To do this you need to undergo open heart surgery and be put on a bypass machine.[^9] Pretty serious stuff.
The dilatation of my aorta is such that it should be repaired. This reduces the risk of fatal dissection. The repair can be affected with a Dacron graft to replace the section of dilatated aorta.[^10] It would be completed at the same time as my valve replacement.
After this, my left ventricle, which is also dilatated, should hopefully return to normal size. This should occur because it will not have to accommodate the regurgitated blood.[^11] This is important because if it dilatates too much it may not return to normal size/function in the future, which would significantly impact my quality of life (e.g. heart failure).[^13]
<figure>
<img src="https://themarfandiary.weebly.com/uploads/2/3/9/4/23940725/2140047_orig.jpg" loading="lazy"/>
<figcaption>
<p>A dilated aortic root and Dacron graft. [<a href="https://themarfandiary.weebly.com/blog/aortic-education">Source</a>]</p>
</figcaption>
</figure>
I've had an echo, an MRI and an appointment with my cardiologist. Now, my case will be presented to the entire cohort of cardio-thoracic surgeons at Christchurch Public Hospital. At the meeting they will agree on the most appropriate surgical fix. After that, I get an appointment with my surgeon to discuss their recommendations and we go from there.
Mā te wā 👋
[^1]: https://www.healthdirect.gov.au/tachycardia
[^2]: An ultrasound of the heart: https://www.healthnavigator.org.nz/health-a-z/e/echocardiogram/
[^3]: A picture showing the shift in sound waves due to the movement of the object they are reflected off. https://ecgwaves.com/topic/doppler-effect-and-doppler-studies-in-echocardiography/
[^4]: https://www.mayoclinic.org/diseases-conditions/bicuspid-aortic-valve/cdc-20385577
[^6]: https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/symptoms-causes/syc-20353129
[^7]: https://healthblog.uofmhealth.org/enlarged-aorta-risks-and-symptoms
[^8]: https://www.mayoclinic.org/diseases-conditions/aortic-dissection/symptoms-causes/syc-20369496
[^9]: https://www.nhs.uk/conditions/aortic-valve-replacement/
[^10]: https://www.cedars-sinai.org/health-library/diseases-and-conditions/o/open-aortic-repairs.html
[^11]: https://www.mayoclinic.org/diseases-conditions/dilated-cardiomyopathy/symptoms-causes/syc-20353149
[^12]: https://www.youtube.com/watch?v=uFoUATyZvLQ
[^13]: https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/dilated-cardiomyopathy
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