“Can a Physically Demanding Job Cause an Early Onset of Heart Valve Disease?” Asks Jerry

I just received an interesting question from Jerry. In his email, Jerry writes, “Adam, I’m 53 and a recent mitral valve repair and aortic valve replacement patient. My question is… Can a physically demanding profession – like wildland firefighting — contribute to, cause an early onset, or accelerate the development of valve disease in a previously healthy person?”

Wildland Firefighter

To help Jerry better understand the progression of valvular disease, I contacted Dr. Luis Castro from the Sequoia Hospital Heart & Vascular Institute in Redwood City, California. Doctor Castro offered several interesting thoughts for Jerry that I decided to share with our community. Here is Dr. Castro’s response:

Jerry, that is a fantastic question!  Although the direct relationship between stress and cardiovascular disease is still under scientific scrutiny and investigation, we can all agree that stress appears to be playing a major role in modulating blood pressure and influencing basic “wear and tear” on the human body.  The human heart is a mechanical pump, with moveable parts, and because of that, is prone to injury as well.  The fact that most of us escape this planet without valvular heart problems is a miracle in and of itself!  Consider the amazing design and beautifully functional structure of your heart valve leaflets.  They open and close with every beat of your heart, approximately 80- 100,000 times per day…  that is at least 1.5 billion times by the age of 50!

Dr. Castro then touched on the potential impact of blood pressure and physical stress specific to the functioning of our valves.

Blood pressure, or stress, can be simply compared to the engine idle of your car.  Not much wear is being demanded at rest — when the engine is idling at less than 1000rpm.  Now imagine your car in neutral with the gas pedal slightly depressed and idling at 3000rpm… the engine is working harder, and it is just sitting still at 0 miles per hour. Now, add a slightly malformed valve at birth, or acquired injury by infection, etc., and you add on top of this, increased vulnerability to wear and tear by additional stresses inflicted by blood pressure and other modulators…  It is certainly within reason to believe that added stress can contribute to early valve deterioration.   We are all deeply grateful to fire fighters and alike who risk their lives on the job as part of a “routine” days work.  I hope that this helps.    Luis Castro, MD

Thanks to Jerry for his question and a special thanks to Dr. Castro for sharing his clinical experience and research with our patient community.

Keep on tickin!

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

To learn how Adam has helped millions of people with heart valve disease, watch Adam's video, subscribe to his free newsletter, or visit his Facebook, or Twitter pages.

  • Travis Watson

    Jerry, I agree with Dr Castro. My entire life I’ve excercised exreemly hard. Much, Much harder than the above average person. This can have the same impact one your heart and blood pressure as stress or drug abuse. I had Mitral repair at age 29 for severe regurgitation. My valve was fixed and one month after surgery my leakage was mild. within 2 months I was back to my normal strenous exercises and had another echo done at 6 months post surgery. That echo showed upper levels of moderate reguritation. I asked the doctor if my workout routine could be causing this and he said no and to keep doing what I do. So continued to do what I do. I had another echo at 2 years post op (July 2013) which showed the same upper level moderate reguritation. After that echo I drastically reduced the intensity and amount of my workouts. Basically trying to weeken my heart. After 2.5 months of reduced intensity and recording my blood pressure four times a day, my blood pressure has significantly dropped from an average of the upper 130’s to the lower 120’s. I will go for another echo in December to see if the requrgitation has slowed down back to a mild level. If my experiment is correct, that may mean that I never needed surgeru in the first place. I’ve never done a drug in my life but I am strongly thinking that excessive excercise or excessive physical or mental stress can have the same damaging effects on your heart as years of cocaine or steroid abuse.

  • Keorapetse Mogaadile

    I would like to thank Adam for such a wonderful discussion with Dr. Castro. I have also done Mitral and Aortic valve replacement in September 2010. I am a police officer and I cannot cope at all with police duties. At at one time during my echo (June 2013) I was told that my mitral valve is having a small leakage which might require correction at some point and also that my heart muscles are very weak most probably due the fact that my heart might have not fully recovered from the operation which I have done 3 years back the reason I was having some chest pains which are now part of my life. I have the same questions with Jerry so that I can see my way forward of which I don’t know what to do. Again big ups to Adam because most of these things we live with them and knowledge is power.

  • Travis

    My answer is yes – and no. I was diagnosed with mild-moderate aortic regurgitation when I was 14, due to a bicuspid valve. At 16 I started my fire service career as an Explorer. At 18 I joined the U.S. Forest Service as a firefighter on an engine company. At the same time I joined another volunteer fire department.
    For two years I worked on the Forest Service engine seasonally, for which we had extremely strenuous physical training. Our Engineer at the time had been a collegiate half marathoner, so she was pretty into fitness.
    After those two years I worked as part of a helicopter module, and that made the fitness training for the engine seem like child’s play. We were a rappell module which required that we make “pack outs” with up to 120 pounds. A pack out could be anywhere from 1 to 10 miles, in the mountains.
    All the while I saw “normal” progression of my regurgitation and normal increases in my ventricular measurements.
    Eventually I went to paramedic school and left the Forest Service for a full time career as a firefighter/paramedic. We train regularly, and I am very fitness minded. I run trails, swim, hike, and recently did a 50 mile trail run/hike non-stop.
    The one thing that I noticed affecting my ventricle was Crossfit. Although after 18 months of Crossfit made me feel like I was in the best all-around shape of my life, I started seeing increases in ventricular measurements. I decided to leave Crossfit and focus more on cardio, less on weight and iso-metric training.
    The outcome – my ventricle shrunk back down to normal-ish. I’m still hoping to put my surgery off for a number of years. I just turned 40, and I’d love to put it off 10 years or more.
    So, to make a short story long – It depends. Cardio centric training seems to make the heart more efficient with minimal growth of the muscle itself. To the contrary, weight training, especially heavy weight requiring significant bearing causes the heart to grow, just like any other muscle. For the likes of us with regurgitant valves, that’s bad.
    Keep fighting fire, focus on aerobic training, and be smart!

  • Travis Watson

    You are in a slightly different boat than me in that yours is a congenital issue with your bicuspid valve which is likely to leak. I personally think that I just damaged my vlave by my exercise habbits.
    But you saw the results that I am speaking of when you did crossfit. Your ventrical enlarges and does not let the leaflets close properly.
    Question… when your ventricle size increased did your regurgitation volume increase?
    and when it shrunk after you stopped crossfit, did your regurgitation volume decrease as well?

  • Travis

    Travis, I’m pretty up on my history and numbers, and I keep a personal copy of all of my records – but I don’t know which number in particular refers to the regurgitant volume. Can you help me out?
    I pulled out my worst study from 2010, and my LVID end diastole was 6.4 with an ejection fraction of 57.5%.
    A mere four months later, after finally deciding to stop regular intense (crossfit/gym jones) training, I was only 5.9 cm and up to 70% ef.
    I have mixed in an occasional Crossfit type workout, and I’m lifting again, although high reps/low weight. I’m due for an echo in December, but in Dec 2012 I was still holding steady.
    I will be interested to see what all of these high intensity workouts due to the myocardium in the long term. Will there be a higher than normal rate of CHF in Crossfitters? Time will tell.

  • Keorapetse Mogaadile

    Dear Travis
    I too do not know, the only thing I know is only about EF (ejection fraction), after my operation in 2010, my EF was always around 60% until I started having some angina pains, that’s when I reduced working too hard, though as a cop you will never say my work is light. Even if I spend time doing nothing, my EF is always below 44% so far with a minimum of 30%. I too do not know what could be wrong. I thought maybe exercising could help but nothing is coming out and my heart failure medication dose is increasing time after time. The most worrisome thing is that they normally give no reason just that they believe I am depressed.

  • Travis Watson

    On the echos that I’ve had there is an area called “MR Volume” Some of my echos show this number and some do not. I don’t know why they sometimes list it on the report and sometimes not? Now that I am doing this experiment I will tell them before the echo that I want the MR Volume listed on my report. There may be some other numbers on the echo report that indicate regurgitation volume but I’m not sure what that number is. Sorry I couldn’t be more help.

  • Travis

    Sorry, no MR or AR listed on my echos. Although I’ll have to ask when I have my next one in December. I’ll update you then…

    Travis

  • John Lim

    Thank you for your posting. What kind of cardiac centric training do you do? I also have mild-moderate AR.

  • Travis Ederer

    John, I really don’t limit my cardio training at all. I run, hike, bike, etc. I work out an average of 6 days per week, where I’ll do at least 45 minutes of cardio and some light circuit workout.
    For example, today I did 45 minutes on a stair mill, then 20 min circuit of 5 pullups, 10 pushups, 15 squats (no weight), and 20 crunches.
    In the last year or so I’ve done a 24 hour 50 mile hike.
    I have always tried to keep my cardiac efficiency high by keeping my cardio exercise regular.
    For reference, I usually cardio train between 125-165 beats per minute. I am 40 years old, and would train up to around 180, but my beta blocker doesn’t allow that.
    I do have the occasional preventricular contraction (extra or skipped beats), and sometimes I’ll have more of the pvc’s if I’m feeling unusually stressed, or if I haven’t been working out regularly.
    If you have any other questions, shoot me an email at tederer@hotmail.com. Put HEART VALVE in the subject so I recognize it in the junk folder if it goes there.

  • David

    I’m a firefighter for the city of Buffalo last year in July I injured my back enduring emergency room exam they heard a large murmur. Come to find out my chordee tendon broke and I had next severe mitral valve regurgitation. it was so bad that my heart was already enlarged I was asymptomatic even to the day of the surgery. I have never had any heart problems in my life I spent four years in a military, have had had multiple surgeries, even earlier that year had had an upper G.I. and no one had detected any murmur! I don’t have high blood pressure I don’t smoke I’ve got no vices that would’ve caused heart problems. My doctor and cardiologist just said that it was hereditary, although there is no history of heart murmurs and my family or heart disease! Even though my Heart problem was caught on duty after a fire when I injured my back ( herniated disc )the city of Buffalo denied my heart problem as an injury. Is there any information or anyone I can contact that could help me with my heart problems being connected with the strain of work?

  • Rick Siler

    David, I’m a now retired Fire Captain who had mitral valve repair surgery after a routine physical detected a murmur that I’d never had before. After 28 years on the job, no cardiac history, and almost no IOD time off, they accepted it as job related. Like me, yours was detected by accident, or providence. I was asymptotic as well. A year later my cardiologist said I was about 6 months away from sudden cardiac death. Congratulations on a new lease on life. Hire a recommended work comp attorney and the details will work out. Know whether you want to continue your career or retire before you start the process. Good luck. Rick

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