Surgeon Q&A: “Can Aortic Stenosis and Aortic Regurgitation Result in Over Exertion & High Stress?” Asks Mark
I just received a great question from Mark about symptoms and potential, patient limitations relating to aortic stenosis and aortic regurgitation.
In his email, Mark writes, “Adam, I was diagnosed in 1999 with Aortic Regurgitation at age 47 and receive annual echos and check up. This year 2014 at age 62, I was diagnosed with Aortic Stenosis, I believe moderate at 1.2 to 1.5 CM2. I have reported to my cardiologist mild shortness of breath and very regular and annoying palpations. My job is high stress and at times includes extreme over exertion. I can’t seem to keep up and at times feel very fatigued, short of breath and ill. My cardiologist is great, but he said my age may be the primary reason, not my heart disease. My primary care physician tends to disagree and thinks my Aortic Stenosis is primarily responsible. My question is with moderate aortic stenosis and aortic regurgitation, is there risk to extreme over exertion, and high stress? I am asking for your opinion because of your knowledge on the subject.”
I wanted to provide Mark an expert response to his question so I contacted Dr. Jeff Gibson, a cardiac surgeon from Nashville, Tennessee. So you know, Dr. Gibson has treated many members of our community including LaTonya Blair, Thomas Bryant and Carol Chandler. 🙂
In his response to Mark, Dr. Gibson noted:
The patient you describe is really asking two questions: (1) Is it possible that my shortness of breath and fatigue are due to my aortic valve? (2) What are my limitations with moderate aortic stenosis and presumed moderate aortic insufficiency, in the presence of such symptoms?
Dr. Jeffrey Gibson
In his answer about symptoms related to aortic valve disease, Dr. Gibson noted:
Shortness of breath and fatigue are not normal at age 62, assuming the absence of severe lung disease or other systemic disease. It is likely that the aortic valve disorder is responsible for this patient’s symptoms, and more careful evaluation of the patient and the echo likely will result in a recommendation for aortic valve surgery. Some patients may develop symptoms with “moderate” aortic insufficiency and “moderate” aortic stenosis, and in this setting it may be reasonable to proceed with surgery if operative risk is very low. As always, it is best for physicians to listen to their patients and make every attempt to reconcile symptoms with the patient’s diagnosis.
Specific to the potential limitations related to aortic valve disease, Dr. Gibson wrote:
The second question relates to exercise precautions with aortic valve disease. Activity level recommendations are based on the severity of the valve pathology (regurgitation or stenosis), the underlying ventricular function, and presence or absence of symptoms. Additional limitations are made for patients with a dilated aorta (usually considered a diameter > 4cm). In general, patients with severe aortic stenosis/regurgitation, or moderate aortic stenosis/regurgitation WITH symptoms (shortness of breath, chest pain) should avoid moderate or high-intensity exercise or exertion. Low-intensity exercise is safe as long as it does not produce symptoms. Patients with dilated aortas should avoid lifting heavy weights, and should avoid high-intensity exercise.
I hope this helped Mark (and perhaps you) learn more about the symptoms and potential limitations related to aortic stenosis and aortic regurgitation. Many thanks to Mark for his question and a special thanks to Dr. Gibson for sharing his research and clinical experiences.
Keep on tickin!
Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.