Mohammed's Journal

Robert Miller  I had valve repairs, i.e. no medical valve. When I talked to the dentist, she wouldn't proceed with testing the pocket size or do cleaning until the cardiologist confirmed I need antibiotics or not. The dentist submitted that request  assuming the worst-case scenario (drilling which I don't need, etc). I think my cardiologist is overly cautious but he said I should take antibiotics for 3 days before any procedure. So if I have to take antibiotics with just a repaired valve, I would assume you also have to take it with a mechanical valve. 

Rita Savelis  Hello Mohammed. I have 2 mechanical valves and take an antibiotic (prescribed either by my cardiologist or dentist) one hour before I have teeth cleaning (every 6 months). My dentist is able to tell me whether I need antibiotics as he is aware of the invasiveness of any procedure and the risk of an infection descending to my heart valves. Please ask your dentist and/or your cardiologist. Take care. And sorry about the root canal!

Mohammed Abdulrahman  Robert , i think you have repair valve and the cardiologist recommend you 3 days antibiotic before dentist procedure.. 
we have mechanical valve and the cardiologist recommends one time antibiotics before 30 minutes 

Susan Lynn  Yes. Premedication is required. I also do one large dose before the appointment.
I've had several root canals, the name is worse than the procedure. You'll do just fine.

Robert Miller  @Mohammed, yes, I just have a repair. My point is, if my cardiologist says to take antibiotics, then someone with a mechanical valve really should take antibiotics. I just checked and I actually have to take the antibiotics for 2 days before the procedure. Each day 2000mg  (4 capsules of 500mg) of cephalexin.

You probably also have to stop blood thinner before the procedure.

Susan Lynn  The dosage depends on the antibiotic you're prescribed. There's a lot of conflicting information, but my dentist is a firm believer in premedication.
 https://www.mouthhealthy.org/all-topics-a-z/antibiotic-prophylaxis-for-heart-patients

Marcus Krauss  My cardiologist has prescribed me 500mg of Azithromycin to take one hour before any dental procedure or cleaning.

Rose Madura  I had a successful implant long BEFORE my surgery.  Just be sure you take antibiotics prior to each procedure. 

Mohammed Abdulrahman  Thanks rose for your response. 
I already take antibiotic (amoxicillin 1000 gm) before procedure 30 minutes. 

Marie Myers  I had a tissue valve in 2017, and had 2 implants with an extraction and bone graft last year. Everything came  out fine, and I expect them to last the rest of my life. 

Mohammed Abdulrahman  Hi Marie , happy to see your comment.

Marie, why you went through bone graft? Do you have specific problem in your jaw ?

Marie Myers  I needed the bone graft because the 2 molars had been missing since i was 18 years old. So over the next 50 years, the bone receded so much, there was not much bone to set the implant in. 
3 months after the bone graft there was enough bone growth to hold the implant. 

Mohammed Abdulrahman  Happy to hear this update.. I hope everything getting well

So , you taken antibiotics before the bone graft procedure? 

Marie Myers  Yes, before the bone graft and for 7 days, I believe. I also had an extraction done at that time with immediate implant. Then months after the bone graft grew new bone, I had the second implant placed in that second spot. Of course, I took more antibiotics for that too. But, it has been a year or so, and everything is good.

Robert Miller  What is your regular hear beat? Compare that to your 115. Sounds high to me. When I use the elliptical machine I get to maybe 130+. When I stop, my pulse goes down to 90 within 2-3 minutes. It takes a bit longer to go down to 60-70 but not one hour. Your resting HB should not be more than around 90. 

Robert Miller  Pamela makes a good point. I have a Galaxy watch (also tried iWatch) and they get the pulse completely wrong. You have to use the EKG function to get the right heart beat. Now, if your resting(!) heart beat (sitting for 5+ minutes/sleeping/etc) is between 80 and 95, that is rather high. I had this issue but after cardioversion it dropped a lot. 

Brady Busch  I may have taken low dose aspirin,when taking warfarin,which was after surgery for maybe a year.Then my cardiologist made Eliquis available,to replace it and he said to use aspirin also.He told me,that it helps with another part of the blood,the platelets,I think.

Marie Myers  Unfortunately, abnormal valves and replaced valves can be more easily infected by bacteria than normal valves. Dental problems can be a serious cause for valve infections, so  it is very important to take care of your teeth!

Marie Myers  I would guess that you might show high levels of C reactive protein or homocysteine. These are blood tests that can indicate inflammation in your body, along with a high white blood cell count which could indicate infection. Also, you might show symptoms such as fast heart rate, fever, chest pain. That is a question best asked of your cardiologist. 

Mohammed Abdulrahman  Thanks so much Marie for your valuable comments

To confirm, white blood cells is in range. 

May i will do CRP and homocysteine test this week for more confirmation

Rose Madura  I'm not a doctor but it sounds normal, I suppose. What is your usual resting heart rate? What does your doctor say about it?

Robert Miller  48 degrees it really high. That's like 120 Farenheit. Are you in Saudia Arabia, Death Valley, Sicily, or some place like that? Heart pressure looks normal. HP seems a bit high but it's 48 degrees so it might be ok After all, it falls to 86. What is your resting hear rate, though. Like when you laid down in your bed for some 15 minutes. Discuss this with your cardiologist. 

Robert Miller  @Mohammed That explains the temperatures. I suspects it's very dry.
You listed your stats when you were in the car but was that a car with an AC running? I would assume so as otherwise the stats would go up. 110/80 is quite good. 86 depends on what you are doing. If you lay in bed in a climatized room (like 80) then it's really at the upper limit. If you are moving around at elevated temperatures (like 90+) then I think it's normal. When you take a hot shower your heartbeat goes up, too. But don't take my word for it. Talk to your cardiologist. 

Brady Busch  Thanks for posting that,Mohammed.After looking further,the European Union,has all but banned these antibiotics,citing possible permanent nerve damage and other side effects.

Brady Busch  Mirza,this is from WebMD:
The fluoroquinolone antibiotics include ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), and ofloxacin (Floxin).

Marie Myers  These antibiotics ( like Cipro) also increase the risk of tendon ruptures…Amoxicillin does not carry this risk.

Brady Busch  I'll do a Richard joke here.If anyone wants to give someone an antibiotic,with the word flox in it,get the flock out of there!

Mirza Baig  My RN prescribed Amoxicillin (4 tablets)for my dental appointment coming up soon- My TAVR was done on August 27,2024

Mohammed Abdulrahman  Hi Marie
I am taking Amoxcilin irregularly, just before going dentist, i seen that  Amoxcilin can interact with warfarin. Is there alternative to warfarin? 

Mohammed Abdulrahman  Hi Mirza
4 tablets you should take at one time? Or frequently? 
what are the amount of 4 tablets dosage? 2gm?

Brady Busch  Mohammed,I
was taking Warfarin,for maybe 3 months after getting a cow type aortic
valve.My cardiologist told me later,that Eliquis(Apixaban),was available instead.So,that is what I'm using.The thing is though,Eliquis is not approved for people with mechanical heart valves.My dentist wrote a prescription for the antibiotic,Azithromycin,which hasn't caused any noticeable side effects for me.

Marie Myers  There is no safe alternative to warfarin at this time. Like Brady said (above), Eliquis (or any other anticoagulant )is not approved for mechanical valves. Also about your question about  the four tablets of amoxicillin, 2 gm would be the correct dose for a one -time dose, like for a dental cleaning. Taking four 500 mg  tablets would give you the 2 gm dose. If you are on amoxicillin for 7-10 days, the dose would be one 500 mg tablet three times a day. Hope that helps!

Rita Savelis  I take Amoxicillan an hour before I see a dentist (for teeth cleaning) as I was told it could prevent infection that could travel to my heart. However, Amoxicillin can interact with anticoagulants so if you are taking it longer term you might need to test and possibly adjust your anticoagulant dose. It might be better for you to take tylenol (acetominophen) when you have a fever unless you are certain you have an infection. Your doctor or pharmacist should be able to advise you.

Marie Myers  Is the amoxicillin for an infected tooth? I remember you writing that you had some problems with your teeth. The only problem i can think of is like Rita explained in the above answer. Amoxicillin may prolong your bleeding time, so you may have to change your dose of warfarin if you are taking it for a longer time. 

Suzette Schear  I also take amoxicillin before going to the dentist. Is your doctor telling you you have an infection and need to take it?

Mohammed Abdulrahman  Hi Marie
Yes i went to dentist and he pulled out the tooth 
but i am felling with some pain and fever 
he told me you should take amoxicilin

Mohammed Abdulrahman  No , i do not have infection , i just went to denstist and he puled out the tooth and i am feeling with some fever and pain underneath the tooth 
he told me you should take amoxicillin, but i heard that amoxicillin not good for heart so why i am posted this question

Suzette Schear    I was always told to take amoxicillin before going to the dentist to help me prevent endocarditis. I never had to take them after.  I would call my doctor and double check if it’s okay.   The fever can be concerning 

Max Jam  Hello Mohammed, congrats on your surgery. At what age did you get your surgery? And i also see that you talked to Dr. Takayama. What did he say regarding repair? Not a candidate due to stenosis?

Brady Busch  After surgery and recovering in the ICU,there was sinus block for about 10 seconds.I'm not sure exactly what that is,but it was serious enough,for them to decide and install a pacemaker.

Yumiko Ishida  Are you on a bridge drug while pausing warfarin for your dental procedure? When I was on warfarin I had to be on enoxaparin if I had to pause warfarin for whatever reason. It’s an anticoagulant that is fast acting and doesn’t stay in your system for very long. Without it your INR could get too low for too long.

Rita Savelis  I don't hear my tick tick sound most of the time. In fact it's very rare that I hear it. I feel for you Mohammed. That first year after heart surgery one can feel nervous a lot of the time.

Mohammed Abdulrahman  Hi Max

I get the surgery at 37 years old. 
My aortic valve was bicuspid valve with severe regurgitation, and when i talked with Dr. Takayama (Mar 2023) he recommended me to replace the valve , as he just recommend repairing tricuspid valves. 

Mohammed Abdulrahman  Hi Brady
I think pacemaker installed for those who have problem in heart rythem ( rapid or slow heart beat) accompanied with symptoms such as dizzy, short of breath , etc..

Mohammed Abdulrahman  Hi Rita
Do you have mechanical valve? 
All kind of mechanical valves produce sound like “clicking mouse” 

Rita Savelis  Hi Mohammed. I have had 2 mechanical valves (aortic and mitral) since 2015. I very rarely hear any clicking from them. Sometimes when it's very very very quiet - but usually I don't hear anything.

Rita Savelis  Mohammed, if a doctor listens to my heart with a stethoscope, of course he/she will hear my valves click and know that I have mechanical ones. Also if someone presses their head to my chest. And occasionally I can hear the sound if it is quiet. But everyone's heart is different and I am really not aware of the clicking sound of my valves. But I have had them a long time (9 years). At the beginning I was more aware. I know some patients are afraid that the clicking will bother them but it was really not something I worried about beforehand. There is so much else to worry about! Hope that you are feeling better and that your infection (from dental work) has gone away.

Ann T  I have a mechanical valve and have also noticed the visible beating at times. Notice it in my feet when I dangle my feet or sometimes arms too. I got nervous one day and called the after-hours line because I noticed I can now sometimes see my pulse bounding in my wrist. Im told as long as Im not in pain or short of breath not to worry about it. Im thinking it is just the way the blood flows now with the  mechanical valve and blood thinners. 

Marie Myers   you should do all you can to treat the gum and tooth inflammation. The new heart valve can be severely damaged by bacteria from infections in the mouth. You should see a dentist as soon as possible to take care of the infection. Have you seen your cardiologist recently? You should discuss this with the cardiologist. Good luck!

Grace Mason   Yes, I agree with Marie. You definitely need to address any teeth and gum issues as soon as possible. Heart health is directly related to gum and teeth health.

Rose Madura  Mohammed, I seem to get a different reading every time I take my blood pressure. I think it's pretty normal for it to vary each time.

Yumiko Ishida  Is there a typo? When you rest after walking the BP maybe 102/82? I think that is normal. Before exercise will be your base line and it goes up during exercise but then it drops right after you stop. Your blood vessels open up during exercise and remain open for a while even after you stop. Heart rate also takes a little time to return to base line.

Yumiko Ishida  I think it’s normal, unless by “a while” you mean hours. My BP takes a dip right after stopping the exercise but it returns to a slightly elevated state for maybe half an hour. Heart rate takes a little longer to come down, but at cardiac rehab they told me it’s ok to resume normal activities if it’s within 10 above the resting rate.

Jennifer Fuller  That sounds really great, but do be careful. I took a walk with my PT yesterday and he reminded me that you should be able to talk a bit while walking. You might be going a smidge too fast. Do you have a target heart rate for exercise?

Jennifer Fuller  There is a “target heart rate” for exercise. It’s based on your sex, age, resting rate rate, goals for exercise, etc. My PT gave me a target of 100 to 120. So when I’m exercising, I check my heart rate (I’m using a fit bit, but there are other options) to make sure I’m working hard enough to make progress, but not so hard that I’m putting too much stress on my heart.

Rita Savelis  You are normal Mohammed and doing very well for only 19 days. Give your body some time and you'll get there. 

Marie Myers  Several people on this site  have reported higher pulse rates after surgery. I bet yours will gradually come down with a little more time. Might be a question for your cardiologist next visit if you are still concerned about the rate.

Karen Hanna  I would definately mention this to your cardiologist.  It is not abnormal after heart surgery.  Pre-mitral valve repair surgery my heart rate was around 64bpm.  Post surgery it sat around 118-125.  Your heart needs time to heal and beating fast does not help.  My doctor put me on low dose Matroprolol and Corlanor.  Heart rate has settled to around 74bpm.  As you exercise more efficiently your heart rate should start to settle and meds can be adjusted.

Laurent G  Not a doctor but the numbers look good for me, I wish I had the same.
Congratulations on your successfull surgery !!

Marie Myers  The fact that your BP and pulse decrease after your walk is great! It shows  that you are getting your fitness back. It is normal for the BP and Pulse to increase with exertion, and  then it goes back down to resting levels. Congratulations!

Allen Carkner  That's about what I was like in rehab. You want to see blood pressure increase slightly with exercise then fall back to normal or even slightly less after exercise. Cheers! 

Marie Myers  I believe the mechanical valve can work with heavy activities once you are fully recovered and back to your full fitness. The thing to be concerned about is getting a serious injury while taking the blood thinner required for the mechanical valve. You should speak to your doctor about this question to get his opinion.

Mohammed Abdulrahman  Thank you Marie 
so, the mechanical valve is better than biological valve regarding with heavy activities and duties? Right?

Marie Myers  The mechanical valve can last longer than a tissue valve, especially if you are younger person. I believe there are some very active people and athletes on this site who have mechanical valves. I hope they will see your note and add their thoughts. 

Dennis Shaffer  I would think things get better as you heal.  I've seen others mention their heart rate having to "settle"

Grace Mason   I believe a fever under 101 Fahrenheit so soon post surgery is not uncommon, Mohammed.
I was told when I was discharged, if it goes above 101 F or greater than 100 F for 24hrs to call my doctor. HR is very variable, but check in with your doctor if you have any concerns

Marie Myers  Congratulations on your surgery! I do remember lots of coughing up mucus after my surgery. Walking does help to expand your lungs and expel the mucus that that built up in your lungs during the surgery. With time, the coughing will decrease and you will get back to your normal condition.  

Klara Čičić  You did it! You had the surgery, I am so glad for you. I also had productive cough for the first week or two and had to work really hard to expell the mucus since it was painful to cough, but soon all of that got better. Take care! 

Leti Tenner  Hi Mohammed, congratulations and welcome home!

I was in a great deal of pain, especially back and shoulder pain, which I wasn't expecting. I learned the back pain resulted from being on my back during surgery on a metal table with my arms extended outward (like a "T") for several hours. The pain was so intense I couldn't sleep in the hospital bed, but instead slept in the recliner chair each night. The hospital provided me with muscle relaxant to help with the back pain. I'm 4 weeks post-op and I'm still sleeping upright in a recliner due to back discomfort.

Regarding breathing, a nurse in the ICU would tell me every hour or so, to make sure I'm breathing. She said I need to re-train my body to take deep breaths. I was so tense I found myself holding my breath or breathing rapidly. In any case, I found it difficult to breathe (deep breaths) post-op and I had to concentrate and make breathing intentional.

You're only a few days post-op and doing well. Walk for as long as your body permits -- even if it's only 5 minutes. Hopefully, you'll notice small improvements each day.

Rose Madura  Mohammed, I think this all sounds normal. Your body had been through a great trauma. Be patient and take one day at a time. Do the breathing exercises that they give you. Hoping you will feel better soon.

Grace Mason   Welcome to recovery Mohammed ❤️‍🩹. You are early days so don't be discouraged. Your discomfort will improve day by day. Sleeping in a propped up position on your back is commonly the most comfortable post OHS. Wishing you well❤️

Marie Myers  Choice of valve is a complex question with many factors. Generally, the younger the patient, either a repair, a Ross procedure, or a mechanical valve are good choices. If a mechanical valve is chosen, the Ony-X valve is a good choice, since it allows for lower levels of anticoagulation. For a tissue valve, there are several different brands, and sometimes different hospitals/surgeons  make the choice for you. My tissue valve is an Edwards Magna Ease . I hope this helps !