This story reflects one person's experience. Not everyone will experience the same results. Talk to your doctor about the benefits and risks of your treatment options.
Bob was a marathon runner, a competitive cross country skier and a canoe racer when he was diagnosed with aortic stenosis, or a narrowing of his aortic heart valve, at age 46. In fact, he was training for a marathon when he first felt a twinge in his chest.
Later that year, Bob was shocked to realize he could not make it up the slight incline outside his home one summer afternoon. He also coughed up a frothy substance that his doctor determined was regurgitated blood, a sign that his heart wasn't working effectively.
At first Bob's doctors wondered if his wood-working hobby had somehow affected his lungs, but tests confirmed his lungs were fine. A standard EKG did not reveal any issues, but an echocardiogram—a more thorough test—showed his heart valve was weak and not working properly.
“They wondered if I’d had rheumatic fever, but there was no evidence of it,” says Bob. “The doctors determined I had a congenital heart defect and scheduled me for heart valve replacement surgery in the fall.”
Understanding His Options
Bob knew surgery was the only choice, but he wanted to learn as much as possible about his surgical options. His biggest fear was not being able to run after surgery . “Nobody wants to give up their lifestyle,” he says.
The recommendation from Bob’s primary care doctor was to replace his defective heart valve with a tissue valve so he wouldn’t have to take anticoagulation medication after surgery. However, when Bob met with his surgeon they assessed his age, activity level and other factors and determined that a mechanical valve was the better choice for him.
“In my opinion, the jury is still out on the longevity of tissue valves,” says Bob, “and I thought one surgery was enough.”
During the surgery, his aortic valve broke apart. Bob believes that if he had not been in surgery when the valve broke, he would have died. Instead, the damaged valve was successfully replaced with a mechanical valve and Bob was on the road to recovery.
Bob's biggest post-surgery challenge was waiting for his chest to heal. As with most heart valve surgeries, Bob's surgeons had to perform open heart surgery to access his heart. His hospital stay was only about four days, and within two weeks he slowly returned to his training routine. Within two months, Bob was almost completely back to normal with only some minor discomfort remaining around his ribs.
Back to Normal with Warfarin
Now that he had a mechanical valve, Bob understood that taking warfarin regularly was an important part of protecting his heart. He also knew warfarin would slow his blood's clotting process, causing concern that the smallest of wounds could result in unstoppable bleeding.
It’s been 19 years since Bob started taking warfarin, and he has never had a problem. He goes to the lab once a month to test his international normalized ratio (INR), or clotting time. Acceptable levels vary for each patient, and Bob is aware of his acceptable range. When he is outside that range, he assesses his diet, and makes an effort to take his warfarin at the same time every day. Then, he repeats the INR test.
Warfarin and the mechanical heart valve have not interfered with Bob’s active lifestyle. “If you want to do something physical, you can still do it unless you have other complications,” he says. In fact, Bob improved his personal best marathon time by 12 minutes during his first post-surgery race.
Advice for Others
Bob is happy he paid attention to the warning signs for his condition and encourages others to do the same. He suggests documenting symptoms to give your physicians a clear picture of what is happening, and he stresses being your own advocate by asking your doctor questions and pushing for comprehensive testing.
“I think my story shows what can be done,” says Bob. “I don’t feel like a hero or exceptionally special. Instead, I give credit to God, my doctors and St. Jude Medical for helping me to do all of these things again.”
Last Reviewed: January 19, 2010 2506