DR. HOOK- Have a heart: Aortic stenosis can sneak up

Arnold Schwarzenegger– excuse me, Governor Schwarzenegger– is quite an interesting man. When I was a teenager and saw him in Conan the Barbarian, I didn't think he could act. (How hard can it be to act like a barbarian?) Even decapitating his enemies didn't seem real. Lederhosen would have been more realistic on him– but then we wouldn't have seen his "pumped-up" body. 

Then I saw The Terminator, and my whole concept of him changed. It was like My Fair Lady. He was transformed from a body builder with no acting abilities into a mega-star... with no acting ability.

When he married Maria Shriver, I was shocked– and I still am. To me, they are oil and water– but I guess together they make a great salad dressing. And in 2003, he became the governor of California. "California, here I come...." He just never ceases to amaze me!

So when I heard Ah-nuld had his bicuspid aortic valve replaced, it was amazing for me to think about Mr. Olympia and Mr. Universe having such a vital congenital defect. It goes to show that if you put your mind and heart into it, you can do anything.  

This time, Gov. Schwarzenegger literally put his heart into it-– with a cardiovascular surgeon. Was it the right thing to do?

The aortic valve is the last part of the heart that regulates the blood being pumped from the left ventricle out to the body. In Aortic Stenosis, the cross-sectional area of the valve gets smaller-– so less blood can be pumped out.  

Most people with Aortic Stenosis don't have any symptoms because it's a slowly evolving process. This presents a problem because the closure can lead to an arrhythmia, or irregular heartbeat, that can cause sudden death. So when you hear someone say, "Yep, he was fine, but before we knew it, poof! He just dropped dead," that is sudden death.

   When symptoms do occur, usually the AS is pretty severe and an aortic valve replacement is needed. But at the same time, when symptoms occur, it might already be too late. Angina, lightheadedness, fainting (or "getting the vapors" as Southerners would say), and shortness of breath during exertion are all symptoms of AS.

Physical examinations are important in detecting AS–which is why everyone should see their doctor regularly. Ahem.

A stress test, certain heart murmurs, and a particular carotid pulse can indicate AS, as well as an EKG to detect ventricular arrhythmias. An Echocardiogram or cardiac catheterization can measure the severity of AS.

There are three main causes of AS: rheumatic valve disease due to an infection, a congenital valve deformity, or degenerative calcific disease, which usually afflicts folks 70 years and older. In the case of Ah-nuld's valve defornity, AS ususally develops at around 50-60 years of age, so that might be why he had his valve replaced. 

But smokers tend to have more AS, and we all know he loves his cigars— bleh!

Since most people with AS are elderly and usually have Medicare, there's a small dilemma because Medicare covers only doctor visits for problems. Medicare doesn't cover annual wellness visits or most prevention visits. 

So elderly people with Medicare who don't have any medical problems can't be reimbursed for having a diagnostic heart evaluation. And I know many patients won't see the doctor if insurance doesn't cover the visit.  

The way our medical care is set up seems pretty heartless to me.   



dr/hook:age 81-have aortic stenosis measured at
.8w/angiogram pressure test &.9 echo. also detected is need for 2 arteries bypass.
question:is minimal invasive surgery available? if yes, where is it done. here in florida, surprised that cleveland clinic surgeon only works with older opening of chest. thank you

Dr. Hong, you are correct that AS can creep up on you. I was 10 years younger than Gov. Arnold and my problem was aortic aneurysm which stretched the aortic valve out to 50% leakage and unable to repair. I had my surgery 1 week after Gov. Arnold and had same valve replacement with Homograft. People and Arnold need to be aware that this homograft has a limited life and without no symptoms but during a yearly check up, it was found that this homograft was so calcified that it was hardly working anymore and aortic leakage bad and causing mitral to leak also. This was spring of 05 and told I would not make it 2 years. I went in for reop in Feb of 06' even though I was still not having symptoms, the valve wasn't working any more.
The reop went better than the original and I thought the first went great but was walking, talking and eating day after surgery and back to work in 7 weeks.
Dr. Smedira did the work and besides being an excellent surgeon, he is a great person who prepares the patient very well and checks up aferwords. He's the greatest.