Tag Archives: clot

Echocardiogram Images 

I thought it would be cool to share my final echocardiogram results from my recent hospital stay. I took some video of the echo screen. My cardiologist points out the clot, which is small enough here to allow me to be discharged.

Also, notice my mechanical aortic valve shape. My doctor points to it in the 2nd video. It is near the middle of the screen. It is a circle, with a straight line that goes from its 12 o’clock to its 6 o’clock. That line will appear and disappear, which are the bi-leaflets closing. Use the picture of a St. Jude’s mechanical valve below to help identify it in the echo. regent-2

 

 

In screen shot below, I have circled the clot.  It appears as a little white smudge. It was larger when it was first detected last Friday. Try to look for that little smudge in the videos above.

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Clot

On Wednesday October 12, while driving to work, the vision in my left eye slowly began to black out. It seemed as though dark clouds were forming around the center of my view. I pulled over and within 3 minutes of when it started, my vision was almost all gone in that eye, with a small pinhole in the center. Then, it started to get better and in a total of 5 minutes, my vision was completely back.
After consulting my nurse friends, I excused myself from work and drove myself to the ER, which was absolutely useless. Loma Linda ER is a trauma center, and during the 13 hours I spent there, it took 8 hours to get a bed, 10 hours to see a doctor, and the only tests they did was blood tests and an eye exam. They did not feel that it was necessary to look at my heart. This is the 2nd time in my life that the Loma Linda University Emergency Room overlooked my condition. The first time was back in 2014 when they were unable to notice that my newly implanted valve was infected and falling off. This time, if they were able to simply perform an echo on me, then they would have noticed what is going on currently.

Today I went in for an echocardiogram with my cardiologist. I was an emotional wreck. My biggest fear was that I had endocarditis again. It turns out that I have some tiny fibrous blood clots on my mechanical aortic valve. One of these tiny clots dislodged and briefly clogged the blood flow to my eye. The condition is called Amaurosis Fugax.
My anticoagulation therapy is Coumadin. Without the Coumadin, clots form on the rigid edges of my mechanical valve. My INR (how ‘thin’ my blood is) was supposed to be between 2.0-2.5. A normal person who isn’t on anticoagulation therapy will have an INR of 1.0. The day of my episode, my INR was 1.8. This means that clots were more likely to form. I missed a dose of Coumadin on Monday, which means my INR was probably below 1.8 then. These clots could have formed then. There’s no way to know though.

Endocarditis can cause Amaurosis Fugax, as can blood clots. Luckily, the clots are very tiny. Even if the clots that are currently in my heart were to dislodge, they would not cause serious damage, such as a stroke. The goal is to keep them from getting larger.

I was just admitted to the cardiac unit at the hospital. I will stay here for a few days to be given heparin while my Coumadin dose is increased. Heparin will keep the clots from getting larger and stop new clots from forming. My INR will be increased to 3.0 and I will now try to maintain that level at home from now on.

They are doing a blood culture to be 100% certain that it’s not an infection again (Endocarditis). They said that bacterial vegetations don’t normally form on the valve leaflets like how it appears in my echo, but since I’m here, and because of my history of endocarditis, they want to be sure. At this point I’m not worried.

I will hopefully be discharged this weekend. I am super disappointed that I will be missing two amazing concerts that I was planning on going to this weekend. As my friend told me,

“There’s a lot of magical stuff goin on in the world. Concerts and Music festivals are like condensed reminders of the beauty, engagement, and interconnectedness that is possible for humanity.”

Check them out the artists that I was going to see this weekend below:

How To Dress Well and Moses Sumney.

The Great INR Balancing Act

Living with a chronic disease/condition comes with up swings and down swings. Things are good, then not so good. It is a balancing act to stay healthy. Yesterday; great news, today; less great news. Below is an explain-y section, and a vent-y section.

Explain-y: Living with a mechanical valve means that I must be on the drug Warfarin (Coumadin) for life. Warfarin is an anticoagulant, which means it slows down the clotting factors in the bloodstream. This is prescribed to patients with mechanical valve because the platelets tend to stick or snag on the edges and surface of the synthetic valve. When the platelets snag, they begin to clot, forming a blood clot, which can then dislodge and cause deep vein thrombosis, heart attack, or a stroke.  Super bummer right?

Warfarin/ Coumadin are often dubbed as ‘bloodthinners’, though they DO NOT thin the blood. ‘Bloodthinning’ implies that the viscosity of the blood changes (Think ketchup vs. water). These drugs are anticoagulants. The term ‘bloodthinner’ is simply a nickname and not to be taken literally.

That being said, even doctors and nurses will use the term ‘bloodthinner’, though I will not for the remainder of this post. The anticoagulant factors in the blood can be measured using a simple blood test called the Prothrombin time (PT) test, which generates a number called the international normalized ratio (INR). A person that is not on Warfarin/ Coumadin will have an INR of 1.0. Someone who has a mechanical valve will usually be directed to maintain an INR between the range of 2.0-3.0. My cardiologist likes me to stay between 2.0-2.5, though it is difficult to stay within that small of a range. Basically, I am tested every other week, and if my INR is too low (under 2.0) they increase my daily dose), and if my INR is too high (above 3.0), they lower my daily dose.

There are lots of risks and factors to keep in mind when you are taking anticuagulation therapy medication like Coumadin. I’ll let you read about how Vitamin-K (found in leafy greens) affects INR, how having a high INR can be dangerous, and other factors by clicking this link.

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Please excuse my Bitmoji use.

Vent-y: For months and months my INR has been stable, but all of a sudden (last week) my  INR was measured at 4.3! That is certainly the highest it has ever been. They adjusted my dose, and ordered me to take my PT two days later. When I took it again, it was measured at 1.5! Too low! Two days after that (today), I measured again and…. 1.4! It is very frustrating, especially since this is a chronic condition, and this problem will spontaneously occur (hopefully rarely) for the rest of my life. As frequent readers of this blog my recall, last year I lost a fellow valver, cyclist, and friend due to deep vein thrombosis/ brain embolism due to clotting issues associated with his mechanical valve.