mechanical heart valve

[Joeybuff]

in 2019 I have a 6.9 aortic aunerysm repaired and a mechanical heart valve put it, it’s been five years and I still hear the ticking clear as day and feel the thudding at random times. It has cause such severe anxiety as I had a heart attack two stents and a stroke due to the mechanical valve. They now keep my inr around 3.0-3.5 which I test twice a week on my machine at home. Does this sound normal to all of you, meaning still hearing the ticking and still getting the thudding. Thanks everyone

[Hanibil]

Hi I had a mechanical valve in 2005 I heard the clicking for a short while and it bothered me a lot , my nephew stood near me one day and said what’s that noise then he said that’s you ticking,. Then my partner said if you didn’t tick you would be dead so get over it.

I have to say that made me think, and the ticking gave me comfort in knowing I had been through a big trauma and survived. I know longer hear any ticking and no one standing near does. I think I heard it ticking because I wanted to if that makes any sense.

[Cliff_G]

Yes, Joey, it will continue to tick, that's quite normal and nothing to be concerned about. If it stops ticking that means either your heart isn't pumping (!) or that there is perhaps some clotting in the valve damping the nice clean click you should get. If so, check your INR immediately. And do you get your home tester checked and calibrated occasionally?

Re. your stroke, is it possible that your INR got too low? What was your previous range - 2 to 3 or 2.5 to 3.5?

It's unlikely to be the valve on its own, but you do need to keep your INR in range to ensure blood does not coagulate on the valve surfaces, especially the pivots, where there are little crevices. Modern mechanical valves, according to NICE, have target INR of 2.5, range 2.0 to 3.0., older ones are target 3.0 so 2.5 to 3.5. They clearly put you up to 3.0 to 3.5 to provide some safety margin at the low end.

That's a little like when they put me up, from 2.0 to 3.0, to 2.5 to 3.0, when I wound up in A&E with a possible pulmonary embolism. This is to make sure I don't go below 2.0 at all, since I had mentioned to the hospital that I was occasionally at 1.7 and it wasn't corrected back to above 2.0 in my view nearly fast enough.

Most people do get used to the ticking and eventually find it reassuring, but you need to get your stroke event over and done with and in the past before you can allow the valve to be just a normal part of you.

[Cliff_G in reply to Cliff_G]

p.s. congrats on getting your aneurysm done, mine was 4.5 when I dissected! Are you getting annual CT scans on the whole of your aorta?

[Joeybuff in reply to Cliff_G]

Yes they do annual imaging of the heart and functionality and yea both my heart attack and my stroke my inr was 1.9 and 2.0 so they bumped my warfarin levels to make sure I stay closer to 3 in case it drops I appreciate it thank you

[Cliff_G in reply to Joeybuff]

With such a large aneurysm, they should also do you an annual CT scan of the whole aorta, to make sure areas other than your repair are ok. I was on annual CT for 4 years after my AD, but looking good and now dropped back to biennial.

Did you have a bicuspid Aortic Valve?

[Rosie1066]

yes, totally normal, I still hear mine all the time fourteen years after my Aortic Valve replacement. It’s very common.

[Mitchum]

I only heard mine for a short while but still very occasionally hear it. Not a problem. As for INR, you don't need to check it twice weekly as the fluctuation is too great on a daily basis, and the range is set by (normally), the cardiologist. Mine is 3 to 4!