7 Weeks Post-Op: Pounding Sensation in Chest with Mechanical Valve – Need Advice

[HeartyPants]

Hi all,

I'm a 27-year-old male who underwent a second open-heart surgery 7 weeks ago. I was born with a bicuspid aortic valve, and initially, in 2012, I had my first surgery to replace the valve with a tissue one, along with part of the aortic root.

This time around, that valve had calcified (along with severe aortic stenosis and regurgitation), so I had it replaced with a mechanical aortic valve, along with a redo-aortic root replacement and ascending aorta replacement).

I'm currently on 4 different medications: Bisoprolol 2.5 mg, Eplerenone 25 mg, Telmisartan 40 mg, and lifelong Warfarin.

Recently—perhaps 4 weeks ago—I started noticing a pounding sensation in my chest. I'm not sure if it was there before; it might have been, but I may have been numb to it because of the accompanying pain. It has gradually become more noticeable (or perhaps I've just started paying more attention to it). Either way, it feels abnormal. It’s not because my heart is racing or beating harder—it’s something I feel all the time. However, if I straighten my back or take a deep breath, it becomes much more prominent and loud.

It’s so loud that people can hear the internal pounding more than the actual clicking of the mechanical valve. If I bend forward or exhale completely, the pounding disappears. It feels like my heart has less space in certain positions, making the sound more echo-like and, therefore, louder.

Obviously, at 7 weeks post-op—especially after such a significant operation—I’m still in the healing process. About 3 weeks ago, I noticed externally visible swelling at the top of my sternum where the initial incision was made, but it gradually disappeared over the next 2 weeks. I’m thinking there might still be some internal swelling causing this physical sensation.

I don’t feel unwell at all. The other symptom I’ve noticed recently is occasional palpitations that come and go. I think this might be due to overexerting myself, as I now have much more strength and energy, and I’ve been pushing myself more than I probably should.

My blood pressure is okay-ish—not perfect—but it averages around 135/85 when resting. My resting pulse is usually about 60. So, all in all, my vitals seem good.

Has anyone experienced something similar at this stage post-op? It’s driving me nuts—it’s like someone is constantly knocking in rhythm on the inside of my ribcage.

Are there any cardiologists or cardiothoracic surgeons here who can help settle my nerves (or not)? Thank you all.

[PadThaiNoodles]

I'm two weeks in front of you (no aortic root issues, but mitral valve repair and aortic valve replacement 9 weeks ago).

I can definitely feel my mechanical valve thudding, particularly in some postural positions. I think it gradually becomes a bit more noticeable after the first few weeks because the inflammation of your heart and chest is going down as it heals.

I mentioned it in the other thread, but I think the CBT I took years ago (for unrelated anxiety) has helped me to just shrug and ignore it.

[HeartyPants in reply to PadThaiNoodles]

Just the fact of knowing that I'm not the only one feeling this makes me feel better. I do in fact agree that it might be the inflammation going down that makes it more prominent, although it makes me think if the overworked heart (from having heart failure because of a failing valve), will heal and adjust to work lighter with time, and therefore reduce the thumping noise.

[Cliff_G]

Yes, indeed, this is what tends to happen with mechanical aortic valves. From what you describe I wouldn't say there's anything abnormal. The sequence of you not hearing it, then hearing it, and having it become clearer is more than likely just awareness, and potentially when you (presumably) came off pain killers.

As well as hearing it yourself, others can hear them, as a number of nurses and echo sonographers have said to me "I think I can hear a mechanical valve?" I heard of one man whose life was saved after a cardiac arrest because his wife called 999 as she couldn't hear his valve.

Having lower blood pressure tends to help, beta blockers or calcium channel blockers will reduce the force of pumping, but these can have minimal effect as the noise is actually at the end of the pumping stroke, not when the heart is squeezing, when the valve closes to prevent blood back-flowing. The aortic graft may make it worse (I have a huge ascending, arch and FET grafts), as they are very inelastic compared to the natural aorta whose job it is to smooth out forward blood flow.

I've never really found mine bothersome; it's now 7 years since it was implanted. I also had ectopics, then atrial flutter, and the valve does make those much more noticeable.

I know it's easy to say "you'll get used to it", but that is more than likely the case. Some people do find it harder than others, but I hope you can manage it ok. You'll have an echo at some point in follow-up, and this will allow the consultant to check for the rare case that there's anything actually wrong.