Brief Answer:
Fainting in AR can be due to decreased blood flow to brain

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in details.
The heart pumps blood to rest of the organs including the brain. In the outflow channel, as it is pumped, the blood flows across the aortic valve and into the aorta. The aorta is a great blood vessel and carries almost all the blood being pumped out of the heart to be distributed through smaller branches to various organs.

As per your report, the heart is doing a great job when pumping because the ejection fraction is 64 percent and is adequate. However when the blood is passing through the aortic valve, there is a back flow which is termed severe aortic regurgitation. Therefor the blood moving forwards across the aortic valve and in to the aorta after each pumping action might be a fraction of the blood pumped out by the ventricles with significant backwards return.

When the above happens, the blood flowing through the vessels from heart to brain might have a reduced flow. These are by the carotid and vertebral arteries on either sides. This is more significant when you are standing upright and doing any moderate to heavy physical activity.

The best way to analyze if the reduced blood flow to the brain is causing your dizziness is by doing a carotid and vertebral arteries Doppler ultrasound. It will show the flow of blood from the heart to the brain and if it is adequate.

It is also probable that earlier you were unaware of your condition and were feeling totally normal and presently your symptoms can be increased due to awareness of your medical condition.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
You have good personal fitness and have symptoms under severe stress

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

It is possible that due to your army training, you have a good level of fitness and high stamina. This is obvious from the fact that you have attended commando training and have been without symptoms till recently.

Therefore you are experiencing the fainting episodes and heaviness only under severe stress when doing physical activities or anxiety.

Severe aortic regurgitation requires regular follow up and medical attention. You need to get clearance from cardiologists at the army hospitals and then proceed with your official duties.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Surgery not required immediately as per echo, pls consult your cardiologist

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

Having gone through the echocardiography reports dated 30-12-2014, there is grade II aortic regurgitation with aortic stenosis and grade I left ventricular diastolic dysfunction.

There are guidelines in place which helps to decide if surgery is required in your case.

1. The AHA ACC (American College of Cardiology and the XXXXXXX Heart Association) guidelines for aortic valve surgery is recommended for patients with severe chronic AR under the following circumstances
(i) Patient is symptomatic
(ii) Patient is asymptomatic, with a resting EF ≤55%
(iii) Patient is asymptomatic, with LV dilation (LV end-systolic dimension [LVESD] >55 mm)

2. The ESC EACTS (European Society of Cardiology and the European Association for Cardio Thoracic Surgery) guidelines say the following regarding surgery in AR
(i) Patients with severe AR with symptom onset
(ii) Patients with LV dysfunction or marked LV dilation, after exclusion of other possible causes
(iii) Asymptomatic patients with severe AR and impaired LV function (EF < 50%)

Under the ESC/EACTS guidelines, surgery should also be considered if the LV end-diastolic dimension (LVEDD) is >70 mm or the LVESD is >50 mm (or >25 mm/m2 body surface area in patients with small body size).

Your LVESD is 39 mm and LVEDD is 60 mm and EF is 64 percent. Therefore an immediate surgery might not be required but you have to discuss with your cardiologist also because they can know if you have any significant symptoms which might require surgery to be done early.

Followup is as directed by your cardiologist. It usually involves getting an echocardiography repeated every 6 to 12 months and earlier if you develop any symptoms.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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