Blunted blood pressure/heart rate response?

[DianeE]

I have been revewing my latest medical records after my doctor has recommended a septal myomectomy and mitral valve replacement.

In a couple of places he mentions "blunted bp response" and "blunted heart rate response". It also says something about having "very little blood pressure to work with" when it comes to medications.

I would like to know exactly what this means as it appears to be one of the criteria he is using to suggest the surgical option.

[LindaSo]

Diane, I have not seen this specifically before but I am ASSUMING that he means that your HR and your BP are on the low side and the medications used will/may make them even lower. The criteria for a myectomy or ASA is left ventricular outflow tract obstruction caused by an asymetrical thickened septal wall and/or issues with the mitral valve. An ASA will not be able to correct the valve issue. I know you are going to a COE soon and you need to ask them what the criteria is and if you meet it. And if you do, what your options are at this point. Depending on the issue with the valve, a skilled surgeon may be able to "save" the valve. My valve was saved and I was one happy camper!!
Linda

[Cynaburst]

I also have a blunted hr response and BP response, especially when you add in beta blockers. That was one of the reasons I had my ICD implanted...so the pacemaker could give me some help and I can tolerate larger doses of medication. I also now use the rate response function of my pacemaker and it helps me even more.

I think that what they are saying though, for you, is not necessarily that you will need a pacer, but that you can't tolerate too much medication as your HR and BP bottoms out. Thus, if they eliminate your obstruction surgically, you won't need as much medication.

[DianeE]

The doctor did explain that my ventricle isn't terribly thick so therefore this might require a valve replacement. Does that sound right?

I have a resting peak LVOT gradient of 150mmHg and post exercise peak LVOT gradient of 170mmHg (December 2011). They have increased from June 2011 when they were resting 89mmHg and post exercise 121mmHg. I think these numbers and the increase in symptoms are the reasons he recommending surgery.

[gfox42]

You've certainly got a substantial gradient. I'd be surprised if someone didn't discuss surgery. It's certainly possible you'll need a valve replacement. Frequently they can't be sure until they're in the heart -- for example, when I had my myectomy they told me the same thing, but once they got in they concluded that my mitral valve was still quite functional.

As I understand it, blunted in this context means that these quantities don't increase as they should -- when you exercise, your pressure doesn't have the expected increase and may even decrease. That does make it harder to treat you medically, since most of the useful drugs decrease your HR and/or your BP.

Gordon

[steve75]

Diane,

I had blunted blood pressure during exercise. Like Gordon stated it meant that my blood pressure would rise during exercise but at a certain point in would start dropping. After my myectomy this condition went away.

[rpeterson]

Diane,
So good to see you getting this advice. Keep us posted.

Bob