Lifting with a Bicuspid Aortic Valve (BAV)

[Ancano]

Well the general idea is when you lift heavy weights it increases your blood pressure and puts pressure on your aorta. 50 pounds seems to be their recommendation for the maximum amount of weight you can lift before you start straining and putting pressure on your aorta. They are totally OK with any kind of cardio though which doesn't make sense, cardio I assume increases blood pressure significantly as well. The doctor also told me I should avoid the Valsalva manuever. Is there a way to lift heavy and not do the Valsalva manuever?

Yes I asked about connective tissue disorders and he seemed pretty sure I did not have any but recommended further testing just to be sure. The other ones he mentioned were Loeys-Dietz Syndrome and Ehlers-Danlos Syndrome. It seems pretty pointless to me though because I do not have any symptoms associated with these diseases. I just happen to have Pectus Excavatum and BAV at the same time.

So far the only thing I can do it seems is endurance empty-bar lifts that emphasize repetition. Does anyone know of any high rep lifting programs that are actually worth doing? To be honest when I do 15 reps of 50 pounds I feel like I am wasting my time and not gaining any strength.

[Mark Rippetoe]

We try to provide the best information on this website, but you just won't read it.

The Valsalva & Stroke | Jonathon Sullivan

Read this a couple of times, and then tell us what happens to the pressure across your aorta -- on both sides of the arterial wall -- when you lift weights.

[Pluripotent]

When I read your reply about the connective tissue disorder concern, it seems to me that the doctors are fishing, which unfortunately is common and also one of the worst things to do. So, similar to my previous story about the tall guy my attendings thought might have Marfan's. (Of course you have to decide for yourself if this fits, since obviously I don't know, being just some dude on the interwebs who may only be pretendingto be a doctor). Sure, as a physician, you want to think about all the possibilities, but that shouldn't mean subjecting patients to unnecessary tests and getting them all worked up over nothing.

Another anecdote: my nephew is a bit small for his age (tends to run in the family), and lost some weight a few months after birth. This prompted his pediatrician to suggest to his parents (my sister) that he might have some kind of genetic nutrition disorder, and they also thought that some random head movements he was doing might be seizures and they suggested he might be developmentally delayed. This scared the shit out of his parents and they agreed to a number of tests for genetic defects and an EEG to check for a seizure disorder. When these were all negative, the docs then recommend an overnight video EEG, "just to be sure." (Insurance was only covering a portion of all this, btw.) My dad and I were able to talk them off the ledge a little and they never did the overnight video EEG, the kid eventually gained some weight and it became apparent that the head movements were a big juicy nothingbuger. They talked to another pediatrician who explained that weight loss isn't all that uncommon when kids transition to the bottle.

I hope I never practice this way, and I don't know what makes people think it's good medicine. I think it's terrible. In residency, many of my attendings do this routinely. And they always have a story about the time they ordered some random lab that wasn't indicated, but ZOMG! it came back positive! As a resident, I usually have to hold my nose and do what they say. Worst part about residency.

Could be Ehler Danlos Syndrome, but that is just complete speculation.

It's beginning to sound like your speculation is based on about as much evidence as the numerous doctors' various speculations our illustrious OP has been working with.

What separates a cardiologist from a "world class cardiologist" other than where they work?

Where they work is one, this is also usually tied to numerous lead author articles in prestigious journals. While their knowledge is real, and I'm not discounting it, there is a real difference between practical medicine and research medicine. (I have worked with some of the med students from a top 10 hospital, and many of them seem to be clinically clueless.) If you get your medical care at research hospital or academic centers (which many people associate with better care, for better or for worse), don't be surprised if they order a lot of tests. Zeke Emanuel -- Rahm Emanuel's brother and a medical ethicist leading the push towards population vs individualized medicine (which turns medical ethics on it's head) -- wrote about this recently. He said, when presented with a medical screen or test:

First, what difference will it make? Will the test results change our approach to treatment? Second, how much improvement in terms of prolongation of life, reduction in risk of a heart attack or other problem is the treatment actually going to make? Third, how likely and severe are the side effects? And fourth, is the hospital a teaching hospital?

As much as I dislike what he is doing to the field of medical ethics ("modern" medical ethicists are all about changing "do no harm" into something like, "do no harm -- unless sacrificing the individual is better for the population as a whole), I agree with all of his points except the last one. In my experience, in a teaching hospital you are much more likely to be presented with the shotgun approach than if you avoid such hospitals. Actually, his last point seems to negate the point of his 4 questions. Is the average patient really expected to question each lab and screening proposed to him is such a rigorous manner, especially if they have already been built up as "world class"? Better to find a place where the doctors are less inclined towards deep sea fishing in the first place, and this means don't go to academic hospitals.

[bcav]

Questions:

(1) Did they say you have some degree of aortic stenosis? As the stenosis worsens and the gradient across the valve increases your quality of life will decline. You can still lift with mild-moderate stenosis but you need to be aware of a few things. It doesn't sound like that's why they put the limit for you, though. As stenosis severity increases your activities will become more limited, to the point where even walking will get you dizzy. I've been there.

(2) Did they say you have an aortic aneurysm? You are talking about aortic dissection so maybe you have this? Generally they will do a CT or abdominal echo to figure this out. But given your age, I find it really unlikely you have one.

(3) Is a murmur audible with a stethoscope? This is a sign of regurgitation. It's often advised that you don't do strenuous exercises like weight lifting if you have this. You can google why, but I wouldn't lift at this point. It's not worth the risk to me.

(4) Did they do an echo to get a gradient? The type of echo done for this is when they put gel on the wand and poke and prod your chest area while you lay on a table for the better part of an hour. I'm curious what the gradient is if they did.

If a medical professional reads these questions they might find some redundant, but given your post was just "hey I have a BAV, doctor said to never lift again besides some arbitrary amount" I want to figure out why the doctor said that. A BAV alone is not reason enough to have such a restriction placed on you. It is true that people with BAV are at increased risk for aortic dissection, and it is true that people who lift heavy weights are at increased risk for aortic dissection, but in both cases the risk is excessively low provided you do not have other issues going on.

Disclaimer: Not a medical professional. I'd definitely adhere to restrictions if you have any of the above 3 points going on. I'd still take the 50lbs with a grain of salt especially because you were green lighted for cardio. It's an arbitrary amount that is pretty much saying "don't exert yourself too much".