scintillating scotoma after mitral valve repair and A-Fib. ablation

Hi Yoanne,
Normally, I would recommend that you post questions related to a neurological condition to the Brain & Nervous System group. But in this case, you posted correctly to the Heart group since you suspect a correlation to your heart medical history.

Your questions definitely are beyond my medical knowledge or experience. I did a quick search and found a couple of mentions of a possible correlation between scintillating scotoma and cardiovascular issues. See
- https://www.reviewofoptometry.com/article/visual-aura--and-scotomas-what-do-they-indicate
- http://www.healthnadvise.com/health-blog/scintillating-scotoma-causes-and-symptoms

I'm also tagging @johnwburns on this conversation to see if he has experience or references to add.
I believe this is worth further investigation with your medical team.

Hi and welcome.
More people might recognize it as 'ocular migraine'. I did some searching and a relationship does show up but only in some blogs such as this:
http://www.heart-valve-surgery.com/heart-surgery-blog/2009/06/22/vertigo-vision-problems-headaches/
so it looks like there is association but maybe not strong enough to imply causation. Its probably just a better idea to focus on follow up treatment rather than the root cause. The cause will likely emerge down the road, maybe. Most of these things are so complex that they can take way, way too many cycles to analyze, especially since the analysis is unlikely to alter the treatment. I know that that's not the most welcome advice if you are analytical by nature but I have burned a lot of time myself looking the 'why' of things myself when the return-on-investment was just not there when I backed away and looked at it.

Hope this helps.

@colleenyoung,
hello colleen!,
I did a lot of thinking since my post. I think I have found a possible (?) explanation for these fenomenon, especially after the heart operation.Unfortunatedly it is very scientificic, so most of your readers won't understand, so did I in the beginning.
some weeks after my discharge from the heart center the transfusiondepartment of the same hospital sent me a new ID of my bloodgroup.why? this new one had a warning,i.e. I had a HIT Type II. this is an abbrevation for Heparin-induced thrombocytopenia -delayed (Type II).this is a very serious complication, due to the great amount of heparine, necessary for the heart-lung machine.Nobody told me about this life-threatining (!) complication during my stay in the hospital.
In stead of the normal anticoagulation effect of heparine,the contrary happened, bloodplatelets clot together (great risk of thrombosis) and the number of the thrombocytes falls rapidly.
Why might there be a correlation with scintillating scotomes??
It is well known,that the neurotransmittor serotonine plays a crucial role in the development of migraine and his neurological symptoms,like for example scintillating scotoma. In the beginning of migraine the thrombocytes aggregation is enhanced, which leads to the release of serotonine. serotonine is a very potent vasoconstrictor in the cerebral microcirculation (that means it narrows the bloodvessels).this is supposed to be responsible for the neurological symptoms .
If a heparin-induced thrombocytopenia happens, a huge amount of serotonine is released. in my case the hypersensibility happened delayed. the serotonine release also delayed. In my opinion this could be the explanation for the occurrence of so many scotomas a couple of days after the operation (which was frightining).
I am a member of the German Heart foundation (Deutsche Herzstiftung). may-be I should present this theory to them as well.
following this theory I realise that a profylactic treatment of my migraine (headache occurs without scotomas ) with amitryptiline might be contraindicated, as amitryptiline is a serotonine-agonist. Therefore I stopped a week ago with this medicine.I will give it a try.

@yoanne I applaud your research abilities. Have you presented this theory to your cardiologist? How would you bring this information forward to the Deutsche Herzstiftung? Do they have forum where you can ask questions or submit theories?

I hope you advised your cardiologist of your decision to stop taking amitriptyline. Did you stop suddenly or gradually over the past week? What have been the repercussions?

I apologize for all the questions. I think this information will be very useful for others.

@colleenyoung
thank you for complimenting me! of course I intend to discuss this topic with others. the problem is, that my flight last tuesday from athens to germany had some unpleasant consequences. I suppose that the meal served by the airline caused an intestinal infection, moreover I catched a virus .I intended to see my family doctor this week but the risk of infecting other people/patients is too big.my appointment with the cardiologist is made for february next year. It's hard to get a earlier one.
Die Deutsche Herzstifung offers several possibilities, if someone has a question.you can write, you can even phone an expert on special days . but this is such a complicated question that I prefer to write.
as to the medicine amitriptyline, I used to take 50 mg, but since a couple of months I reduced it, 25 mg. this is a very low dosage.there was no need for a further gradual reduction, so I stopped 8 days ago in greece.since then I find it hard to fall asleep.and I wake up very early. I have to wait, may-be it is not the drug, but the other medical problems.

So sorry to hear about the infection Yoanne. Gute besserung! Please keep us posted.

@colleenyoung
Colleen, I must admit, that I was wrong. 25 mg amitriptylin is a low dosage, nevertheless it would have been better for me to take half of it, i.e. 12.5 mg before stopping the medication. I am quite sure that my sleeping problems were due to the sudden withdrawal , I decided to begin again, but only with a dosage of 12.5 mg amitriptyline. That worked! no problems anymore.
It is not only good for me to know, but definitely also for your members.
thanks for your best wishes (in german!)

Your heart works hard every second of the day, pumping the necessary amount of blood throughout your body. It has four valves that play an important role in that process, one of which is called the aortic heart valve.