LV Hypertrophy on EKG

[MitchMiller]

My hernia surgery pre-op EKG showed LVH as well as low pulse (< 50bpm).  I've done some research leading me to believe someone my age (62) with about 17 years of ARV therapy that includes NRTI's has at least a 30% chance of having an enlarged left ventricle in their heart.  I've got an echocardiogram scheduled to see if I can be cleared for surgery.  Given the surgery is done under a local anesthetic w/sedative, and that the surgery is classified as low risk, I'm hoping the surgeon will perform the operation.

Has anyone else had an EKG showing LVH?  Did you follow up w/an echocardiogram?

I've been a regular exerciser for 37+ years and have a resting pulse 48 - 52 bpm.  It's likely due to my endurance training (climb 415 floors on stair climber in 64 minutes).  GWBush's was an avid runner w/a resting pulse of 45 bpm.  I've read LVH is likely to show up on my EKG due to my level of exercise alone. 

I'm not stressed about the LVH, but more about the possibility that my hernia surgery may now be canceled.  Given Obamacare may be overturned next year by the Supreme Court, I don't want to be walking around uninsured, w/a hernia that might require an emergency repair resulting in an $80K bill from the ER.

[kentfrat1783]

You can do 415 floors in just over an hour?  WOW!!!  I'm happy when I do the stair machine for 10 minutes.

The last time I had my heart checked it was 5% less than normal.  Nor a big deal but even when I switched doctors to Cleveland Clinic they were concerned about it.  I'd hate to see what it is now. 

Let's just hope the doctors say it's OK for you to get the surgery. 

[MitchMiller]

Ken:  Thanks.  I'm hoping the technician doing the test Tuesday can give me a hint if things look ok because I have to wait until Friday for the doc's interpretation.

In preparation for the surgery, I did a viral load and cd4/8 test at Quest Labs, through request-a-test.  Yikes... I didn't know Nevada has a legion of HIV police that require all HIV tests to be reported to them.  Now I'm getting calls from the NV health dept.  In CA I didn't have to deal with this.  I'm wondering if they have the power to force me into costly treatment that I'm trying to avoid for another 2.5 years, until I can get Medicare.  Obamacare doesn't cut it for me and may be declared unconstitutional next year by the SC.  I'm debating if I should leave the state now. 

[bocker3]

I suspect the NV Dept. of Health is coming at you because you are a "new case" to them.  Once you show them that you aren't "new", they should stop.  They are required to report new cases.

I know of very few things where a state may "force" someone to go on treatment -- in fact, the ONLY one I've seen that happen with is TB.

If there was any state forcing people to go on ARV's for HIV, we'd almost certainly have heard about it here.  I wouldn't worry too much. 

Mike

[MitchMiller]

Mike:  NV seems to be a bit more invasive with their surveillance program.  They appear to monitor all HIV tests.  Here's the pertinent part of NV's directive to all labs licensed in the state about HIV:

According to the revisions (see NAC 441.235.5), the director or other person in charge of a medical laboratory shall report the results of any test of any specimen derived from the human body to the health authority if:
 The test results confirm the presence of HIV; or
 The test was conducted to monitor the progression of HIV, including, without limitation, all levels of CD4, and both detectable and undetectable viral loads.


NV also has a 90/90/90 program to get HIV+ people into treatment.  I've only found one case, in WA, where the public health dept. forced an HIV+ into treatment.  My meds cost me < $2K annually.  Through the US system, I would have to spend up to my max out-of-pocket $8K annually.  If I'm unable to purchase insurance next year, the cost would likely be > $20K annually until I reach age 65.  The problem is that I have retirement assets that would take a significant hit if I'm forced to use them to buy meds in the US.  That's why I may have to leave the country, or at least NV.

https://www.southernnevadahealthdistrict.org/news-release/hiv-aids-call-to-action/

https://www.washingtonpost.com/news/morning-mix/wp/2014/09/12/seattle-court-orders-hiv-positive-man-to-stop-infecting-people/?noredirect=on&utm_term=.a4f83e1cc6f0

[MitchMiller]

Well, got cleared for surgery.  Everything was normal on the echocardiogram for my age except for RVSP (Right ventricular systolic pressure) at 41.89.  45 is high end of normal for age 50 - 75.

HIV has been noted as a cause for pulmonary hypertension (PAH).  What's odd is that my endurance seems to be really good for my age.  Lack of endurance is the primary symptom of PAH.  Cardiologist says it needs to be monitored, no additional meds (thankfully since I'm asymptomatic), but YIKES yet another expensive ongoing treatment.  I think each echocardiogram + evaluation costs me about $2000.  With two per year, that's about $350/month.
   

[MitchMiller]

Another curious development is that I noticed my PCP requested a referral to the ID doc.  I'm not sure whether the health department put her up to that or not.

At any rate, the insurance company denied the referral.  I'm actually happy about that, but not sure why they would have rejected it since the viral load test came back "HIV detectable < 20."   Nothing I'm concerned about, but is proof I'm infected.