Cole Moro was training to become a physician assistant. During one class, the students practiced listening to one another’s hearts. As a classmate held a stethoscope to Cole’s chest, he said, “Oh wow, you have a pretty strong murmur.”

Cole had heard this before, during a physical while trying out for the varsity lacrosse team at Western University. He didn’t think a heart murmur was something to worry about. He lived an active life with lots of cycling, lacrosse and hiking. He thought that maybe his high fitness level made his heart sound different.

Then, at age 27, the meaning of that murmur became clear when Cole was diagnosed with severe aortic valve disease. He shared his insights as both a heart valve patient and a healthcare professional.

How were you diagnosed with heart valve disease?

When I moved to Hamilton from Toronto, I switched primary care providers.

I had a very diligent nurse practitioner who was able to identify that my blood pressure was off — my diastolic level was way too low. This was a virtual appointment because it was during the pandemic. So, she sent me for an echocardiogram and an ECG (electrocardiogram), as she wasn’t able to do a stethoscope check. The echo demonstrated that I had severe aortic regurgitation and severe aortic stenosis with associated aortic root dilatation.

How did it feel to get that diagnosis?

I was at the gym when I got the call., riding a stationary bike. When the nurse practitioner told me about the diagnosis, it felt like everything was in slow motion, like how it's portrayed in movies.

I kept pedalling for a while, just to process the news. And then I realized — aortic regurgitation, that means I need surgery. I called my wife.

It was so surprising to get that diagnosis, because I lived such an active life. I had experienced some weird sensations around my heart; my carotid pulses were very prominent, and my pulse pressure was very high. Still, it didn't seem like this could happen to me.

What happened next?

I saw a cardiologist who I had actually worked under in the cardiac ICU. He did another test to confirm the diagnosis, then referred me to a cardiac surgeon.

After a CT scan, the surgeon did a great job of walking me through the options to replace my aortic valve. The choice was either a tissue valve or a mechanical valve. He recommended the mechanical valve because, with me being young and athletic, a tissue valve might not be able to withstand the demands of my lifestyle. He also explained that with a mechanical valve I would need to be on a blood thinner.

Next thing you know, I was booked for surgery. I only had to wait about a month from my diagnosis.

What helped you prepare for surgery and recover?

I learned a lot by talking to people who had been through this. I heard that heart surgery can increase your risk of depression. So going into my procedure, I was actively practicing meditation, and also reading literature around Stoicism, such as Marcus Aurelius.

For evidence-based research, I think the Heart Valve Voice Canada website is a really wonderful resource to inform patients who are approaching those sort of procedures.

After my surgery, I didn’t go to a cardiac rehabilitation program because this was in January 2022, in the middle of COVID. I was given a booklet that told me what I could and couldn't do. It gave me a list of exercises to complete.

I have a kinesiology background, so that helped me understand my limitations. After my initial recovery, I would try to go on three or four short walks a day. Then, when I had a follow-up appointment with my surgeon after about six weeks, I got the green light to start light aerobic exercise. I began riding the stationary bike again.

How are you doing today?

I feel great!

Coming out of this experience, I feel that I have a bigger responsibility to my own physical health and wellbeing. So, I try to exercise more. I bike to work, which I really enjoy.

Being on a blood thinner was an adjustment initially. My INR (a measure of how long the blood takes to clot) was up and down, and I didn't really know what affected it. There were a lot of unanswered questions.

Managing the dose was a process, but I got wonderful support from the thrombosis clinic at Hamilton General. They coordinate my blood tests and email me after each test, to tell me what my dose should be.

Now I don't see the blood thinner as a limitation at all. The only thing I can't do is play hockey — but I wasn't very good, anyway.

This summer my wife and I went on a five-day, 88-kilometre hike in Iceland. It was hard but it was wonderful, and I felt really accomplished after .

*Cole’s exploring Iceland post treatment*

How did this experience affect your work as a physician assistant?

It was very humbling. I think ultimately it made me a better clinician, because I understand what patients are going through physically, emotionally and mentally.

For instance, if I need to remove a central line for a patient, I can say, “Hey, you know, I've actually had this done... it's not that uncomfortable.”

I was fortunate to have had a lot of my care done by physician assistants, alongside other allied health professionals, surgeons and residents. I received amazing care. Being treated with so much respect made me realize how important it is for me to make that same impact on my patients.

What do you want people to know about heart valve disease?

I think people should be more aware of heart valve disease. For instance, almost everyone that I told about my diagnosis, who wasn't in a healthcare-related setting, had no idea that this is something that can happen.

Hearing my story, a lot of my friends went to their primary care provider and made sure they got a stethoscope check.

I think it's important for people to have regular check-ups with their primary care providers and get a stethoscope check. If there’s a problem with one of your heart valves, you want to catch it before the disease gets too bad.

Published February 12, 2024

“It didn’t seem like this could happen to me.”