Subject: Re: Dilated Cardiomyopathy, AF and Morbid Obesity
Forum: The Heart Forum

Topic Area: Arrhythmia

I have posted here before and received invaluable information regarding cardiomyopathy and AF. I am a 33 year old male who weighs approximately 440lbs. I have lost 110 pounds in the past 11 months through dietary changes and exercise. I have no history of diabeties. I don't smoke, drink infrequently, and do not use nonprescription drugs or consume caffine. In August of 1998 I weighed 550 lbs. That month I had an episode of AF that lasted for 72 hours. I was successfully electrocardioverted. Prior to the cardioversion a TEE was completed which showed dilated cardiomyopathy which affected all four chambers. My EF was 40-45%. The attending electrophysiologist thought that the most likely reason for the dilation was weight and hypertension. Since the cardioversion, I have had several episodes of AF which self terminated (with the longest lasting approximately 5 hours). My medication regime includes: Coumadin, Toprol XL, aspirin, a diuretic (not Lasix), Rythmol, and Xanax PRN.

A few weeks ago I had an episode of tachycardia that was quite mild (105-115 beats per minute). Because I was able to distinguish the difference in this sensation from AF, I went to an emergency room. They kept me there for observation for approximately 2 hours and then discharged me. The only recommendation was an increase in Toprol (both frequency and dosage) and a discontinuation of Cardura and Mavik (an ace inhibitor). I asked the attending physician if I should follow up with a general cardiologist or electrophysiologist. He said that I didn't need to see either and could be monitored by my internist.

I continue to lose weight and exercise. I am able to walk long distnaces without tiring. Arrythmias are not triggered by walking, but sometimes seem to correlate with stress or body positional changes (i.e. rolling over in bed or bending or stooping). Earlier this week I had another episode of tach which lasted approximately 3 hours. My rate was 109-115, my blood pressure was 170-108 (average of three readings). My questions are as follows:

1. Would you recommend that I see a cardiologist regarding the latest symptoms?

2. Are beta blockers alone as effective in the management of dilated cardiomyopathy as ace inhibitors?

3. How common is dilated cardiomyopathy in severly obese people?

4. My blood pressure (while being treated with medication) is usually 150/90...does this not seem high with a diagnosis of dilated cardiomyopathy? Should I ask to have this treated more aggressively?

5. If I continue to lose significant weight, does the latest research indicate that my heart size will return to normal or at a minmum stablize or is it likely that the disease will continue to progress? Is it likely that I will continue to have episodes of AF?

Please understand that I am asking for information based upon the latest research. I live in Lincoln, Nebraska; I am not sure that my doctors are up-to-date on the latest research.

I feel great most of the time and have plenty of energy...but am concerned about the aforementioned issues. Thank you for your time.

1. Would you recommend that I see a cardiologist regarding the latest symptoms?
Yes. I would recommend seeing a cardiologist - one that specializes in heart failure would be best.

2. Are beta blockers alone as effective in the management of dilated cardiomyopathy as ace inhibitors?
There are no "head-to-head" trials of beta-blockers vs. ACE but both have been shown to be effective in heart failure.

3. How common is dilated cardiomyopathy in severly obese people?
Obesity in itself is not cause for heart failure and other causes should be examined such as sleep apnea and heart blockages.

4. My blood pressure (while being treated with medication) is usually 150/90...does this not seem high with a diagnosis of
dilated cardiomyopathy? Should I ask to have this treated more aggressively?
Your goal BP should be < 135/85.

5. If I continue to lose significant weight, does the latest research indicate that my heart size will return to normal or at a
minmum stablize or is it likely that the disease will continue to progress? Is it likely that I will continue to have episodes of AF?
The AF is a chronic condition and it is likely you will have further episodes. Depending on the cause of the cardiomyopathy will determine the outcome.

Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.

Follow Ups:

• Dilated Cardiomyopathy, AF and Morbid Obesity Scott 6/28/1999 (1)
  • Re: Dilated Cardiomyopathy, AF and Morbid Obesity CCF CARDIO MD - CRC 6/29/1999 (0)

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