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How Do You Feel After Meals?
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How Do You Feel After Meals?

Good Morning!

I've posted questions about this topic a couple of times over the past few years...

I have coronary microvascular disease with right-sided enlargement/systolic dysfunction. My entire heart leaks, which I think is a sign that my heart is progressively enlarging.

My echo revealed Aortic Regurgitation in 2003. Each year another valve starts leaking. BTW, is Tricuspid Regurgitation—the largest leak—always benign? What is the significance of Pulmonary Regurgitation? Finally, does cardiomyopathy present with leaky valves, or are leaky valves intrinsic to a congenital defect?  

I had another echo today; my EF was 55%. How much weight should I give EF’s? My EF was 70% last summer. The lowest recorded EF was 50% in 2003 around the time I was misdiagnosed with chronic bronchitis and sleep apnea.

After a second opinion, accurate diagnosis, and proper treatment, I began taking a diuretic, ACE-inhibitor and beta-blocker and my EF rose to 60%! The “bronchitis” and sleep apnea also cleared up. Hmmm...

I haven't been diagnosed with CHF—the left side of my heart is, “Not too bad” according to what my sarcastic but brilliant cardio said today. I also discovered that I have an S4 gallop. (What does that mean anyway?)  

If I don’t have compensatory heart failure, what could be causing the faster HR and fatigue I feel after eating? I've seen two super-duper GI specialists who couldn't find anything wrong. But one of the GI docs discovered that my blood norepinephrine level is “very high.”  Isn’t norepinephrine an inhibitory catecholamine produced by the body under stress and in chronic heart failure? If this is the case, couldn’t it slow down digestion, perhaps causing my symptoms???

I am confused... I have two cardios, one in town and another a few hours away who specialize in CMD. Both doctors bring up my normal EF when I ask if the symptoms after meals could be related to compensatory heart failure. But I have the feeling they’re holding out to spare me because I'm pretty darn fantastic and the mother of three utterly fantastic young children.  

If we look at the facts, none of my heart tests have been normal. Whenever I have an echo, the tech leaves the room and asks for the doctor to examine me before I am able to leave. When I wore a pulse ox in my cardio’s office, my blood-oxygen level desaturated when I walked around the clinic—not good. My heart cath and MRI both found coronary flow deficits and a “pathological” perfusion defect due to small vessel occlusion which isn’t treatable. (Hopefully some day we’ll have nanostents!)

My heart speeds up or "overreacts" to any strain, such as physical activity, housework, or emotional stress—all new symptoms as of this year. I also go to bed with a racing, pounding heart rate and wake up with a racing, pounding heart rate, i.e., 90-100 BPM. I swear that my average HR was 45 until a few years ago!

I remember once in college (20 years ago, I'm 43), I had to take a physical to qualify for overseas study. When the nurse ran my EKG and read the results, she looked scared before running out the door to get the doctor. When the cardio came into the examining room, he looked nervous and ran the EKG again. Afterwards he ripped off the sheet with the results and held them up for me to see: I had a HR of 39! He couldn't believe that I was alive.

Ah, the good 'ole days...  

For the first time, two weeks ago after a busy day, I developed "pitting" edema in both ankles. The edema comes and goes now and 100% correlates with activity and salt. Isn’t "pitting" edema a blatant sign of right heart failure? I showed my ankles to my father, a doctor. He stuck a finger in the edema (yuck) and frowned. The skin stayed dimpled where he had stuck his finger.  

The first night I had swollen ankles, I raised my feet up on two pillows before I went to sleep. When I woke up the next morning, my ankles were less swollen, but some of the fluid had moved to the left side of my belly and lungs. I heard a gushy sound whenever I breathed in!

I’m adjusting to yet another “new normal.”  

I saw my local cardio today and in classic form; he avoided my questions about whether or not this could be the start of overt right heart failure. He put me on a low sodium diet and said if that doesn't work, he'll adjust my diuretic and that’s it. No further questions allowed.  

Thanks for listening and answering my questions, too, if you can!  

My best,
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2 Comments Post a Comment
sorry to disappoint you I am no expert,just wanted to say you seem to have a very interesting heart.I too have lots of questions but doctors seem to have plenty of practice at avoiding answering.let me know if you find out how to pin them down.
I do have CHF and tend to feel sick after a meal.I try to rest as I think my heart cannot cope with supplying enough blood for digestion and muscles at the same time.
After giving my new prescription the doctor said I have to work out how many frusemide tablets to take(couldn't he do that for me?)
to me the patient deciding what meds to take is a new idea
Thanks for sharing. It's easy to feel sorry for yourself, isn't it? I try not to let my condition get me down but it has been wearing on my mind and emotions.

Your doctor learned how to calibrate medications in Medical School or during his training; remind him of this when you see him next!

I think my father told my cardio to be vague about my condition, although I can connect the dots, I don't need him to do it for me. My father's a world renowned doctor and mind-body guru. He believes that women are more intuitive than men and that when it comes to emotions and health, we can create and even worsen our own health problems through negative thinking. So if my cardio confirms mild right-sided heart failure, I'll be even more sensitive to my symptoms and their implications.

On the other hand, I'm not an idiot. As a medical writer, I'm more informed about medicine and health than most. So withholding information hurts the trust I feel for my doctor, and makes me question the value of adhering to my medications and a low-sodium diet!  

My best,
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