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Surgery for someone with CHF
I have CHF which has been stable for over 1 year. Have bi-vent pacer. EF%25%. Diagnosed with DCM in 2001 with damage to LV from chemo. Nodule on CT scan right middle lobe on the fissure. Failed biopsy due to blood in sample. Need VATS to identify. Plan on wedge. I am most concerned with post op days and weeks because of my CHF (not the surgical procedure). Any advice will be appreciated. I do not have diabetes or hypertension. Some minor GI distress. Follow a strict low sodium diet and take meds as directed. I am aware of side effects of meds etc. and know s/s of decompensation CHF. Thanks.
MEDICAL PROFESSIONAL
Hello and welcome to the forum.
The two questions that are typically posed regarding a person like yourself about to undergo noncardiac surgery are:
a. What is your risk of sustaining a heart attack due to the stress of the surgery?
b. What is your risk of worsening heart failure following surgery?
Although I dont know all the details of your history, it sounds very much from what you did tell me that the risk of sustaining a heart attack following this type of surgery is quite low for you...so this should be somewhat reassuring.
The bigger question though (as you seem to have identified yourself), is what is the risk of complications associated with your heart failure. What is most important is that you have "stable" chf and this is very important when going into surgery. Second, although it is not a trivial surgery, it is also not a major surgery that you are faced with which is also good. The big thing for the docs to keep in mind (and I am sure that they will) is that if there are significant fluid shifts associated with the surgery (for example if you bleed a bit and require replacement fluids and/or blood products), they will also need to realize that you also are likely to need diuretics to maintain an even fluid balance given your history of CHF. They may also choose to place a central line (possibly even what we call a PA or swan-ganz catheter) in order to closely monitor your heart and lung pressures as a guide for them during and shortly after the surgery.
In the end, I think you are likely to do fine and aside from the typical pain in the first few days following surgery in general, you should likely recover and get back to your current "baseline".
Finally, I have to imagine that it has been determined that the surgery is necessary. This is not quite my place to comment on this, but I was wondering whether they have been watching this nodule for some time and now it is growing or whether it is simply quite large and they feel it needs to come out? Perhaps they just want to make sure it is not related to your prior cancer from many years ago?
Anyway, all surgeries have certain risks but as long as you are in competent hands and with your doctors well aware of your heart condition, I suspect there is a very good chance that you will do just fine with the surgery. Even more importantly, you sound like an excellent patient who is well informed of his/her condition and this will continue to serve you well. Hope this helps.
Wishing you all the best in health and happiness,
Dr. Rich
The two questions that are typically posed regarding a person like yourself about to undergo noncardiac surgery are:
a. What is your risk of sustaining a heart attack due to the stress of the surgery?
b. What is your risk of worsening heart failure following surgery?
Although I dont know all the details of your history, it sounds very much from what you did tell me that the risk of sustaining a heart attack following this type of surgery is quite low for you...so this should be somewhat reassuring.
The bigger question though (as you seem to have identified yourself), is what is the risk of complications associated with your heart failure. What is most important is that you have "stable" chf and this is very important when going into surgery. Second, although it is not a trivial surgery, it is also not a major surgery that you are faced with which is also good. The big thing for the docs to keep in mind (and I am sure that they will) is that if there are significant fluid shifts associated with the surgery (for example if you bleed a bit and require replacement fluids and/or blood products), they will also need to realize that you also are likely to need diuretics to maintain an even fluid balance given your history of CHF. They may also choose to place a central line (possibly even what we call a PA or swan-ganz catheter) in order to closely monitor your heart and lung pressures as a guide for them during and shortly after the surgery.
In the end, I think you are likely to do fine and aside from the typical pain in the first few days following surgery in general, you should likely recover and get back to your current "baseline".
Finally, I have to imagine that it has been determined that the surgery is necessary. This is not quite my place to comment on this, but I was wondering whether they have been watching this nodule for some time and now it is growing or whether it is simply quite large and they feel it needs to come out? Perhaps they just want to make sure it is not related to your prior cancer from many years ago?
Anyway, all surgeries have certain risks but as long as you are in competent hands and with your doctors well aware of your heart condition, I suspect there is a very good chance that you will do just fine with the surgery. Even more importantly, you sound like an excellent patient who is well informed of his/her condition and this will continue to serve you well. Hope this helps.
Wishing you all the best in health and happiness,
Dr. Rich
Thank you for your responses.
MEDICAL PROFESSIONAL
Sounds like you are in excellent hands.
As a transplant cardiologist myself, this makes a whole lot more sense--definitely cant miss something only to allow it to "blossom" while on immunosuppression. While small nodules are common, if they begin to grow or have certain characteristics, it is often in your best interest to diagnose it sooner rather than later (it often turns out to be nothing to worry about but in the even that it is "something", at least it will now be gone!).
Good luck and all the best.
Dr. Rich
As a transplant cardiologist myself, this makes a whole lot more sense--definitely cant miss something only to allow it to "blossom" while on immunosuppression. While small nodules are common, if they begin to grow or have certain characteristics, it is often in your best interest to diagnose it sooner rather than later (it often turns out to be nothing to worry about but in the even that it is "something", at least it will now be gone!).
Good luck and all the best.
Dr. Rich
I have been on the heart tansplant list for 2 years. Most are surprised with my success at staying well and keeping CHF controlled. My nodule which is small at 9.6mm has beenwatched for almost 2 years. Slight increase in size and a thickening. Transplant team want answers! I totally understand about the immuno drugs post transplant and their implications on cancer. So after a failed biopsy this was the 2nd.step in attempt to identify what this nodule is. I have been given permission by my transplant team to "manage" my own diuretics. Have not really needed on a day to day basis for few months. However, in talking with my "own" cardio man and not transplant cardio people "we" have agreed that taking Lasix 40mg for one week prior to the VAT would be appropriate. Thank you for your most welcomed comments which were helpful. Yes, I do intend tomorrow to discuss diuretics with surgical team. They will use SWAN and an art line together with esophageal doppler. I am aware of my current readings from right side heart caths and their meanings. Again I thank you for your comments. I found them to be reassuring.
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