Alcohol?

[Mom2four85]

I'm getting together my information for my new doctor and set up a list of questions, I found something interesting in my cardiac cath which I've been researching and can't find any info on.  Does anyone know why they would tell me to avoid alcohol? I thought maybe because it dehydrates the body, but is a certain amount acceptable?

We're going to Epcot food & wine festival and I wanted to taste test some of the wine's of the world but won't be able to ask the dr why no alcohol until mid Nov.  any thoughts?

8/28/2009 Cardiac Catherization
Hemodynamic assessments demonstrates mild systemic hypertension and moderately elevated LVEDP.

The coronary circulation is co-dominant.  There was no angiographic evidence for CAD.

EF: 40%
Aortic Pressure (S/D/M) 120/70/90
Left Ventricle (s/edp) 120/34

There was also an ECG that accompanied it during the procedure -

8/28/2009     EKG
Vent Rate:         60
PR Interval         134
QRSD                96  
QT/QTc             430/430  
P/QRS/T Axes   56/70/42

notes: Electronic Atrial Pacemaker; Low Voltage QRS;  borderline ECG when compared with ECG of 8/27/2009 electronic atrial pacemaker has replaced sinus ryhthm.

Recommendations: Patient should avoid alcohol
Impressions: Non-Ischemic Cardiomyopathy with an ejection fraction of 40%; no kinks, plaque, blocks or clots.

The dr did not explain anything to me other than no CAD; I don't know why I have a moderately elevated LVEDP or why it shows mild systemic hypertension when my bp stays at 90/60 and I was dx with NCS/OI.

[Mom2four85]

I hope you're not misreading something or mixing signals; I don't have a problem with alochol or even soda, my one vice is coffee in the mornings :P oh, I do drink 2 gallons or so of water daily - I crave the stuff ugh

I've heard soda, caffeine, foods etc are all bad on the body, when I first got sick June 2009, my dr's tried process of elimination to see if anything environmental was causing my problem - none were found.

Imagine my shock that my test results says patient should avoid alcohol - I never even drank alcohol until I was 25 (not a drop) because my mother was an alcoholic and I was completely against it, never even experiemented as teens do with alcohol; drugs or anything - I refused to do that and turn into my mother.

Since 1999, I have only drank 1 drink per year on my wedding anniversary, until my daughter gave me a gift for Christmas 2009; which was a bottle of Long Island Iced Tea mix.  Had I known anything was said about no alcohol or my heart was enlarged like this or it could be dangerous there is no way I would have drank a drop of it...and won't ever again - I value my life way too much.

I'm glad you found the strength to stop alcohol; some can't and blame others for that.

[Detours211]

Hey there,

I'm new to all of this but one thing I can say for sure from experience is that alcohol (and caffeine and lots of sugar, and other substances) can really wreak havoc on the body, particularly the heart.
My particular weakness is soda and I asked my doctor the other day if I should drink it he said, "no, not at all."  
I share this with you so that we can all share in what we are "missing out on" - for you it's alcohol, for me it's soda, for people with diabetes it's sugar and carbs and other things.
We're all going through it together and you will get through!  
If it helps, I gave up alcohol Dec 31, 2009 and have not touched it since.  I have no desire to ever touch it again and it was very easy to not drink it.  you can go to your event and have an amazing time with your friends or family without alcohol.  

Good luck to you and know that you are among friends here who truly understand!  God bless!

[Mom2four85]

wow, you're not kidding that's a TON of info =)  thanks

I got part of my records for my hospital stay 7/26/2009 (before ablation & pm/icd implant) - it says suspicous CP & CHF symptoms.

My CT and EKG's show Cardiomegaly of the heart; vascular crowding and frequent multifocal pvc's; which I didn't know I had multifocal pvc's before now; everything else pretty much goes along with my other tests I've had.  

I'm still sifting through hundreds of pages of material that I can barely decipher due to poor fax quality, so I'm going to request a hard copy and tape of my CT next week.

I know cardiomegaly is enlargement of the heart; which would be a cause in the cardiac cath for them saying no alcohol; no clue what vascular crowding is or what causes it...multifocal pvc's puts a wrench in my thinking of my pvc's :P

I'm just wondering what else I'll find that my dr's haven't told me...

[kenkeith]

It is everything you will ever what to know about LVEDP! :)

Cut and paste the following:
Articles in PresS. Am J Physiol Heart Circ Physiol (October 21, 2004). doi:10.1152/ajpheart.00681.2004

[Mom2four85]

I haven't read that info, but would love to know the source  =)  someone did mention to me AS before, but I don't have a murmur (that I know of) so I dismissed it.  

Further reading about AS, I see strep infections can cause this - I had Group B streptococcus in November 1997 which turned septic; I don't recall alot because I was so sick but I do remember being on meds for awhile after.  My SoB and CP is noted Nov 2004 in a dr's report, but I don't have earlier records and I can't remember that far back.  

I'm wondering if this could be the cause; which I'll mention to my doctor when I go in =)

thank you again for all the info, you're da man! :P

[kenkeith]

There can be systolic preservation or reduced EF with decreased diastolic function. Usually LV pressures that are not normal are result of aortic stenosis.  The left ventricle enlarges (dilates) to overcome the gradient pressure between the LV and aortic valve orifice.

Higher LV pressure affects filling phase.  Normally, the LV pressure is less than the pressure of the LV atrium.  The decreased gradient pressure increase the velocity and a fast filling time about 60% of capacity, and as the chamber is filling the gradient pressure increases and velocity is slowed and less blood to the LV decreases accordingly.

When there is diastolic dysfunction the chamber heart muscles do not relax and gradient pressure across the mitral valve is increased.  Less blood is fills the LV and as a consequence less blood is pumped into circulation with each stroke, but the same % of blood is pumped out of the LV....LVEF stays the same but heart rate increases to pump the amount of blood/oxygen in demand. Normal compensation.

Is the following something you read? "The gradual process of narrowing of the aortic orifice leads to concentric left ventricular
hypertrophy and a reduction in left ventricular compliance – the myocardium becomes
thick, the end-diastolic pressure (LVEDP) rises, but there is no dilatation. Typically this
occurs as the valve area decreases over years from the normal 2.5 – 3.5 cm2 to about 1
cm2. The left ventricle (LV) generates very high systolic pressures to overcome the
stenosis, but aortic pressures are normal. Because of the decreased compliance, LV filling
during diastole depends on adequate preload as well as atrial contraction. While the latter
contributes less than 20% of filling in the normal heart, it may contribute twice this
amount in AS.
This phase of AS is termed “mild” stenosis with physiologic compensation.  Certainly, there is a need for research that provides evidence-based management strategies for patients with heart failure and a normal LV ejection fraction.

LV pre–A-wave pressure was defined as the LV pressure midway through diastole; LV end-diastolic pressure (LVEDP) was defined as the pressure after atrial contraction just before LV systolic pressure rise. An LVEDP >16 mm Hg was considered abnormal; in the setting of a normal LV chamber size, a pressure >16 mm Hg can be taken as a major indicator of LV diastolic dysfunction. LV pressure data were digitalized at 5-ms intervals, and the relaxation time constant was calculated with the method of Weiss et al.8 The vast majority of normal human beings exhibit a time constant <44 ms; we also used a more conservative limit of 48 ms as an indication of abnormal LV relaxation
These average data indicate that the LV pressure parameters are more frequently abnormal than the echocardiographic indexes of diastolic function. Catheterization and/or echocardiographic measures of LV diastolic function were abnormal in the vast majority of our patients.

[Mom2four85]

thank you so much =)  that makes sense; wow I don't know why they didn't explain this to me and I couldnt ask since I just got these results after a year

I've had CP & SoB for 5 years, along with frequent pvc's but didn't develop CM until August 2009.  I failed my stress test and had problems during it with sob and some weird things they said they couldn't explain and I passed out - I could only do 4min 55sec on my test whereas a few months before I was walking/running for 30 min - 45 5-6 days a week.  SOB with little exertion has been the norm for me and I didn't know why until now.

I did find systolic dysfunction/failure and LVEDP where the parameters were >24 was systolic heart failure; but I can't find that site again :( any idea what causes elevated LVEDP or systolic dysfuntion?  I'm going to see if I can find the info I had before, but appreciate anything you can give me.

ack! I won't drink again that's all I need is to increase the size of my heart along with my other problems; grrr it irritates me they didn't tell me this - they had my history and knew my problems and no alcohol seems important...

thanks again, that helps tremendously

Lisa

[kenkeith]

For some insight ischemic cardiomyopathy is caused by coronary artery disease and heart attacks. Lack of blood damages the heart muscle, causes damage to it, resulting in cardiomyopathy. You do not have CAD so your lower than normal EF as the underlying cause.

Non-ischemic cardiomyopathy is an enlargement of the heart that would relate to heart muscle disease that results in a decrease of the left ventricles contractility. The
Dilated Cardiomyopathy at first, the chambers of the heart respond by stretching to hold more blood to pump through the body. This helps to strengthen the heart's contraction and keep the blood moving for a short while. With time, the heart muscle walls weaken and are not able to pump as strongly and this is consistent with Frank/Starling law of physics.  This condition would be systolic dysfunction, and a lower than normal EF would be the result..

Another category relates to diatolic dysfunction.  The heart walls thicken and lose their ability to relax, and this condition inhibits the system's ability to adequately fill the heart chamber with blood/oxygen to be circulated.  Other causes as well.

You are relating system blood pressure with LVEDP (systoloic and diastolic), there is another pressure... pressure inside the heart.  Left ventricular diastolic pressure, or "wedge" pressure, the latter being an estimate of left atial pressure.  Both LVEDP and wedge are normally less than 12. Elevated LVEDP has little significance unless you are short of breath with little exertion.  If so, LVEDP offers part of the info needed to effectively treat shortness of breath.

Alcohol can exacerbate or cause an increase the size of the heart.  Alcoholic Heart would be the reference.

Hope this helps, take care.

[Mom2four85]

I normally only drink alcohol once a year...anniversary in April, but I got Captain Morgan's Long Island Iced tea as a gift and tried it a couple of months ago and didn't notice any problems.  Epcot Food & Wine festival is so much fun and we haven't been in years so we planned to go.

I had no clue I wasn't supposed to have alcohol - dr's have not mentioned this to me; so it was a complete surprise reading my cardiac cath that it said no alcohol.  (just got it in the mail not long ago after asking for a year for the results)

[ireneo]

I don't know to be honest. I know I can't drink much alcohol at all. Most wines (more than a sip) will set off my arrhythmias. I can handle about 4 ounces of some beers but even that can set me off. I don't think a few ounces of wine would dehydrate someone but I do know I can't drink like most people or I'll pay the price with hours of pounding erratic heart beat. It's not worth it.

[Mom2four85]

still no info on why this recommendation on my cardiac cath and no alcohol; however I did find this - Limit alcohol intake. Alcohol may make you susceptible to fainting in patients with Neurocardiogenic syncope - again probably the dehydration factor