Blood Pressure with chf

[ROGER H]

Hello:
    I was diagnosed with IDCM which caused my CHF. At diagnoses my ef was 20% by angiogram. About four months later I was started on coreg to go along with my altace and digoxin. I worked up to 25mg twice a day. A year after diagnoses I started feeling really tired..not just SOB from climbing stairs or anything..but down right tired..hard to function properly. I can get no answers from my cardiologist or my doctor as to why. I now have High B/P averageing 145/102..it is up and down from there. My heart rate is also running around 80 -90 bpm. I have noticed that the slightest effort it rises to about 110 but settles quickly. My doctor thought that perhaps the increase in my B/P could be good news but my cardiologist was concerned about it. There was no change in the last six months from what the last echo said. EF still 35% but developed a slight valve leak. Could the high B/P be a good sign? What would cause it to rise..I never had a B/P problem before..even before this disease I was good. My coreg was increased to 37.5mg twice daily and my altace was doubled to 10mg once a day. Thanks for your time..it is greatly appreciated. Roger

[CCF CARDIO MD - DLB]

The blood pressure rise is difficult to interpret. It certainly is a good sign that your heart is at least strong enough to generate that sort of blood pressure. However, I think your blood pressure should be controlled even more, to decrease the workload on the heart and allow it to become (hopefully) stronger. The fatigue could be a sign of heart failure or could be a side effect of the medications.

[ROGER H]

I am confused..I think of the heart as a piece of equipment to try and rationalize it but it doesn't make sense. If the B/P is 145/102 and the output is still 35% of volume then what is going to happen when it is lowered..will the output (EF) decrease? There won't be as much pressure to push it out. Also this extreme tiredness just started in august..the doctor didn't think it had anything to do with the heart or meds as everything was fine up till then.He did some blood work and everythihg was fine. I was tolerating all meds. Could it possibly be all the extra work that the heart is doing under the high B/P ? I guess I am grasping at straws..I really don't like feeling so tired..it seems so hard to handle. I won't be able to continue working with this..it make it difficult for me to give as much effort as I used to and I just do desk work..no physical labour. I used to pride myself on being able to give a little more than a 100% and now I can't anymore. But I guess that will be a call I will have to make. Something I do not look forward to..it seems so final. Thanks for your help. I guess the thing to worry about right now is get the blood pressure down and go from there..day by day. Thanks...Roger

[CCF CARDIO MD - DLB]

Ideally, when the blood pressure is lowered (not too low though) the heart will not have to work as hard and the EF will increase. Again, the fatigue could be from the heart failure, though I would not expect it to affect desk job type activities. Medications can certainly cause fatigue as a side effect. Alternatively, the fatigue could be due to some non-cardiac reason.