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Heart Disease (Expert Forum)
CHF,decreasing EF, central apnea and Cheyne-Stokes
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
CHF,decreasing EF, central apnea and Cheyne-Stokes
by Charlene__0__0, Jun 09, 1999 12:00AM
Posted by Charlene on June 09, 1999 at 09:44:46
Brief history:
Male age 69 excellent health till MI
MI 11/98 with double bypass next day (left mammary to the LAD and vein graft to the diagonal)
in CHF since surgery with edema around belly, none in legs
January EF 40% cholesterol 117
May EF 25-30% cholesterol 111
May Tomographic imaging shows majority of left anterior descending distribution is infarcted
May Central apnea dx with Cheyne-Stokes respirations
RX Lasix, potassium, digoxin, Avapro, Coumadin, Sinemet at bedtime for restless legs
Completed 3 mos cardiac rehab and now goes to gym 4 days a week
Has not regained much muscle mass or strength that was lost. Still gets breathless and tires quickly. Food tastes bad, but eats adequately. Will doze off anytime he is sitting and not actively involved in something.
What can we expect in the near and long range future? Doctors are not forthcoming with any expectations or symptoms we might need to watch for. Thank you for whatever answers you can give.
Charlene
Posted by CCF CARDIO MD - DLB on June 09, 1999 at 10:13:22
Dear Charlene
It sounds like he had a large heart attack. The respiration pattern may be due to central apnea, as you have written, but can also be seen in congestive heart failure that is poorly controlled. I think he ought to be evaluated by a cardiologist with some expertise in heart failure and by a sleep center, to see if he really has central apnea. Until it is clear what is causing his symptoms, it is difficult to speculate on his prognosis.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Posted by Cjharlene on June 09, 1999 at 12:12:34
Dear Doctor,
The patient is being treated by an experienced cardiologist. He has had a sleep study to confirm apnea. I forgot to mention that 3 weeks ago he was put on BIPAP with O2 at night.
Additional information:
Left atrium severely dilated
Has A-fib
So much to deal with!
Can you offer any insight with this additional information?
Thank you,
Charlene
Posted by CCF CARDIO MD - DLB on June 09, 1999 at 14:17:19
Dear Charlene,
This makes much more sense. The combination of heart failure, sleep apnea and atrial fibrillation is not good. One possibility would be to try and convert him from atrial fibrillation back to a normal heart rhythm, either with medications, electric shocks, or both. This may help with his sensation of breathlessness. His cardiologist would be in a position to set that up, if appropriate.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Posted by Charlene on June 09, 1999 at 15:03:37
Dear Doctor,
He has had 3 cardioversions that were not successful. Is there anything you can tell me about his short/long term prognosis? Are ther any signs we should be watchful for? His doctors are reluctant to discuss the future, but with his current condition I can't help but think that long term isn't there for him. What can we expect in the short term based on your experience?
Thank you,
Charlene
Posted by CCF CARDIO MD - DLB on June 09, 1999 at 17:51:11
Dear Charlene
Your doctors are wise not to discuss his future. No human being can predict how long someone will live - there is too much uncertainty in medical science; anyway such predictions would only serve to rob him of what hope he has. Since you keep pressing the point, I think his long-term prognosis is bleak. In the short term, I suspect he will have several repeat hospitalizations for heart failure, despite the best efforts of his doctors. You mentioned his food tastes bad - one thought would be to have him evaluated, and potentially treated, for depression.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
