Does Diastolic Dysfunction just go away?

[fanta]

I was tested by 2 dfferent cardiologists from the same heart clinic about three years ago when I was referred by my primary care physcican after experiencing edema and shortness of breath. The first cardiologist found nothing wrong after an EKG, echo and stress test. The second cardiologist, which is the main doctor for the clinic ran the same tests about a week later plus a cardiac catheterization and diagnosed me with diastolic dysfunction which he said was a form of heart failure. He put me on Accupril, and Lasix which has been upped from 20 mg to 80 mg.  A few months ago I was referred once again because I was having breathlessnss at rest.  The cardiologist who saw me then, (another different one), ran the same tests, except for the cardiac cath and concluded that "whatever was wrong with your heart has gone away."  He told me however to continue taking my meds and I have found out that if I don't take them I do start getting SOB and get the swollen ankles, etc.  Does diastolic dysfunction just go away, and if so why do I still need the meds?  I have tried asking them at the clinic and all I was told by the last doctor was that the only thing wrong with me now is "being out of shape" which I felt insulted about because I have been trying to exercise daily to feel better.  Also was diagnosed with moderate pulmonary hypertension by the doc that did the cardiac cath.  Is that something to worry about?  I was not prescribed anything for that.   Thanks so much.

[Cleveland Clinic]

fata,

When we refer to the function of the heart at any given moment, it is generally reflective of the conditions effecting the heart at that time.  Thus, the heart is a pump and anything to optimize the function of the pump can imporve or worsen the efficinecy of the pump.  Thus, diastolic function if measured on an echo is a picture of the diastolic function of the heart at that moment with that blood pressure and heart rate.  So any medication such as a diuretic which changes the volume that the pump has to move, or a blood pressure medication which changes the pressure the heart pumps against can change the function of the heart from one point to the next.

The issue of the pulmonary hypertension should be examined further.    It is not just a diagnosis that happens. If your cardiac evaluation is normal other things such as rheumatoloic diseases and sleep apnea should be examined.

good luck

[WPWGuy]

What in the cardiac cath lead doctor #2 to the diagnosis of Pulomonary Hypertension?  If the results of the cath were the original reason for the diagnosis, I dont see how doctor #3 could conclude that the problem has gone away, without performing a cath, or seeing the results from the cath that doc #2 did.  If I were you, I think I would, for one thing, return to doctor #2 with the test results gathered by doc 3. Would doc 2 change his mind, based on the analysis of doc 3? Would Doc 1 and Doc 3 change their diagnosis if they saw the cath results?

Also, given the seriousness of these some of the possible outcomes, as well as the difficulty of makeing the diagnosis --- from what I read, Pulmonary Hypertension is often missed --- I believe I would be very careful with your approach to managing your medical care.  2nd and 3rd opinions are good, but be sure all doctors share information, and understand what you are asking them to do.  

You are/should be looking for a complete assessment, and a comprhensive strategy for dealing with it, not for an assessment bounded by the doctor's area of specialization, and lacking a plan of action  (A plan that says "do nothing" is ok, as long as that approach has been weighed against other rational approaches).  So it is good to have at least one doctor who is aware of all findings and is helping you do some thinking.

Regards,