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Heart Disease (Expert Forum)
Heart Failure Progression
Answered by
Cleveland - OH
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.
Heart Failure Progression
by Kristin391, Sep 12, 2004 12:00AM
I have a long complicated story but I will keep this short. I have had two open heart surgeries for mitral valve replacement in the course of 1 year. I also have a pacemaker, had a AV node ablation for rapid and uncontrolled Atrial Fib/Flutter after repeated cardioversions, drugs etc. My last surgery was in April..had a redo of the mitral valve, tricuspid ring and ablations in both atria. I did very well after surgery for four months, could exercise without difficulty up to 1 hour. Suddenly, I became SOB with activity couldn't do 15 minutes, developed significant peripheral edema etc. Diuretics were increased but there was little change. I am on amiodarone 200mg and diurtics only. BNP was 301. An echo showed a decline in left ventricular function from 50% before surgery to 30% now. Valves and everything else were great. There was mild increase in PA pressures. My questions are many:
1. Why would this surface so suddenly and not be evident after surgery? I have been told that the cause of this is probably multifactorial, i.e. prolonged valvular dysfunction, prolonged increased heart rates, repeat surgery etc.
2. I am now on Coreg, lisinopril and demadex as well as electrolyte replacements. Will I just be compensated or could I improve my cardiac function over time? I try to exercise each day.
3. What can I do to get back to an EF of 50%? What should I definitely avoid so that I would have a better chance. I am a relatively young person, working full-time (pretty physical) plus a couple of other part time jobs for financial reasons. Is this a problem?
1. Why would this surface so suddenly and not be evident after surgery? I have been told that the cause of this is probably multifactorial, i.e. prolonged valvular dysfunction, prolonged increased heart rates, repeat surgery etc.
2. I am now on Coreg, lisinopril and demadex as well as electrolyte replacements. Will I just be compensated or could I improve my cardiac function over time? I try to exercise each day.
3. What can I do to get back to an EF of 50%? What should I definitely avoid so that I would have a better chance. I am a relatively young person, working full-time (pretty physical) plus a couple of other part time jobs for financial reasons. Is this a problem?
Doctor's Answer
by Cleveland Clinic, Sep 12, 2004 12:00AM
, Sep 12, 2004 12:00AM
kristin
thanks for the post.
1. Why would this surface so suddenly and not be evident after surgery? I have been told that the cause of this is probably multifactorial, i.e. prolonged valvular dysfunction, prolonged increased heart rates, repeat surgery etc.
If your symptoms were sudden in onset then I would be interested to know hoe the valve looked with an echo in addition to evaluating you for other causes of shortness of breath including PE. With the lower extremity edema, it hints that the pressures in the lungs or on the right side of the heart are high. I would be interested in knowing the pulmonary pressures making sure I was comforatble with the measurements by echo, and the Right ventricular size and function.
2. I am now on Coreg, lisinopril and demadex as well as electrolyte replacements. Will I just be compensated or could I improve my cardiac function over time? I try to exercise each day. 3. What can I do to get back to an EF of 50%? What should I definitely avoid so that I would have a better chance. I am a relatively young person, working full-time (pretty physical) plus a couple of other part time jobs for financial reasons. Is this a problem?
I will combine these. If you search back over the last week, I explained why the EF can be decreased after mitral valve surgery. In fact it is relatively common for this to occur. Over time, with strict blood pressure control, and the addition of the beta blocker and ace inhibitro, the ventricle may have some ability to remodel and you may be able to improve your EF. EF isnt everything though, there are alot of peopel with an EF of 10 that have less symtpoms then those with an EF of 40. Dietary restriction, blood pressure control and fluid maintainence are all important.
There are other options. If you dont seem to be improving, a visit to a heart failure sepcialist may be of some benefit.good luck
thanks for the post.
1. Why would this surface so suddenly and not be evident after surgery? I have been told that the cause of this is probably multifactorial, i.e. prolonged valvular dysfunction, prolonged increased heart rates, repeat surgery etc.
If your symptoms were sudden in onset then I would be interested to know hoe the valve looked with an echo in addition to evaluating you for other causes of shortness of breath including PE. With the lower extremity edema, it hints that the pressures in the lungs or on the right side of the heart are high. I would be interested in knowing the pulmonary pressures making sure I was comforatble with the measurements by echo, and the Right ventricular size and function.
2. I am now on Coreg, lisinopril and demadex as well as electrolyte replacements. Will I just be compensated or could I improve my cardiac function over time? I try to exercise each day. 3. What can I do to get back to an EF of 50%? What should I definitely avoid so that I would have a better chance. I am a relatively young person, working full-time (pretty physical) plus a couple of other part time jobs for financial reasons. Is this a problem?
I will combine these. If you search back over the last week, I explained why the EF can be decreased after mitral valve surgery. In fact it is relatively common for this to occur. Over time, with strict blood pressure control, and the addition of the beta blocker and ace inhibitro, the ventricle may have some ability to remodel and you may be able to improve your EF. EF isnt everything though, there are alot of peopel with an EF of 10 that have less symtpoms then those with an EF of 40. Dietary restriction, blood pressure control and fluid maintainence are all important.
There are other options. If you dont seem to be improving, a visit to a heart failure sepcialist may be of some benefit.good luck
Thanks for your excellent answer. My valves on echo were fine, PA pressures were at the most 39. There was global decline in contraction and function of the left ventricle. I forget what the word was to describe the global decline. There was no evidence of a PE. My blood pressure is around 100/60. I have never had high blood pressure. I have clean coronaries, no diabetes or other chronic problems. They think it is related to the long period of time that I did have regurg, to the rapid heart rates over the past year, right ventricular pacing that has caused asynchrony of the ventricular contraction, and the two surgeries. I am exercising each day, though it is difficult to do. I watch my sodium intake but have not restricted fluids. I would be interested in what other options exist for congestive heart failure.