Options for suspected CHF or Pulmonary Hypertension
Im looking for some advice from a cardiac specialist. I know that I should seek advice from my treating physician but I am just after some guidance. Here is my history.
I am a 72 year old male with history of right pneumonectomy due to TB back in 1960. As a result of this procedure I have been under treatment for COPD since then. I have lived a full life and managed very well with my condition. I have no other medical conditions.
A few years ago I had an acute exacerbation of my condition and was found to be in type II respiratory failure. I have been a chronic CO2 retainer since. Regardless of this, I have managed well on nebulised bronchodialators and nebulised steroids.
Last year I had another acute exacerbation and was admitted into hospital where I was put under the care of a new Respiratory Consultant. This consultant put me on home BIPAP therapy designed to manage my CO2 retention. I use this non invasive ventilator 8-9 hours per day (so usually over night). Once again, whilst on the BIPAP therapy, I have previously been managing well and still active.
Last month I began to progressively become more and more breathless on exertion. At rest I was fine with my sats in high 90’s. But on slight exertion I would desaturate to the 80’s and become dyspnoeic. I do not feel faint and have not suffered syncope. At its worst I got peripheral eodema – swelling in my ankles and feet with pitting. My hands also became swollen. This resolved after a few days. Currently I have no peripheral eodema. I am fantastic at rest and have even clocked my resting sats at 99%. But on exertion I become very very breathless. Even when walking across the room. I also feel pressure around my chest sometimes. This isn’t acute pain or radiating pain or crushing pain associated with MI or angina. This is just a dull, long lasting feeling of weight on my chest. It is worse when I lie down. In fact I am unable to lie down.
I spoke to my respiratory consultant about this and he ordered an echo. I had my echo last week. I am very interested to see if there is evidence of CHF or Pulmonary hypertension. I am yet to hear from my consultant but he implied that the next step would be to put me on ambulatory oxygen. He said the respiratory nurses will deal with that and that I was to see him in 6 months for a review appointment.
Now here is where I would like my guidance.
I am a bit worried that my doctors will put me on ambulatory oxygen to relieve the symptoms without trying to resolve the underlying condition. I am also worried that wont get to talk to a doctor about the results of my echo. If my echo shows evidence of CHF or Pulmonary hypertension, should I be requesting that pharmacological intervention (ACE inhibitors, digoxin, diuretics, ect) be carried out to relieve the strain and load on my heart which may relieve the breathlessness? Or should I just accept the fact that I have to carry round oxygen wherever I go? Is oxyen a first line treatment? Should I be speaking to a cardiologist or is a respiratory specialist adequate to manage my condition
I just want some information to hand for when I have this discussion with the department.
What I have also noticed is that previously, my usual resting HR was between 90-100. Tachy for normal people but it seemed to be normal for me, on account of my one lung. Recently my HR is always low at 70-80. Even when breathless and exerting myself it rarely goes as high as it used to. Am I showing signs of decompensation? Is my heart no longer able to compensate and keep up?
We don’t have the results of my echo yet, but what are my options?
I'm certainly not a cardiac/pulmonary specialist, but I share some of your issues.
I suspect, based on my own symptoms, that your pulmonary problems are trumping your cardiac issues. That being said, the pulmonary pressures probably have enlarged your right atrium. Where I live, I have access to all my tests, and I just had an echo, stress test, and breathing study, and have requested copies of the procedures, and by law am entitled to them.
You have a history of pumonary issues, I have a history or cardiac issues, but an enlarged right atrium results in the same issue, we have trouble getting our breath. I'm your age, by the way.
If you can't talk to your doctors directly, I suggest you get a copy of your studies and post the results here, or on the pulmonary site, or both.
Keep us informed.
I certainly have a history of cardiomegaly, likely a result of a life of compensation. Chest films confirm i have an enlarged heart, and have done for years.
I feel that perhaps, only now is it becoming an issue as i am beginning to de-compensate. Thats why i am worried that my pulmonary specialist is jumping to oxygen (to relieve my breathlessness) as opposed to pharmacological management of my heart (to relieve the load and strain).
I also have access to my results. Will share my echo results here when i get them
My common sense is telling me that if your saturation comes to low 80s on exertion you will need oxygen. If I were you I would get it and will use it when I feel I need it, not necessarily 24 hours to start with.
In the other hand, if the result of your echo shows dilated chambers and/or reduced EF, a visit to a cardiologist will be logical to get the right medication.
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