Re: CHF,decreasing EF, central apnea and Cheyne-Stokes

[Charlene__0__0]

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

[CCF CARDIO MD DLB]

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.

[Cjharlene]

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

[CCF CARDIO MD DLB]

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.











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CHF,decreasing EF, central apnea and Cheyne-Stokes Charlene 6/09/1999
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Re: CHF,decreasing EF, central apnea and Cheyne-Stokes CCF CARDIO MD - DLB 6/09/1999
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CHF,decreasing EF, central apnea and Cheyne-Stokes Charlene 6/09/1999
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