Re: Rt. sided vs Lft sided

Posted By CCF CARDIO MD - MTR on March 03, 1998 at 00:30:12:

In Reply to: Rt. sided vs Lft sided posted by Jill  on February 27, 1998 at 13:13:19:








Are the mortality statistics any different for folks with left sided disease
vs right sided disease?  I am 46, was diagnosed with CM in April, 1997 after
a cold that wouldn't go away (no history of ischemic disease, hypertension,
family history of heart disease etc).  I had no pedal or abdominal edema
but was in CHF.  My echo estimated my EF at 25%, a later cath showed it to be 28% (which I
assume in not statistically significant).  I have a left bundle branch
block, left atrial enlargement, left axid deviation, Grade 1/VI systolic ejection
murmur, 2+ mitral insuff and no artery disease. I have not required any hospital-
ization to date.  I take Accupril 5mg daily, Lasix 40mg daily and KCL 10meQ
twice daily.  The statistics about CHF are very frightening to me, 50% death
within 5 years - but I don't know who's in that group that's cited - does it
include all ages? all causes?  It might help some of us if we knew what populations
are in that group that is always cited, given the number of elderly people
who die of CHF also.  Thanks.



  _
Dear Jill, thank you for your question.  It sounds like you have dilated cardiomyopathy
which occurs when the left ventricle of the heart dilates and its contractile function
deteriorates.  The causes of dilated cardiomyopathy (DCM) are diffuse including viral infections, rheumatologic disorders, and diseases where the heart muscle is infiltrated with abnormal proteins.  Irrespective of the cause, the prognosis for DCM depends on many
factors.  Advanced age, poor exercise capacity, severely reduced ejection fraction (<20%),
rhythym disturbances, or a rapid progression of symptoms are all bad prognostic signs
in this disorder.  However, survival rates are hard to predict because each patient is
unique.  Given what you indicate about your condition, I don't see that you have any
adverse prognostic signs of DCM.
  Left and right heart failure are not differentiated prognostically but represent a continuum
of heart failure.  Initially in heart failure, the left ventricle's contractile function decreases to
cause blood to back up into the lungs which is called pulmonary edema.  Shortness of
breath and limited exercise capacity are the main symptoms.  With time, left heart failure
leads to right heart failure where the venous blood volume and pressure increase.  This
causes ankle edema, an engorged liver, abdominal edema (also known as ascites), and
prominent neck veins.  In isolated disorders, right heart failure can exist without left heart
failure but it sounds like you don't have one of those disorders.  Therefore, prognosis cannot be predicted by left vs. right heart failure.
   You are being treated appropriately for heart failure with acupril (in a class of drugs called ACE inhibitors), lasix (a diuretic), and potassium to replete the potassium that is lost in your urine when lasix is used.  ACE inhibitors are known to improve survival and symptoms in heart failure while diuretics relieve the symptoms of shortness of breath.  If your symptoms were to progress, you could be put on digoxin (which improves symptoms as well) and/or carvedilol which is an exciting new beta blocker that has recently been shown to work well in patients with heart failure.  Overall, it sounds like you're doing quite well.
  If you have any further questions, don't hesitate to write back.  
Information provided in the heart forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your physician.