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Right-sided heart failure & CAD
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Right-sided heart failure & CAD

  I referred to your August 20, 1998 posting in the archives regarding a definition of right-sided heart failure.  Your definition and diagnostic procedures agree with that of several physicians regarding my condition during the past year.  My medications are atenolol, isordil, valsartan, furosemide, aspirin, premarin, and a multivitamin.  On Thanksgiving morning I awoke to symptoms of very rapid heart rate, shortness of breath, extreme fatigue and more fluid retension than usual although I had been monitoring my salt intake very carefully.  The symptoms resolved in about 4 hours; however since then the least exertion causes rapid heart beat and shortness of breath.  My family physician diagnosed right-sided heart failure with hepatimegaly and referred me to a cardiologist.  Since I am new in this city and don't know the reputation of the cardiologists here, I took my physician's word that this person was the very best the city had to offer.  
  When I went to see him, though, I became very confused.  After listening to my heart (which has a murmur, by the way) and ordering an echo, the cardiologist told me that my bicuspid valve was leaking, my EF was 55%, I did not have "conventional" heart failure, my heart was essentially normal, and that if I had heart failure at all it was "ischemic."  I also do not have any signs of pulmonary hypertension.  Then he went on to say that I had CAD (which I already knew).  He ordered a heart cath to be done in a couple of weeks and said that if he was right, a blocked artery was causing my heart failure.  When it was repaired I would never have trouble with heart failure again.  
  With all my reading here, on the internet, and some material from my physicians in the past year, I was led to believe that heart failure was irreversible.  So here are my confused questions:  Whom do I believe?  How can a blocked artery cause heart failure no matter which side it is on?  Do I really have an excellent prognosis?  Is it as simple as repairing a blocked artery, or is it more involved than that?  Please help me.  I don't know what to think anymore.  I feel so stupid.
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Dear Ruth,
Believe the cardiologist who believes you need to be evaluated for ischemic heart failure as it appears he not only has been the most thorough, but also that he is the one who is ruling out all possibilities, especially the most likely/prevalent one, i.e.ischemic heart disease.  
You would need a lesson in anatomy to understand the answer to your second question which of course is beyond the scope of this forum.  Suffice it to say that the left ventricle is fed by the left and the right coronary arteries,and the right ventricle is fed only by the right coronary artery.  Keep this in mind when whomever goes over the cath lab results with you.
The one important issue here is that you need the cath for two reasons.  To look for blockages but also to know the ststus of your heart overall since a bicuspid valve is one that usually requires repair if not replacement (open heart surgery) once symtoms (symptoms) of heart failure develop.  Make sure you ask your cardiologist his/her take on the valve: is it contributing to the heart failure and at what point will it need to be repaired and or replaced?  At the Cleveland Clinic, we are making great efforts to preserve the patients own valve by attempting repair early and only replacing valves when necessary.  Unfortunately, the aortic bicuspid valve is not the easiest one to repair, but if not treated in a timely manner, it will lead to irreversible heart failure and death.  I believe that the issue of your defective heart valve is just as important if not more so than your CAD, especially if on your cath they find only minimal CAD/blockages in your coranary arteries.  The best evaluators of heart valves are those cardiologists that work closely with the heart valve surgeons, usually only found at major/university medical centers; this is especially so in the patient who has CAD and heart failure symtoms (symptoms) with a valvular abnormality.
If you simply have  heart failure based on a blocked artery or two then yes your prognosis is excellent once this CAD is addressed, however, should your heart failure be due to the abnormal valve, the prognosis is not as favorable unless you get the issue of repair and or replacement addressed quickly.
I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
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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