Stage 1 Diastolic dysfundtion + Asthma or COPD

[andydandy]

I am a woman of 68 years and have been on bronco dialators as a result of Bronchitis in early 90's.  On Advair since it first came out.  Worked just fine until last Christmas when it stopped working.  Compuvent carried me through until referred to Pulminoligist. After long history, he diagnosed Mycoplasma pneumonia and placed me on major antibiotics and steroids..blood test seemed to comply w/diagnosis.  I followed the directions even though I'm not certain I believe in that routine...but when you can't breathe, you do it.  Plus, he told me I would be a new woman in a few months!  Who doesn't want that!  I have never been so sick...one infection after another...prednisone each time. Finally in late May my ankles were swelling...I had never had anything but a blood test so he ordered a cat scan of the lungs and an echo.  Before that happened my family Dr placed me on Diflucan for Candida...I was hesitant to take because the write up said if allergic to dye talk ro DR.  She had me have benadryl handy...all seemed well until about an hour passed...began to have breathing problems that became extreme..went to ER the next day...Oxygen level 85 .. they kept me & I changed Pulminoligists!  They ordered C scan of lungs % Echo in the hospital. (An echo in the 90's was OK.)  This one says mild left ventricular hypertrophy w/preserved left V. systolic function and EF around 60%..Stage one.  Dr said nothing you can take for it and since it was mild .. I would think about it later.  In the hospital they treated me for infection w/prednisone & strong antibiotic.  It is possible it wasn't the dye and I was getting infection that sent me to ER..I'll never know!  After prednisone I immediatly began many trips to the bathroom & ankle swelling returned to normal without lasix.  Took my last prednisone about 10 days after leaving hospital.  A few days later my ankles were beginning to swell...I had pulmonary function test scheduled so waited until then to talk to Dr.  His response was to refer me back to family internist.  She ordered only 3 lasix as she did not have a copy of the echo...they helped but did not bring back to normal.  When I called again they were confused as to who ordered echo and did not have a copy as yet..I read the nurse mine.  The response was to get the hose that compress the leg..mild form but no lasix.  A week later my husband had a routine app ( I could not get in until the 20th of Aug)so I went along...at the end of his app I asked if I could ask a question?  Why did she not think I needed Lasix for ankles & feet which  were really swollen.  She said she did not think it was my heart causing this...I asked what then and she said, age and veins!  The Pulminoligists and resident in the hospital inferred the swelling was from the heart. Decided to wait until the 20th appointment to make sense of this.  My feet and ankles really hurt and now I have this dull ache in my heart area.  I am terribly out of shape...weak from 7 months of UTI's, coughing & antibiotic treatment etc...I am overweight also and trying to lose weight.  They are sending me to pulmonary rehab if I qualify...actually my function tests were not as bad as they or I expected!   But I can't go with these swollen ankles or can I...maybe that is what I need?  Forgot to mention I am back on Advair & it is working fine...new Drs do not agree with previous diagnosis...so I am also confused about that!  But what about this dull ache over heart!  I am a Realtor and was working up until the 20th of last December...since then I have been a serious couch potato due to all this...what little muscle tone I had, has disappeared and the skin on upper thighs is hanging!  Forgot to mention I called my husbands Cardio...talked too much in my message because when nurse called back she knew more than I had told her..like names of pulminoligist, internist & family Dr...she said I should check with her first.  I said I can't get in until the 20th and I already know her thoughts.  All I want is for someone to explain...seems too coincidental that I all of a sudden end up with this Stage 1 thing and swollen ankles at the same time after never having them before!  I gather by telling nurse too much, I stepped on someones toes and she called the family DR.  Any thoughts would be appreciated!  PS;  I took one of my husbands Lasix yesterday...and ankles are mush better...I may take one more for some relief.  Surely it can't hurt, can it?

[andydandy]

Thank you for taking time to read my ramblings!  No trearment for blood pressure, so age it is!  Also no brownish spots as yet. Never thought about the echo...no one mentioned fluid so I guess I can assume there was none.  Good point!  In the hospital they did not give me Lasix but put me on prednisone(before echo was done) for the infection & breathing, I began to pee like a racehorse!  Feet & ankles went down to normal over the next 24 hours...does that make sense?  Too bad prednisone is terrible for you...gives me greater energy, makes me happy as well as keeping ankles thin!   Compression hose here I come!

[maggiemag]

Fluid around the heart would've been picked up on the echo.  Venous insuff. can lead to brownish areas on the skin, like on the shins, as I mentioned before.  If  you   have to sit to work, then the compression stockings are the answer.  Put them on before you get out of bed in the am, unless you take a morning shower, then put them on right after it.  Exercise will also help decrease the edema.   Left heart dysfunction usually refers to a lower ejection fraction, which you don't have, and if you already have low blood pressure, the DD is probably due to age, sorry.  Unless your blood pressure is low because you are already treated for it.     My thoughts for today!        

[andydandy]

Forgot to mention that I have low blood pressure.  I was told this diasrolic dysfunction is like high blood pressure in your left ventrical.  Not sure where this came from!

[andydandy]

Thank you for your reply!  I have seen your fun messages with others so know you are knowledgable.  About taking husbands meds...I know I shouldn't ... only did for two days.  Great relief!  But since I did not take any today, they are swelling again!  My Father was a pharmacist with his own store so he often treated us...therefore I sometimes do my own thing...but I am aware of the danger!  Sorry I was all over the place with my question before...thought info on last 5 months might be relevant.
I have just a couple more questions....how does one know if it is the heart or this venous insufficiency?  And if it is the venous thing, I imagine there is no magic pill?  The only thing left that looked decent were my thin ankles and feet...vainity!  And on top of the vain thing, the swelling in the feet really hurts.  Everyone says...are you keeping your feet elevated? How can you do that unless you sit all day!  And even then, it is a bit difficult at a desk!  The finding of the left ventrical dysfunction and my feet and legs swelling seem like they have to be related....having never had either before.  The only reason they ordered the echo was because of the swelling.  I will try the hose around the house.  Do you think they really work?  Also the ache over my heart has passed...hope it wasn't fluid around the heart.  Guess I'll find out since I am not taking any more lasix.  
I am afraid I have lost a little faith in Drs in the last 10 years or so.  My husband has Atrual Fib as a result of graves disease.  He was on coumadin & monitered it well, but had a couple months of headaches which he never has and dizziness which he also never had.  Family Dr ordered MRI but nothing showed...finally I went to Dr with him because I could sense something was terribly wrong.  They were just going to do more blood tests so I suggested the ER to solve it...a sub dermal hematoma...he had brain surgery 36 hours later!  Fortunately, he came through without any side effects! I learned that a cat scan of the brain is a better diagnostic tool than an MRI in this case!  He also had a first bout of congestive heart failure about a year ago.  Dr had taken him off one portion of blood pressure medicine...that I later learned had a diruretic.  He was lethargic, sleeping a lot, and breathing heavy...called Dr but she did not think it could be that.  Possibly pneumonia so take him to ER.  Turned out to be CHF so now he is on lasix...and has had no more bouts thank goodness!  Therefore my access to lasix!  I guess I have learned that you must follow your instincts because the Drs are not always right.  I seem better able to care for others than myself!  Your thoughts when you have time?

[maggiemag]

YES, it can hurt!  No one should ever take someone else's meds.   Most often Lasix causes electrolyte losses, as potassium, and most people on it are also on potassium supplements.  Low potassium can cause arrhythmias, that can be serious.  Eating a banana just wouldn't be enough, but people will tell you that.  You could also become dehydrated, and drop your BP.

Soooo,  let me see.  I did have a hard time following your story as it is complicated,  but I will tell you that not all edema is from the heart.  If they told you to go get the compression stockings then they must've felt it was due to venous insufficiency.  That gets more common as we age.  The veins just don't drain as well as they used to.  doctors will notice other signs of venous insuff. besides edema, like a brownish discoloration on the legs.  And, yes, you could certainly exercise with swollen ankles, so you could do the pulmonary rehab.  That might really really help you.  If you are deconditioned then you need to get out there and exercise!  Diastolic dysfunction is generally due to higher blood pressure, along with the mild left ventricular hypertrophy.  Stage 1 DD that wasn't picked up before is probably mild.  It just means that the ventricles do not relax enough to fill. We get that as we age as well.  I know you aren't that old  ;-) as I am only about 10 years behind you!  An echo is also not exact science, and much is open to interpretation, so you might have had a different doctor read this echo.  I wouldn't worry about it but I know that is easier said than done!  I don't know about the dull ache over the heart area.  That is so non specific that it could be due to many different things.