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Options for suspected CHF or Pulmonary Hypertension
72, male. History of pneumonectomy due to TB in 1960. Under treatment for COPD since then. lived full life & managed very well with condition. No other medical conditions.
1 yr ago – Acute exacerbation. Admitted into hospital & found to be in type II respiratory failure. Chronic CO2 retainer since. Recently put under the care of a new Respiratory Consultant who put me on home BIPAP therapy (night time only) designed to manage my CO2 retention. Have been managing well & still active. ABGs within normal limits.
1 month ago - Began to progressively become more breathless on exertion. At rest I was fine with sats in high 90’s. But on slight exertion I would desaturate to mid 80’s & become dyspnoeic. I do NOT feel faint & have not suffered syncope. At its worst I got peripheral pitting eodema of ankles & feet. My hands also became swollen. This resolved after a few days. Currently no peripheral eodema. I’m well at rest (sats 99% sometimes) but on mild exertion I become very breathless. 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 supine.
I spoke to my respiratory consultant about this & he ordered an echo. I had my echo last week. I’m very interested to see if there’s evidence of CHF or Pulmonary hypertension. I ‘m yet to hear from my consultant but he implied that the next step would be to put me on ambulatory O2. He said the respiratory nurses will deal with that & that I was to see him in 6 months for a review appointment.
I’m a bit worried that my doctors will put me on ambulatory oxygen to relieve the symptoms without trying to resolve the underlying condition. I’m also worried that wont get to talk to a doctor about the results of my echo. If my echo shows evidence of CHF/Pulmonary H.tension, should I be requesting pharmacological intervention (ACE inhibitors, digoxin, diuretics, ect) to relieve the strain & 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? Should I be speaking to a cardiologist or is a respiratory specialist adequate .
I just want some information to h& for when I have this discussion with the dept.
Am I showing signs of decompensation? Is my heart no longer able to compensate & keep up?
1 yr ago – Acute exacerbation. Admitted into hospital & found to be in type II respiratory failure. Chronic CO2 retainer since. Recently put under the care of a new Respiratory Consultant who put me on home BIPAP therapy (night time only) designed to manage my CO2 retention. Have been managing well & still active. ABGs within normal limits.
1 month ago - Began to progressively become more breathless on exertion. At rest I was fine with sats in high 90’s. But on slight exertion I would desaturate to mid 80’s & become dyspnoeic. I do NOT feel faint & have not suffered syncope. At its worst I got peripheral pitting eodema of ankles & feet. My hands also became swollen. This resolved after a few days. Currently no peripheral eodema. I’m well at rest (sats 99% sometimes) but on mild exertion I become very breathless. 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 supine.
I spoke to my respiratory consultant about this & he ordered an echo. I had my echo last week. I’m very interested to see if there’s evidence of CHF or Pulmonary hypertension. I ‘m yet to hear from my consultant but he implied that the next step would be to put me on ambulatory O2. He said the respiratory nurses will deal with that & that I was to see him in 6 months for a review appointment.
I’m a bit worried that my doctors will put me on ambulatory oxygen to relieve the symptoms without trying to resolve the underlying condition. I’m also worried that wont get to talk to a doctor about the results of my echo. If my echo shows evidence of CHF/Pulmonary H.tension, should I be requesting pharmacological intervention (ACE inhibitors, digoxin, diuretics, ect) to relieve the strain & 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? Should I be speaking to a cardiologist or is a respiratory specialist adequate .
I just want some information to h& for when I have this discussion with the dept.
Am I showing signs of decompensation? Is my heart no longer able to compensate & keep up?
Best Answer
Thank you so much for your reply. Its much appreciated.
As mentioned in my original post, i had an Echo last week.
I'm awaiting the results but my main concern is the fact that my specialist implied that i wont be seeing him for 6 months and that the Echo will decide whether i will need ambulatory oxygen or not. He suggested that if ambulatory oxygen is required, the respiratory nurses will arrange everything and attend the house to provide all my needs.
My question is, if the Echo shows evidence of CHF or Pulmonary hypertension, shouldnt there be pharmacological management (ACE inhibitors, digoxin, beta blockers, diuretics, etc) involved to relieve the load on the heart, as opposed to oxygen to just relieve the symptoms?
I need the advice to hand so i can discuss this with my specialist in an informed way as i cannot accept that i have had a special investigation like an Echo but i dont get to speak to a specialist about the results.
As mentioned in my original post, i had an Echo last week.
I'm awaiting the results but my main concern is the fact that my specialist implied that i wont be seeing him for 6 months and that the Echo will decide whether i will need ambulatory oxygen or not. He suggested that if ambulatory oxygen is required, the respiratory nurses will arrange everything and attend the house to provide all my needs.
My question is, if the Echo shows evidence of CHF or Pulmonary hypertension, shouldnt there be pharmacological management (ACE inhibitors, digoxin, beta blockers, diuretics, etc) involved to relieve the load on the heart, as opposed to oxygen to just relieve the symptoms?
I need the advice to hand so i can discuss this with my specialist in an informed way as i cannot accept that i have had a special investigation like an Echo but i dont get to speak to a specialist about the results.
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Breathlessness on exertion, peripheral edema, pain in chest—while can be due to severe COPD, it can also be due to a failing heart. At times a chronic lung disease puts back pressure on heart and this causes strain on heart. On the other hand, it can also be a direct heart condition like an enlargement or angina or MI. You definitely need ECG and ECHO to rule these out. Please go to an ER as soon as possible. Take care!