hep c cirrhosis and heart disease

[frankie8]

I have been cured of HCV a year now, have an indeterminate diagnosis of cirrhosis and feel tight in my chest and can get a little breathless of exertion. My doctor had me perform a lung function test in her surgery and it was normal. My BP is variable, sometimes normal for my age (60), sometimes high, especially diastolic, in the 90s.

I have asked my doctor if further testing should proceed, but she doesn't think its necessary. She does not know a lot about HCV and extra hepatic manifestations and I basically have had to share my research.

At my age, and with cirrhosis and tight chest sensation, should I insist on some heart test, and if so, what sort of test?

[HectorSF]

Fibroscan kPa Score
For people who have hepatitis C liver damage the following scores are used to compare with the Metavir scoring scale
http://hepatitiscnewdrugresearch.com/fibroscan-results-the-scoring-card.html

"I have had a Fibroscan test, which measures 4.8kpa"
4.8 kPa - F0-F1, BETWEEN STAGE 0 - STAGE 1 liver disease.

pre-Tx measured 7.6
7.6 kPA = stage F1, STAGE 1 liver disease

Stage 4 liver disease (CIRRHOSIS) on the kPa scoring card is a score >14.7 kPa on the kPA scoring card

What is your platelet count?
A very easy marker for cirrhosis.

Noting close to cirrhosis to cirrhosis here and the Fibroscan is very accurate at measuring higher F scores. Something doesn't add up.

Hector

[JimmyMose]

I CAN'T tell you to call 911

[JimmyMose]

Congratulations on achieving SVR as I did 18 months ago.

I have cirrhosis but well compensated. Because I am obese and that causes my ultrasound to be sub optimal my doctor alternates between US and CT with contrast every 6 months so far all good.

Four years ago in June I had been using a treadmill and had started to experience chest discomfort and shortness of breath.  I told my primary who ordered chest x-ray (ok), EKG (ok) and a stress test with nuclear dye and that showed arterial blockage. The doctor referred my to cardiologist and scheduled a CT of heart in July. Met with cardio  August 10 he told me had major blockage and scheduled angioplast.

  After getting out of work at 3am last day of 12 day fair l.  Went in for procedure at 7 am Monday when I woke up at 10 am was told they put 4 stents me.
Had to stay overnight I was free to do most things except not to lift over 15 lbs or overexert myself for 1 week. So on Wed. I went back to work at the next fair on light duty for a week.

I was lucky I had my chest pain properly reported and checked so I may have very well avoided a potential heart attack or even worst.  So any having similar chest discomfort , shortness of breath and other warning signs. I can tell you to call 911 that's your decision. But in my opinion report and see a doctor soon and get some preliminary test run

[frankie8]

thank you for sharing your experience Jimmy. I will see my GP and ask for the same tests you had. HepC can cause blocked arteries, and that is what I'm concerned about. Btw, do you have any other conditions with Cirrohsis, as I'm not sure whether i have RA since completing successful treatment last April.
Best wishes :)

[JimmyMose]

Your Hepatologist is following the recommendations of the professional medical organizations HectorSF mentioned in his reply for your situations.

My non-medical opinion regarding your chest pain is that your primary doctor should run some preliminary tests like chest xray, EKG, stress test then based on those resultes decide whether to refer you to a cardiologis.

If chest pain becomes worst or other signs you should follow the recommendations to call 911 or go to the Emergency Room.

You might want to check appropriate communities here.

Best wishes for resolving your concerns

[frankie8]

thanks :)

[frankie8]

thanks Jimmy :)

[HectorSF]

I can't make any comment on heart disease per se as I am not familiar with it personally.

What I can comment on is... you don't know if you have cirrhosis? Cirrhosis is serious advanced liver disease. You must find out if you have cirrhosis or not as if you had/have Cirrhosis (F4) or bridging fibrosis (F3), despite clearing your hep C you are still at risk for developing complications from your liver disease if you had cirrhosis.

Particularly liver cancer (HCC). If you have cirrhosis you need to have surveillance for cancer every 6 months. Liver cancer is a very serious cancer that if not caught in its early stage can be untreatable and fatal. In other words like many cancers, by the time you have any symptoms, the cancer is too far advanced to be treated.

----------------------------------------------------------------------------------------------------------
AASLD/IDSA HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C


"Recommended Follow-up for Patients Who Achieve a Sustained Virologic Response (SVR)"

Surveillance for hepatocellular carcinoma (HCC) with twice-yearly ultrasound examination is recommended for patients with advanced fibrosis (ie, Metavir stage F3 or F4) who achieve an SVR.

A baseline endoscopy is recommended to screen for varices if cirrhosis‡ is present. Patients in whom varices are found should be treated and followed up as indicated.
-----------------------------------------------------------------------------------------------
Find a competent doctor who understands liver disease. Perhaps a gastroenterologist or hepatologist who understands liver disease and hepatitis C. There is no reason anyone in this day and age should be walking around not nothing if they have cirrhosis or not. What you don't know can hurt you.

Also get a referral and see a cardiologist about your heart related concerns.

Why waste your time and money on an incompetent doctor who is not giving you proper post hepatitis C treatment and liver disease?

Be well.
Hector

[frankie8]

Thanks for your reply Hector. I don't know if i have cirrhosis because I have had a Fibroscan test, which measures 4.8kpa (pre-Tx measured 7.6, an ultrasound, which reports irregular margin on liver (aka cirrhosis, according to my hepatologist) and pre-Tx a Fibrotest rating of F3! Though my Alt pre-Tx was always higher than my AST (apparently thats relevant in dx cirrhosis? Consequently, my hematologist cannot give me a straight answer, as to whether i have cirrhosis or not! My GP, as I said is a little beyond her depth with my condition. I see my Hepatologist in July, so I think i shall ask him to refer me to a cardiologist (I hope he will), as well as a Rheumatologist, as i am over a year post HCV Tx, and yet i periodically suffer from aching wrist and stiff finger joints. Feeling a little disappointed, that I don't feel better having cured HCV.

[frankie8]

Hepatologist not Hematologist! predictive txt fault!

[frankie8]

Btw, my Hepatologist will be ordering blood and ultrasound tests every 6 months due to my 'possible' cirrhosis