Diastolic Dysfunction - is it reversible?

[soscared872]

Hello Doctor,

My background: I was an obese kid. After 17 I became an exercise fanatic and have been generally slim since then. I am 52, male. My mom had hypertension and died of both cancer and a stroke at 65 (obese for 30 years). My aunt (her sister) died of congestive heart failure in her 70s. Their uncle died of same in his 90s. I am a lifelong non-smoker. Light drinker, occasional binge up to the age of 32. I swim usually two miles four times per week (about 8 or 9 miles total) and I inhale every fourth count - so that I can balance out shoulder rotater cuff issues on my right shoulder.

My doctor told me to lay off sodium and caffeine. I can do that. He also said to control my cholesterol. The test readout said to consider a calcium blocker and statin to reduce LDL below 70mg. But the doctor did not put me on meds. My BP in March at the time of the echocardiograph tests was 126 over 80. Yesterday at the doctor office it was 110 over 74. The doctor followed the recommendation of the lab to basically say I need to get another echocardiograph in a year.

The diagnosis was hypertensive heart disease, primarily due to diastolic dysfunction. Also Myocardio (spelling?) fibrosis. I did not expect this at all. I had the test 3 months ago and told the doctor if there is nothing alarming, I would like an appointment June 24. I had a vitamin D blood test the same day. I commute long (several hundred mile) distances and am away from home for two weeks at a time and back for weekends.

1. Does this suggest that I have a chance to control this to stop from getting worse if I keep my BP below 120/80? My BP was borderline for several years but this was my first echocardiograph since I got a new doctor and I'm over 50.

2. Also, am I at risk of a heart attack by my swimming technique - few inhales? I don't get out of breath.

Thanks

[soscared872]

Well I guess no one bothered to answer.


My BP went up to 146 / 9x (91?) Tues night. I never saw my reading that high. I had a backache in my upper back and pain in chest for two days. It changed when I moved so I determined it was muscle pain. I had dizziness Tues. night. I checked into a hospital and they ran a lot of tests. Chest x-rays, CAT, brain scan, MRI, EKG, blood test, ECHO.

Also the cardiologist at the hospital was alert to point out the number LAs (see above). It was within the range of 1 and 4, which was the test result paper my primary physician gave me. So it indicated I was within the range of normal left atrial size. Also the E. Prime Vel. figure of 8.1 was above 8, which still was okay. My own doctor did not critique the numbers from the text. It was a sloppy test result the lab in Missouri gave back.

But I still have to go on BP medicine. I have to eat a heart healthy diet. I got the answer about my swimming too. I can still swim and no, the technique I swim does not cause this.

[soscared872]

Here are my numbers
RVd 2.6.   Est. EF.  61.
LVd  4.8.   E Prime Vel.  8.1
LVs 3.0.    AO.  3.2.  E/E Prime.  6.4
IVs 1.0      AV  Peak Vel. 121.0
LVPW 1.0. MV Peak Vel 52.1.  LVOT Peak Vel. 107.6
LAs 3.8.    TV Peak Vel. 44.7.  LVOT diameter 2.3.
LA V 75.    PV Peak Vel.  134.9 (60-90 range). LVOT VTI  23.8
LA V I. 40 (<29).  PAP. 32.  

HR 70.  Bpm(60-100.  Stroke Vol 99.  Cardiac out.  7.0.  CI 3.6
Height 70.9 wt 165 BP 126/80
BSA. 1.9.  

Principle findings: features consistent with hypertensive heart disease associated with diastolic dysfunction, preserved LVEF (61%), findings of myocardial fibrosis.

Considerations: isolated diasolic dysfunction: goal: continued optimization of resting LV filling pressure, irrespective of BP. Highest tolerable dose ARB; calcium channel blocker (dihydropyridine class); statin with a goal of LDL cholesterol < 70mg/dl.

Suggested followup : echo / Doppler to assist in management of CV dysfunction in one year or sooner is appropriate if there is a documented change in clinical status or symptoms.

No significant valvular stenosis. No significant valvular regurgitation. Trivial mitral valve regurgitation. Trivial pulmonary valve regurgitation. Trivial tricuspid valve regurgitation. No evidence for shunt by color Doppler interrogation.

Normal right ventricular size and systolic function. Severe left atrial enlargement. Right atrial enlargement. Mild thickening of the aortic and mitral valves. Structurally normal pulmonary and tricuspid valves. The inferior vena cava is of normal size with normal respiratory collapse. Normal aortic root and ascending aorta dimensions. No intracardiac mass or thrombosis. No pericardial effusion.

That was the essence of the echo report. Comments on whether I should be super worried. One looks at me and says I appear to be in my late 30s, but it is what is inside that counts.