Diastolic Dysfunction of the Left Ventricle

[Lad50]

Hello,

I am a 49 year old who was previously diagnosed with hypertension in January of 2002. Over the years it has been difficult to manage, at one time I was on Zestril 20 mg, Toprol Xl 100 mgs and Procardia XL 50 mgs. Since late 2006, I have suffered 4 Hypertensive Emergencies requiring hospitalization.

I am in pretty good shape overall, eat a heart healthy diet, up until late October of this year, I was walking 2 miles + per day. Suddenly in late October, my lungs felt very heavy, I describe it as like having concrete filling up my lungs. With the extreme shortness of breath came more angina. I have been using sublingual nitro for 3 years plus to treat what I was told as unstable angina.

I was in cardiac telemetry several time since....my bp was very high and my heart rate was in the upper 30's and 40's. A chemical echo-stress test was done and all of my EKGs' were not normal, most with an Anterior Infarction questioned. My left side cardiac catherization revealed a mild enlarged/dilated ascending thoracic aorta. Usually mild means, no need to do anything now....is this something that is monitored periodically through MRI or other testing?

Since the dyspnea has continued (I was taken off the Toprol XL and now take 60 mg Imdur, 20 mg Zestril and 325 mg aspirin, plus Sl nitro PRN), my internist ordered an echocardiogram.
The findings are (per the report):
Concentric Left Ventrical Hypertrophy
Diastolic Dysfuntion of the left ventricle
Trace Tricuspid Valve Insufficiency
Trace Mitral Valve Insufficiency 9peak velocity across TV was 1.7m/sec suggesting a pulomnary artery systolic pressure of 20 mmhg

Also noted during the echo was a marked inverted T-wave on the cardiac monitoring. What is that significant of?

One reason for this echocardiogram was to r/o Pulmonary Hypertension.

Since October, my ability to walk has diminished to nothing as any exertion (even rest) leads to dyspnea and more chest pain...it seems like the right lung feels the 'heaviest' and then it progresses to the entire chest region, with a feeling of cinder blocks set upon my sternum.

My internist didn't explain things in depth and no adjustments were made to deal with the continued dyspnea. he has ordered the following labs: TSH, T4 and T3 (?). Should I seek a second opinion....what can be done for this stiff heart and dyspnea? I have looked up a few articles and information and it looks kind of dismal to me.

Sorry for the length, any help is so greatly appreciated.

Laurie

[Lad50]

Thank you for your comments. On the echo report, there was no mention of the degree of diastolic dysfunction....just Diastolic Dysfuntion under the list of findings.re: the Concentric Left Ventricular Hypertrophy, the septum measured 1.6cm and the free walls, 1.4 cm. I do agree that my history of hard to manage hypertension over the years has taken its toil. In addition, my cardiologist did say that while doing the left cardiac catherization, the vessels suddenly constricted and he sprayed them with nitroglycerin to dilate. I was told that my lungs are in great shape and my cholesterol is great.

I am following up with my family history as my nephew of 27 had a 6cm aortic aneurysm last spring repaired as well as replacement of his tricuspid valve. The aneurysm developed over a 1 year span. I am so happy for him as he and his wife brought a set of twin boys into this world last June.

Happy Holidays to you and yours,
Laurie

[maggiemag]

Quickly as I don't have much time to go into a lot of detail, your pulmonary artery pressure is wonderful; perfectly normal so you don't have pulmonary hypertension.  Sometimes people can get that secondary to diastolic dysfunction.  You don't say the degree of DD, which is related to hypertension usually.  I think with the advanced echo techniques they are finding this more and more.  If it is mild and your bp is now controlled, they probably won't be too concerned.  The concentric LVH is probably due to your history of HTN.  The trace leakage is not anything to worry about.   The labs are for thyroid function.  Your symptoms sound cardiac to me, like unstable angina.  Hope this helps!