Cardiomegaly, Peribronchial Cuffing, Kirley B, etc.

[kd]

My dad (81 yo, ~6' tall, 165 lbs, non-smoker or drinker, heavy exerciser) recently had a stroke. During examination, an x-ray showed:
1.Cardiomegaly
2.Prominant central pulmonary vasculature and pulmonary vascular redistribution
3.Peribronchial cuffing
4.Scattered Kirley B lines
5.Mi pulmonary vascular congestion
6.Arthrosclerotic aorta
7.Sclerotic metastisis - R scapula w/coarsened trabecular pattern
We know that cardiomegaly is an enlarged heart and we know what #6 is, but we don't know what the other things are or their significance to his well being and recovery. All his doc will say is that he has a "weakened heart."

In the last week he has developed arrhythmias. He was already on Cardizem CD, the doc put him on Coumadin followng his stroke, and just put him on generic Prinevil (sp).

Questions:
a) Would you explain #2,3,4,5,7 and tell us what it means to his longevity/recovery?
b) My dad has been complaining of shortness of breath and fatigue for about 6 mo. to his doc but his doc told him last month that he had a healthy heart that would carry him to 100. Do these things occur all of a sudden?
c) We also don't understand how long standing high BP may cause this.
d) Could his stroke have been caused from his heart condition?
e) My brother and I have some mild pulmonary hypertension. Would there be any relation to my dad's problems? (I also have a small PFO and severe MVR)
f) What symptoms might we expect if he worsens.
g) His doc has not suggested that he see a cardiologist. Shouldn't he have one?

Sorry about the N of ????  No answers elsewhere.

[Cleveland Clinic]

kd, thanks for the post.

Sorry to hear about your father.

a) Would you explain #2,3,4,5,7 and tell us what it means to his longevity/recovery?

These are all x-ray terms, and in isolation are impossible to give specifics with his recovery. However, they do indicate other disease such as:

2.Prominant central pulmonary vasculature and pulmonary vascular redistribution
3.Peribronchial cuffing
4.Scattered Kirley B lines

Are associated with elevated heart pressures that can be associated with congestive heart failure. This along with #1 would be indirect indicators that he may have an element of congestive heart failure.

#7 May indicate that he has changes in the bone that can occur when a neoplams metastsizes.

Both of congestive heart failure and neoplasms can adversely effect prognosis of critical illness. These are indirect indicators of these conditions and each would need to be evaluated further.

b)  Do these things occur all of a sudden?

They can. If he has CHF, then it can be the result of a long standing process such as hypertension or occur more suddenly from an event such as a heart attack or inflammation of the heart. Some believe there can be basic changes associated with heart function with acute neurologic events.

c) We also don't understand how long standing high BP may cause this.

The heart is a pump. Just as in a mechanical pump, damage can occur over time if it's made to work at a higher level then its degned to. High blood pressure causes the heart to have to work harder.

d) Could his stroke have been caused from his heart condition?

There are different types of stroke. Some from high blood pressure and some from embolism of things like atherosclerotic pieces and clots.  All these conditions are intertwined. the simple answer is they probably are related.

e) No. But there are genetic components. It would indicate to me that you should be aggressive about controlling your risk factors such as hypertension, cholesterol and smoking.  You should also be followed for evaluation of when to fix your mitral valve.

f) What symptoms might we expect if he worsens.

After an event you should hope for quick intial improvement. What doesnt happen in the first few weeks, whould hopefully come back a little over time. I cant comment on the specific symptoms since there are different types of strokes.

g)His doc has not suggested that he see a cardiologist. Shouldn't he have one?

It sounds as if he has some element of heart failur on his xray, and hypertension.  i would discuss this with your internist and neurologist.  

good luck

[kd re: longstanding MR]

thanks for your answer.

Would you mind finishing out the sentence for #2? I think you forgot.

Also, by (f), I meant "what symptoms might we expect if his heart situation worsens".  I think you thought I meant his stroke.  He is making progress in his stroke recovery but we are concerned about how we can tell if he has CHD and it gets worse.

Thanks again,
kd

[Cleveland Clinic]

All #2-5 are non specific radiographic findings when taken in totallity are associated with congestive heart failure as mentionin the answer.

Typical heart failure symptoms are respiratory difficulty, increased edema, and progressive fatigue.

hope thats a start

[kd re: longstanding MR]

Thanks.  It is a good start.
His oxygen level on the finger clip is only 91 so we are working to get him to breathe deeper.  That's a hard thing to learn to do.  We'll make it tho.  He's tough.

kd