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Shortness of breath
Last July I started having episodes of extreme SOB that lasted a few minutes. This was a very sudde onset. I do have asthma and thought that's what it was. I went to my PC and for a week that's what she treated. To make a long story short when I had no weezing she sent me to the ER thinking I had a PE. I did not I was having a heart attack. Had a cath and 2 stents were placed. They discovered my mitral valve was severely damaged and thought the SOB might be coming from this as I still had the problem and it was getting worse. I had PFT that were not abnormal enougt to cause the extreme SOB. I then had mitral valve repair to solve the problem. Well, almost 4 months later I still have the SOB. Pulmonoligist says it's heart related since my lungs sre clear and cardiologist doesn't think it's heart related. MVR was not totally successful.
Can anyone offer any suggestions on this situation. The SOB is not just getting winded, I am totally dibilated during these few minutes.
I am 62 and in normal good health for myy age aside from these problems. Thyroid has been checked along with holter montoring...all normal. Any suggestions would be appreciated.
Can anyone offer any suggestions on this situation. The SOB is not just getting winded, I am totally dibilated during these few minutes.
I am 62 and in normal good health for myy age aside from these problems. Thyroid has been checked along with holter montoring...all normal. Any suggestions would be appreciated.
I'll try to answer some of your questions, but your understanding is far superior then mine. There has never been any evidence of pulmonary hypertension and my oxygen levels are always high (96-99) even when I'm having an episode. My thryoid levels are also in the normal range.
I saw my pulmonologist today and he decided since I did seem to be a tad improved when he put me on steroid therapy last month, we would do a low level dose (10mg) until I see him next month.
The end of April I have an appointment with a valve specialist at The University of Pennsylvania. Hopefully, he will have some answers.
Thank you, again.
I saw my pulmonologist today and he decided since I did seem to be a tad improved when he put me on steroid therapy last month, we would do a low level dose (10mg) until I see him next month.
The end of April I have an appointment with a valve specialist at The University of Pennsylvania. Hopefully, he will have some answers.
Thank you, again.
If EF is sustained over approx. 70% EF requires the left ventricle to dilate. There are flucutations of dilations with the LV...increase dilations stronger contractions, reduce dilations less forceful contractions. The variations help maintain a balance of blood flow between the right and left sides of the heart. Also, heart rate and blood pressure variations contribute and are integrated with the system to help maintain the balance. As an example, if the heart rate is slowed and to maintain a balance the heart left chamber will dilate and increase the EF, etc. But the dilation has an effective range, and if there is an underlying cause that causes the dilation...untreated the LV will overcompensate with a dilation that causes weak contractions...There are specialized myocyte (heart cells) cells that have the ability to stretch and recoil to normal...but there is a limitation. . The phenomonon relates to the Frank/Starling mechanism and has been compared to a handspring as an analogy.. When the handspring is stretched there is strong recoil, over stretch and the spring becomes flaccid. A heart that is overworked will continue to dilate, and the continued dilation will result in heart failure if the underlying cause is not resolved.
Your question regarding rapid respiration triggered by the heart can also be due to hypoxia. We know ischemia can cause a harmful depletion of oxygenated blood supply to a subject location and that causes pectoris angina, and hypoxia also relates to a deficit of oxygenated blood to heart cells and can cause angina but flow is normal. The blood itself lacks a good oxygen level caused by asthma, anemia, toxic substances, etc. I believe the low oxygen level may be what you have in mind, and that would also trigger a respiratory response. You are correct the heart would have to signal a distressed condition to the body system to increase respiration, etc. I speculate and say it is a CNS involvement that dilates the left ventricle, constricts peripheral vessel to increase blood supply, increase heart rate, etc. Maybe the thyroid is involved as I understand that has a controlling feature for all or almost all system organs.
Your question regarding rapid respiration triggered by the heart can also be due to hypoxia. We know ischemia can cause a harmful depletion of oxygenated blood supply to a subject location and that causes pectoris angina, and hypoxia also relates to a deficit of oxygenated blood to heart cells and can cause angina but flow is normal. The blood itself lacks a good oxygen level caused by asthma, anemia, toxic substances, etc. I believe the low oxygen level may be what you have in mind, and that would also trigger a respiratory response. You are correct the heart would have to signal a distressed condition to the body system to increase respiration, etc. I speculate and say it is a CNS involvement that dilates the left ventricle, constricts peripheral vessel to increase blood supply, increase heart rate, etc. Maybe the thyroid is involved as I understand that has a controlling feature for all or almost all system organs.
"Your EF is marginally high at 70% and with a margin of error with an estimate and the fact that EF is dynamic you may have heart that is overcompensating and above 70%. This can lead to an enlarged left ventricle and a rapid decline to heart failure if the underlying cause is not treated."
Thank goodness that isn't the case with me.
Thank goodness that isn't the case with me.
Thanks everyone for their imput. I am going to the pulmonologist today and will ask him these questions.
Good Luck to you !!!
Good Luck to you !!!
There is a biochemical association with the heart and the dysfunction of endothelium cells (innerlining of the coronary vessels). The most prevailing mechanism of endothelial dysfunction is an increase in reactive oxygen species, which can impair nitric oxide production and activity by several mechanisms. The most prevailing mechanism of endothelial dysfunction is an increase in **reactive oxygen species**, which can impair nitric oxide production and activity via several mechanisms...and environmental stress may be the underpinning.
**"Reactive oxygen species (ROS) are chemically-reactive molecules containing oxygen. Examples include oxygen ions and peroxides. Reactive oxygen species are highly reactive due to the presence of unpaired valence shell electrons. ROS form as a natural byproduct of the normal metabolism of oxygen and have important roles in cell signaling. However, during times of environmental stress (e.g., UV or heat exposure), ROS levels can increase dramatically. This may result in significant damage to cell structures. This cumulates into a situation known as oxidative stress. ROS are also generated by exogenous sources such as ionizing radiation".
Your EF is marginally high at 70% and with a margin of error with an estimate and the fact that EF is dynamic you may have heart that is overcompensating and above 70%. This can lead to an enlarged left ventricle and a rapid decline to heart failure if the underlying cause is not treated.
**"Reactive oxygen species (ROS) are chemically-reactive molecules containing oxygen. Examples include oxygen ions and peroxides. Reactive oxygen species are highly reactive due to the presence of unpaired valence shell electrons. ROS form as a natural byproduct of the normal metabolism of oxygen and have important roles in cell signaling. However, during times of environmental stress (e.g., UV or heat exposure), ROS levels can increase dramatically. This may result in significant damage to cell structures. This cumulates into a situation known as oxidative stress. ROS are also generated by exogenous sources such as ionizing radiation".
Your EF is marginally high at 70% and with a margin of error with an estimate and the fact that EF is dynamic you may have heart that is overcompensating and above 70%. This can lead to an enlarged left ventricle and a rapid decline to heart failure if the underlying cause is not treated.
"To provide a perspective: If your SOB is heart related it would be due to a low cardiac output. The 45% EF is below the normal range which is 50 t0 70% and that indicates the amount of blood pumped with each heartbeat. "
Could there be more at work here? The reason I ask is that I've had many periods of time with SOB during my 4 years of heart problems and yet my Lungs are perfect and my EF is 70%. Maybe cardiac muscle gives out some kind of message to tell us to breath faster? I know the usual way the body controls respiration is through acidity of the blood, but maybe there's a second method underlying this where the heart can demand faster breathing?
Could there be more at work here? The reason I ask is that I've had many periods of time with SOB during my 4 years of heart problems and yet my Lungs are perfect and my EF is 70%. Maybe cardiac muscle gives out some kind of message to tell us to breath faster? I know the usual way the body controls respiration is through acidity of the blood, but maybe there's a second method underlying this where the heart can demand faster breathing?
To provide a perspective: If your SOB is heart related it would be due to a low cardiac output. The 45% EF is below the normal range which is 50 t0 70% and that indicates the amount of blood pumped with each heartbeat.
If you have an insufficient mitral valve, that could also contribute to a low cardiac output. The EF is based on volume in the left ventricle before the left ventricle contracts and then again after the contractions just before the filling phase. If the mitral valve has a serious regurgitation problem the amount of blood going into circulation with each heartbeat is not accurately represented with the EF. The EF accounts for the volume before and after pumping phase but does not consider the amount of blood going back into the upper chamber rather than into circulation. As a consequence there is a low cardiac output represented by low EF and backflow of blood that does not get into circulation and that can cause your symptoms, but it seems a doctor would have an understanding of that possiblility?!
Other possibilities of low cardiac output can be due to diastole dysfunction (chamber filling capacity). The EF can be almost normal or normal and have a low cardiac output due to not enough blood is being filled into the left ventricle, and that condition can be due to the right side of the heart is not functioning normally by not sending an adequate supply of blood to the lungs...as a result less blood goes to the left ventricle and this results in a low cardiac output. Also, the heart walls could be enlarged and that would reduce the filling capacity causing reduced blood supply into circulation. Also, abnormal fluid within cardiac sac that could also impede filling capacity.
If you had a heart attack as stated, is there heart wall damage?
Hope this helps provide some insight to the possibilities of a heart related condition that can help you discuss the possiblities with your doctor. If there is some assurance that the cardiac output is sufficient then the focus would be with the respiratory system such as pulmonary embolism (ruled out according to your post), but has high pulmonary pressures been ruled out? The pulmonary artery may be occluded or stiff, etc. that can impede blood flow to the lungs.
Take care, and thanks for your questions,
Ken
If you have an insufficient mitral valve, that could also contribute to a low cardiac output. The EF is based on volume in the left ventricle before the left ventricle contracts and then again after the contractions just before the filling phase. If the mitral valve has a serious regurgitation problem the amount of blood going into circulation with each heartbeat is not accurately represented with the EF. The EF accounts for the volume before and after pumping phase but does not consider the amount of blood going back into the upper chamber rather than into circulation. As a consequence there is a low cardiac output represented by low EF and backflow of blood that does not get into circulation and that can cause your symptoms, but it seems a doctor would have an understanding of that possiblility?!
Other possibilities of low cardiac output can be due to diastole dysfunction (chamber filling capacity). The EF can be almost normal or normal and have a low cardiac output due to not enough blood is being filled into the left ventricle, and that condition can be due to the right side of the heart is not functioning normally by not sending an adequate supply of blood to the lungs...as a result less blood goes to the left ventricle and this results in a low cardiac output. Also, the heart walls could be enlarged and that would reduce the filling capacity causing reduced blood supply into circulation. Also, abnormal fluid within cardiac sac that could also impede filling capacity.
If you had a heart attack as stated, is there heart wall damage?
Hope this helps provide some insight to the possibilities of a heart related condition that can help you discuss the possiblities with your doctor. If there is some assurance that the cardiac output is sufficient then the focus would be with the respiratory system such as pulmonary embolism (ruled out according to your post), but has high pulmonary pressures been ruled out? The pulmonary artery may be occluded or stiff, etc. that can impede blood flow to the lungs.
Take care, and thanks for your questions,
Ken
Thank you for your response. My EF is 45%. The cardiologist is nt totally ruling heart out he is just stumped as to what else to do.
Do you know your EF number? It sounds Heart related for me, why your cardiologist thinks it is not? Based on what? Did he say?
I know what you mean on totally dibilated..:(..my EF was 20% back ,when I feel that....You need more attention and answer from your doctors that is for sure , and solution!!
My best!!
I know what you mean on totally dibilated..:(..my EF was 20% back ,when I feel that....You need more attention and answer from your doctors that is for sure , and solution!!
My best!!
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Good luck to you and do not hesitate to ask second opinion from other doctors! Also you might want to post that here on the “related expert forums” just roll down about the middle of the page and right side it is, click on the ‘heart disease’.
Hope it helps.