Dr. Fett and anyone else

[jmonte]

Hi Dr. Fett- You are a popular guy around here lately! I wanted to ask you a couple of questions especially as I read some other posts. I am in the 35th week of pregnancy #2. I have had two echos- both remained the same. To give you a quick reminder of my story, my team of doctors seem to think my cardiomyopathy wasn't preg. related and I have IDCM- my own "normal" is 45-50% and they believe I've been operating at this level for a long time. I had an uneventful pregnancy in 2002 and was told I only had about a 3% risk of serious complications. That being said, up until now I've been pretty comfortable with how things were going except at the last cardio appt I had about 2 1/2 wks ago. I had an echo and it was the same. My cardiologist at the Brigham who I think is great basically said there was no need for me to come back just to say "hi". I am having a c-sction at 39 wks and assumed I'd have another echo before surgery and one before I left the hospital. Not only am I not having another echo before, she didnt want me to schedule one until January- 2 mos ppartum. This scares me as I was asymptomatic with my first and even though they ruled out PPCM for the most part, we can't be certain since I didn't have an echo until 7 mos PP. What are the chances that my heart was much worse post partum and by 7 mos pp, it had adjusted to the 45%-50% level. How hard can I push my doctor to do something other than nothing? Or should I just relax and be glad things are going smoothly? It just seems that I'm not really being considered high risk even though I see a high risk OB. I'm getting really nervous.....

[JAMESFETT]

Having IDCM, I am very reassured about the present course you are on, and the echo recommendations sound reasonable. Perhaps your doctors would consider doing a blood BNP in your last month of pregnancy, and again in the first month postpartum?, which, if normal is extremely reassuring, and which, if elevated, may be advance warning of deterioration of left ventricular systolic function. I don't know the cost in your area for a BNP determination, but it is a lot less than an echo, and I would guess it is in the $35 to $50 range (or less).

James

[tabs]

I was in your same boat. I spent my third pg with an ef of 43% that remained stable (according to echos). My cardio said that she would see me after delivery.

If your cardio won't test you, then you must really watch yourself and demand attention if you feel something is wrong. Watch your weight/swelling. Watch for right sided abdominal pain - If you get this, bring in a copy of the e-med article found on the main PPCM website as this symptom is only seen in pregnant women. Watch for unexplained coughing.

If you have any further questions, please PM me.
Twilah

[JAMESFETT]

You are correct, Twilah. Right-sided abdominal pain comes from stretching of the liver due to back up from the failing heart. Earlier this year, one USA woman 3 weeks after delivery had right-sided abdominal pain from liver enlargement and went into liver failure. She was being prepared for liver transplant when (finally) an echocardiogram was done and her PPCM was discovered. Proper treatment cleared up everything--the liver failure, the liver enlargement, the right-sided abdominal pain--and she went on to recover completely in her heart function. Think of that! Almost went for a liver transplant before an echo was done and PPCM was considered.

James

[SarahsMom]

WOW!!! Amazing....that's so weird, I remember the right abdominal pain VIVIDLY. I had to cancel a big dinner meeting for work, I went to the OB/GYN's office - I could barely walk - felt like a peircing cramp in my right side abdomen. I demanded that they take a look with an u/s to see what was going on. They found nothing of course and said it was probably the baby pressing on my diaphram or something. I just learned to live with it and chalked it up to another "wonderful" side effect of pregnancy! GEE WHIZ!!!!!

~Kari

[jmonte]

Oh my God, I've never even heard of that. Thank you , thank you!! This site is so valuable. I feel very prepared because of all the incredible information given by Dr. Fett and all the women here. Thank you so much for
sharing!!!!

[tabs]

The right-sided abdominal pain got me as well! That is why I always remember it. I have Crohn's so the pain was not new, but I spent my pg on prednisone and did not have any pain. Then just after 32 weeks, I started to feel worse and started to feel the pain. I phoned the doc and they felt that it was probably Crohn's. I wasn't so sure, but we sat on it for a week. It continued and I was examined for HELLP (or HELPP?) and then for gall bladder problems. They finally decided it was both Crohn's and gall bladder, but I ended up delivering early and then the ef of 7%. I am sure that the pain was my first symptom of my deteriorating condition.
Twilah

P.S. Dr.Fett, Thank you for telling us about the other lady. It is hard to believe that anyone would be happy to receive a diagnosis of PPCM, yet I am sure that she was very thankful!

[Tammy]

Ok, I have a question reguarding the right sided pain. I never expierenced any pain or discomfort other than normal pregnancy stuff before I had my son. The only thing I think was a bit extreme for me was that I was bit more short of breath, epsecially during the last trimester. This of course is looking back.

I didn't get any right sided pain till after I went home and the pain relieving drugs got out of my system. I was dx before I left the hospital with PPCM.
It wasn't till 8 mths post partum with my son that it was found to be gall blatter problems in which at the time I had surgery to have it removed. After that recovery I have had no more pain.

How is all that connected, or is it?

[JAMESFETT]

Gall bladder origin of pain in right side of abdomen must always be considered, and gall stones are detectable by ultrasound. They would have nothing to do with PPCM except that pregnancy makes the bile more likely to form stones in the gall bladder or bile tracts. So pregnancy has a lot to do with the formation of gall stones.

James