8wk Echo and BNP controversy

[sfekke]

Update - My BNP level is 28 and my echo 50-55%. Next echo in two wks. The cardio said I have a 4-6% chance of pre-eclampsia recurring and a 5-20% chance of PPCM.


I had an echo today unexpectedly. I saw a cardio who specializes in women and maternal heart problems today, and he managed to fit me in. I'm so happy to get this done so soon (my reg cardio scheduled one at 3mo). The truth is I haven't been feeling well and this will either give me peace of mind, or allow me to make the tough decision sooner when it will be at least somewhat easier. I had an echo in Feb at 55-60% so the doc should be able to compare pictures. The tech said it looked like 50%. The 5% points doesn't concern me, but a discernable difference in pictures from 2 echos WILL give me major cause for concern and I'm very nervous about it at the moment. We're starting to grow attached to the pregnancy, even though we won't be able to think of it as all systems ago until around 16wks.

I also saw a perinatologist last friday. Neither he nor my OB new what I meant by BNP baseline or B-type N. I showed them one from the medical records I carry around with me. The then peri said the BNP is the same as ANP which naturally goes up in pregnancy, sometimes 3X as much. I know now -thanks to the BNP thread and Emily's post, that BNP and ANP although similar peptides are not exactly the same, so I'm confused. How much of a BNP rise should I be concerned with? I'm anxiously awaiting the test results for that this week.

Anyone know the lowdown on this?

Sarah

[miachic]

I was told by my heart failure doctor (who I'm no longer seeing because I didn't care for her) that anything under 100 is "normal" and that if it's lowish to not be concerned. I was also told by the resident that works in their office that even a normal person without heart problems could walk around with a higher BNP. By higher I mean higher than what mine was at the time. I had a level of 28. The resident said that he could have a BNP of more than that. It really depends on what your heart is doing at the time and if it's a little bit stressed it can secrete more of those heart hormones and such.

I would also ask them to draw and check a high sensitivity C-reactive protein. Dr. Fett has stressed this time and time again as a potential lab value that could be used in recognizing an inflammatory process in the body such as what happens to the heart in PPCM. I am going to demand that they do one a few times during my next pregnancy if we get to that point. You can read about it here:

http://www.nlm.nih.gov/medlineplus/ency/article/003356.htm

Here's another link about BNP that I think is easier to understand:

http://www.chfpatients.com/tests/bnp.htm

Hope that helps! Ask lots and lots of questions, demand that they do every test in the book and push them for answers...fast answers...not have to wait a few weeks answers. This is your health and you are your best advocate for it so take charge and tell them what's up :p .

Hope that helps! Try to relax.

[sfekke]

Here I go again, can't seem to stop blabbing.

I wanted to add the cardio seemed very skeptical when I mentioned a 78% non-recurrance rate (this is different from the algorithm but comes from a different study). He mentioned he has had numerous PPCM patients and 2 who had recurrances in sub pregnancies. I didn't ask him specifics, like did they recover prior to, do you have any successful sub pregnancies. The truth is I don't hold too much stock when doctors give you their worse case stories. The studies show stats from a much larger data sampling set. It did remind me of the gravity of my situation.

And of course what is good is that he wanted to look at all my past echos in detail. Based on the details of my specific case he'll try to get a better idea of prognosis. THAT is very encouraging, comforting..

[SusanD]

I think *in general*, you are going to find most docs very skeptical since very little new research has been published. They are going to be stuck in the old days and will always err on the side of caution...mainly due to the bad outcomes they remember (before we had such great meds and sensitive tests !) and because of that monstrosity that hangs over every physicians head=============>malpractice.

I hope you can find one who will at least listen to more current stats. I used to be the WORST here about being negative and skeptical of women wanting a sub pregnancy. When all of the ducks are lined in a row to speak and recovered EF and all that Dr.Fett mentions is in order, the outcomes are so much better.

[sfekke]

Update - My BNP level is 28 and my echo 50-55%. Next echo in two wks. The cardio said I have a 4-6% chance of pre-eclampsia recurring and a 5-20% chance of PPCM.

[SerenaWelsh]

Congrats on the good numbers!

[agm324]

Do you mind me asking what other study you were referring to?? I met with an OB/GYN on Wed who is willing to look at Dr. Fett's findings. He made an appt. for me to meet with a maternal committee at the hospital. He says he thinks the chances are low of reoccurance and he thinks it is worth a shot, but he wants to study it a little more before helping me make a decision. I cried when he said he just wanted to read it.. my other doc said she would no longer be my doctor! So, the more info I can get.. the better! He is actually taking Dr. Fett's journals on his vacation to read! He was really great! He said he understood the desire for siblings for my only child. He is just a really great person.. so let me know what other studies you found...

Thanks,
Alana

[melissamph]

Congrats and wonderful news for this wonderful Easter weekend!!

[miracle baby]

Congrats and good news.

[sfekke]

Thanks everyone for the support.

Hi Alana, sounds like your doctor is a "diamond in the rough".

Here are two links I have. You have to delve down into them to get to the subsequent pregnancy section.

http://72.14.203.104/search?q=cache:b-mxfi5GoaoJ:www.aapsga.org/ajcm/2004/summer/pdf/ajcm-summer2004-article04.pdf+%22Peripartum+Cardiomyopathy:+A+Case+Report%22&hl=en&gl=us&ct=clnk&cd=1


http://eurheartj.oxfordjournals.org/cgi/reprint/23/10/753


I also had a report from Harvard Medical Journal that recommended telling women who had fully recovered from PPCM that risk of recurrance is minimal, but I think it was based on studies already mentioned above.

Good luck to you.

Sarah

[agm324]

Thank you for the links. I am not really sure what to make of them. One says that four out of six recovered LV functions had reoccurance of symptoms. The other said that you would more than likely live if your LV function normalized, but you could have decreased LV function, not enough to kill you, but you could have decreased LV funciton. It also stated that with decreased LV function you could die over a matter of years. I am just thinking this out in my head. I am nervous as all get out. I am thinking of every angle. I just don't know what to do. My appt with the maternal fetal team is on May 22. I will see what they say. It is just such a hard decision. But then again you see all of the women on this site who did have babies successfully. But do we know about the ones who didn't?? I don't know. Did you go through this thought process.. I sometimes feel crazy!

I am so happy you decided to have another baby.. I am sure all of these questions hit you too.. I am just starting to sift through them. I guess the true question is do you trust God. If I got preg again.. would it be a sign from him.. or did he already send me the adoption sign.. I think he did...but now I am having doults because this doctor is willlling to listen. Ok.. I am crazy.. I wish I could just forget about this topic for one day. I think about it non stop.. I am obsessed!

Ok..my miracle baby is calling.. I hope I didn't ramble too much.. I have no one else who will listen to me.. no one understands!

Alana

[sfekke]

Hi Alana,

What's frustrating about the test results is they're just stats. You don't know what year or if the population pool was skewed in someway, for example did the women have other illnesses contributing to their PPCM.

I haven't seen the studies by Dr. Fett that report about 10%, but I think he's got the most up-to-date info. The study of 44 women showed around a 20% recurrance.

The cardio I got at Miami is a specialist in maternal fetal cardiology and he told me 5 - 20%. You're never going to get an exact number. When I found out I was pregnant I was scared #$%^&less! I pretty much decided to terminate on a Wednesday, had an appt. to do so on Friday, then had an anxiety attack and changed my mind, cancelled the appt. on Thursday. I'm ok with it now and just look forward to the moment when I can actually believe I'm gonna have a baby. I believe if it comes back that it can be managed, and I do not think I'm gonna die.

Do I trust god?:) Absolutely! But I've got no idea of His plan or His will, or even his opinion on abortion. I'm just trying to make the right decisions based on my convictions. I'll tell you the anxiety and stress of all this came around making the decision. Let's say I had a miscarriage. I don't know if I would try this again. For now the decision has been the hardest part. I'm at peace with it now and comforted by my increasing knowledge and the 25mg of Coreg I'm still taking;)

Take care,
Sarah

[agm324]

Sarah,

I totally understand your fear. If you want my 2 cents.. I believe God has a plan for everyone. I believe it was his will for you to get pregnant. I also believe it will be his will for you to have a beautiful healthy baby.. and for you to be there for your family. You see, we did infertility treatments for a year before getting pregnant. I had an exploratory surg and was told I would never have children without invitro. I took a month off of all treatments to thing about the cost of invitro. We decided to do it once.. I called to set up the appt. and I was preg.. the month with no help.. except from above. My daughter had two due dates... the first was the day my sis in law passed away before I ever met her. The second was the day my father in law passed away 4 years ago. So, if I wasn't a believer of miracles and help from above... I am now! We have decided that if we do try to have another baby.. there will be no fertility treatments. If God wants me to have a biological child, then that is what will happen. If he sends me a child through adoption, then that is what should happen. SO... he sent this baby to you for a reason. I am glad you did not terminate the preg. I am a believer in choice... but I am glad you made the choice to keep this miracle. From what I hear and read, the state of your mind and thoughts can play a heavy role in this. So, stay focused and positive. You will be fine. I see you are due in November... it will be a happy time.

It is great talking to you.. I am here.


Alana