Question about recovery

[LORIH]

Dear Mr. Fett,

I am a daily reader of this website but dont post often. I am very frustrated and I am just looking for a second opinion. I was diagnosed in April of 2006, 1 day after delivery. My BNP at that time was 6600, the highest I have seen on this site. My Ef was 40%. In September of 2006 my EF was up to 55% according to a stress test and my BNP was down to 53. I also have left bundle branch block as a result of the cardiomyapathy. Everything else according to echo and stress test were normal.

Although I am trying to rejoice in the numbers, I still dont feel good. I am unable to go to the mall or to a store without feeling sob and dizzy and lightheaded. I also still have a hard time going up stairs.

I also feel absolutely horrible in the morning, very short of breath and lightheaded. My BP in the morning is always low around 95/60, heart rate is usually around 70-80. I always feel alitlle better after taking my medicine but it usually takes me about three hours to start feeling a little better.

My meds are 6.125mg Coreg, 10mg Lisinporil, 10mg Torsemide, (?)Spironoctolane, daily aspirin.

I am so confused and frustrated that ny numbers look better but I don' feel better. My Doc mentioned that people with good EF can still have heart failure? That does not make any sense to me and I don't understand.

I would appreciate any advice that you can give me.

[tammer]

Have no fear...you will feel better. I had an EF of 15% on dx. I could not walk even the length of 3 houses on my street, I was also sob, and dizzy. My bnp was 7000+. You are still only in the recovery stage and you need to realize what a major hit your body jusy took. Not to mention the fact you just had a baby...also a major hit on the body.

I found Coreg to be a real nuisance at the beginning, it truly made me feel horrible and exhausted most of the day. Eventually the body adjusts..I am now on 50mg 2x/day so let me tell you I have spent alot of the past 18 months feeling like crap.

You WILL start to feel better when you adjust to your meds. My bp is always low like yours which does not help with the dizziness and lightheadedness. Just hang in there, I promise you will start to feel better. Congrats on the EF of 55, that is fantastic and I am insanely jealous.
Just give it some time, you will feel more like your old self soon. Tammy

[JAMESFETT]

I agree that you should feel better with the numbers you mention. Bear in mind that symptoms of heart failure do not follow in a straight line with the level of EF, and it works both ways sometimes with low EF no symptoms, higher EF more symptoms; but you certainly do not have systolic heart failure any longer sine your EF is 55 percent. So there must be other explanations for your symptoms. I think it would be good to review the other numbers with your physician, such as pulmonary artery pressures, right atrial and ventricular sizes, and diastolic dysfunction (indicators can be found on echo report). Did you ever have a pulmonary embolus? Do you have any pulmonary or respiratory conditions? I do wonder why you are still on spironolactone, and is your serum potassium normal? Also, do you have the chemical or generic name for Torsemide, and why are you taking that? I'm not worried about your BP, that's perfectly normal in a young person.

James

[JAMESFETT]

Also:

Are you anemic? Is your Hemoglobin <11 gm? or your Hematocrit <30 %?
Is your thyroid function normal (TSH blood test)?
Are you on a conditioning program with progressive aerobic exercises?

JDF

[LORIH]

Dr Fett,

I am reviewing my last stress test doen in September, I have not not had an echo since July and I have one scheduled for March. The Echo resukts read as follows:

Normal myocardial perfusion with no evidence of ischemia or infarct. Gated studes revealed normal left ventricular systolic function with ejecyion fraction estimated at 57%

I was not put on the spironoctolane until July because I was still SOB and had a hard time filling my lungs with air. I was not put on the Torsemide until November, because at that time still had the same problem, and sometimes have a hard time catching my breath when I lay down. My understanding is that Torsemide is a diuretic, although I have not heard of anyone else taking it on this site.

I did have a blood test in September for the following;Calcium, Thyroxine, bun, glucose, tsh, t3 uptake, Creantinine, and Electrolytes ( I am reading from the bill) all of these came back normal.

My cardiologist said I am one of those patients that he wonders about at night when he sleeps because he cant figure it out.

Again, I know that you are not here to offer diagnosis, just advice is all I am looking for as to what steps I should be taking.

P.S.I am not excersising because I just get to tired and short of breath. I have asked for Cardiac Rehab and he says that I do not need it. I guess because of my high ef.

Thanks so Much
Lori

[LORIH]

Tammy,

Thanks for the words of encouragement, I hate to whine because my numbers look so good. It is just so frustrating when you dont feel good, especially with children and a full time job!

Thanks again, I appreciate it so much!

Lori

[LORIH]

[QUOTE=JAMESFETT]Also:

Dr Fett,

I have also noticed one thing recently and that is that I have been getting a lot of sores on my toes that last several months. Sone of them look like blood blisters, other times just a red sore, or sometimes the skin on my toes is just red and sensitive. I am not doing anything, or wearing anything different. Does that have anything to do with any of this?

Lori

[JAMESFETT]

The results you report are good. That just means that there is something else that is not among those reports that still needs explaining. These are the things I would ask your doctors about:

-what is my hemoglobin (?above 11 gm) or hematocrit (?above 30)?
-what is my pulmonary artery pressure, right ventricular size and pressure?
-have I ever had a pulmonary embolus? Is a part of my lung not functioning normally?
-do I have any diastolic heart dysfunction?
-what is my sedimentation rate and hsCRP? (looking for evidence of inflammation and/or arteritis/connective tissue disease)
-is my anti-nuclear antibody (ANA) screen normal? (thinking of your skin lesions on toes)
-are my blood proteins, globulins, normal? any cryoglobulins?

James

[LORIH]

Thanks so much for your advice. I will keep you posted as to the outcome.

Do you not think that I should be on both of the diuretics?

Thanks again

[JAMESFETT]

The Torsemide (chemical, torasemide) is a loop diuretic, a kind of successor to furosemide, and may have some effects in addition similar to spironolactone (Aldactone)--for that reason one would want to be doubly sure that the serum potassium is not too high. If thinking only of systolic heart function and EF of 57 percent, then I think neither diuretic is any longer necessary. Your doctor has all your information, and may be using them for other indications of which I am not aware. So it is something to work out with your doctor.

James