Dr. Fett, A question please

[TwinMommie]

I posted this on the PG board, but I wanted to ask you personally.



I just have a small question to ask you all I am almost seven weeks and I have been getting some dizzy spells and some heart racing here and there sometimes with a overall feeling of feeling crappy, and I was wondering since I do not rememeber when I was pregnant with the twins if I had this, is it normal? I know fatigue and dizziness can be normal, which I am very much tired, but I am just curious if your heart will race once in a while to since it is working harder. I guess considering my EF (45) is not exactly normal I am nervous I am presenting early symptoms of a possible problem.
My Dr. Doesn't know to much about Subsequent PG after PPCM, so I figured I woud ask you, do you think I am presenting and issue aready?

Aso is there any suggestions you coud offer my Dr, of how things shoud be handled, like how many echos or what to check or what while pg and even after. I mean he is a great cardio, but he hasn't had a patient who has gotten pregnant after I am his 1st!

Thank you so much in advance!

[JAMESFETT]

Chelle, if I can be a resource that might help in any way either you or your doctor, I am certainly available. Most doctors don't like to receive counsel/info over the internet from a physician they don't know, but perhaps there would be interest in looking at some of the scientific journals and articles we have published (or perhaps they have already done so). Abstracts of those articles via Entrez PubMed, search under either "ppcm" or "fett jd" I am available as a consultant and there is no fee associated, my contact info is contained on this site.

I am concerned about the symptoms you report and your current pregnancy with last known EF of 45 percent. Here are things that I think would be helpful to know about you:

1)what is your up-to-date echo EF and size of left ventricle?
2)Are you experiencing heart rhythm problems? Is a Holter monitor indicated?
3)Are you anemic, or is your hemoglobin/hematocrit normal?
4)What is your current, up-to-date serum BNP?
5)What is your current, up-to-date serum hsCRP?
6)Are you on any medications?

The above tests will indicate if any treatment is necessary. Be assured that a lot of treatments are available for PPCM moms with a subsequent pregnancy should treatment be indicated. And the treatment is very effective to help bring mom and baby safely through the pregnancy. Best regards,

James

[TwinMommie]

Thanks Dr Fett,
On Feb 1st I got my echo which indicated 45-50% EF...I was not told what my ventrice is doing I am sure it didn't show enargement, he did say overall from when I was first seen I have made great strides. I have not had those blood tests but I will request them. I am currently not on any medications, After I lost my weight the coreg at a small dose made my BP and HR Very low...So I was taken off. I don't get this dizziness all the time and it is not consistant, seems more when I am very exhausted I get it, the racing feeling only happened yesterday. I have never presenting rythm issues, A year ago I was on an extended moniter that showed no rythm issues. But As I tod my Dr if need be I will wear one my whole PG. As far as I know I a not enimic, I take Iron daily as well as my prenatals, cacium and B12 injections 1x a month

He did call a heart failure specialist from University of Penn Dr B I am not sure of her whole name. She felt that because I did show that I can make a recovery and that I was feeling good my chances are good, there is a higher risk of relapse for me because I am not fully recovered, but she said she felt the death percentage for me was low...Both she and my dr said that I will be kept a close eye on and if symptoms present itself medication action will follow

I will contact my Cardio tomorrow and give him your info so you and he can tak, I am more intrested in being heathy that someones issues with someone giving advice! I would like to carry this baby, for this was a true miracle to my husband and I since this baby happened w/o medical intervention, I will be having my tubes tied after this. Do you think I can do this? I am willing to risk a weaker heart, but not death, my children that I have mean the world to me

[JAMESFETT]

Thank you for that information. Your doctors are on the right track, that is for sure. It may be that your EF of 45-50 is your stable level post PPCM. As you stated, your risks for relapse are higher than someone who has recovered to EF over 50. In that case it is important to monitor even closer:

Is your current BNP normal? That would be reassuring
Is your current hsCRP below 10 mg/liter? That would be reassuring.

If the above two are abnormal, then earlier intervention (treatment) would be indicated. Relapse of PPCM in a subsequent pregnancy is treatable with diuretics, beta-blocker, and hydralazine/nitrate. Such treatment with one, two or all three of those is very effective. Periodic echos will help to know if or when such treatment is needed. From what you have indicated, I believe your doctors are right on track and will take very good care of you.

James