Dr Fett I have a few questions....

[ibvalerie]

Sorry I am still working on this

[ibvalerie]

Ok my kids need me so I had to run! So sorry. Here they are

First While having a pacer replaced in 2000, (7weeks post pardum) I deleloped pericarditis. I had 2 echos watching the pericarditis. I was never told anything other then the peri is going to be subsiding you should start to feel better soon. It took me a long time to feel better, somewhere around 9m. I left the care of this DR, because she kept cancelling my apts, or not showing up for them at all.
Then I became pregnant in 2003, with Nathan, my PPCM pregnancy. I had my pacer checked in 2003, and all was fine with the PACER. So at 35 weeks I was put in the hospital, and it was discovered them I had PPCM and my EF was 10. By the time I left the hospital I was at 15 EF. Then after my new BI-V-pacer/icd, I am now at 30-35.

I requested my records and after many failed attemts to get them from the DR I requested and recieved them from the Hospital I had that pacer (2000) placed in. It those records it said my EF was at 40-50 at 8 weeks post pardum, 1 week after the new pacer was placed. (this is the echo that showed the pericarditis) The report said "normal left ventricular size, thickness. In the conclusions it went on to say wall motion abnormalities consistent with ischemia and or infarction versus cardiomyopathy." (Which was later proved incorrect because I had a angio gram 12-04, to rule out and blocks, but all that could be found was the cardiomyopathy, and poor EF)

Then a week later I had another echo done 10-00 (by the same tech, and Dr read them) and it said my EF was 35-40. Then I was told at that time to come back in 3m. which I didnt because the Dr cancelled, then the next time she didnt show up. So I never went back!

I was not on any meds, till Nathan (6-04) PPCM.

My Question is do you think I could have had PPCM that went unDX?

I am starting to think I should have been told something is showing with your echo and we want to watch you. I was never told anything about my EF, or being on the low side.

My new cardio who DX the PPCM, has now said he thinks I may have idopathic cardiomyopathy? He said that the lower EF in 2000, is from having a pacer for so long. He said he believed this because I wasnt post pardum, which I reminded him I was infact post pardum at that time. All he said was OH? And now it says in my records is PPCM/ idopathic?(I had a echo in the mid 1990's and they said everything was normal) But normal I am not sure what that means anymore.

Then I was at a DR at UCLA who runs the CHF- transplant clinic, and she said that PPCM was just a kind of cardiomyopathy that is noticed in pregnancy, and is treated the same way, as normal cardiomyopathy. Is this true?

Sorry this is so long.........

Valerie
Confused and feeling yucky today.

[JAMESFETT]

Valerie, your medical history is truly fascinating, and it is not easy to reach conclusions regarding your questions. Here is how I sort out your situation:

1)your pericarditis at 7 wks postpartum in 2000 may have been a part of myocarditis/pericarditis/cardiomyopathy (PPCM maybe since you were 7 or 8 weeks postpartum). Your EF 40-50 at 8 weeks postpartum in 2000 is compatible with either PPCM or IDCM or post-viral myocarditis/pericarditis.

2)You may have started your 2003 pregnancy with cardiomyopathy, EF unknown at start of pregancy, and during the pregnancy your EF dropped to 10, which represents a relapse of heart failure.

3)You do not have coronary artery disease. You do have a cardiomyopathy which could be post-viral myocarditis/pericarditis or PPCM or IDCM (or all 3 because they well may be the same entity.)

4)Your present EF of 30-35 means that you have not yet recovered. What medications are you taking? I assume you have no family history of familial dilated cardiomyopathy. If that is the case, your present cardiomyopathy, whether IDCM or PPCM has the potential for additional healing. Have you recently had the test for left ventricular failure, called plasma B-type Natriuretic Peptide? If so, was the level normal? Have you recently had a test for inflammation, called plasma high sensitivity-C-Reactive Protein? If so what is the level?

The UCLA doctor may be right, but we don't know that yet. Uri Elkayam, cardiologist, is located at UCLA, and has done some nice work on patients with PPCM who have had subsequent pregnancies. He has a couple of reports, one in 2000 (New England Journal of Medicine) and one in 2005 (Circulation).

James

[ibvalerie]

Dr. Fett~

1. My pericarditis in 2000 was from inflamation. I didnt recieve and antibiotics, so at least that is what I assuming. (My records show inflamation too) I also dev. pericarditis in March when the new one was placed too.

2. Now that I look back I think I was having some symtoms of heart failure right about the time, I became pregnant. Swelling, the cough, and trouble sleeping. Once i found out I was pregnant I dismissed them as pregnancy issues.

3. At this point nothing would surprise me! :)

4.I am taking Coreg 25 mg 2x daily, Aldactone 50mg 1x daily, Warfarin 10 mg, lotensin 40mg 1x, Mag 64 2x daily, and Lasix 40mg 1x daily. You are right no family history at all. (My 91 yo grandpa has had a triple bi pass, but he was 88 at the time) I have not had those tests. But I will ask my Dr when I see him next week.

Well at least I am not boring!! LOL

Thank you again~

Valerie Hanson

[ibvalerie]

I have had the BNP test, sorry I have never heard its whole name before. Silly me. I believe it was 500+ last time it was taken, could that be right? Is it a "bad" number?

I dont think I have had the other test...but I will ask

[JAMESFETT]

Depending upon your lab's range of normal, 500 for the BNP could be on the high side. If it was done when you were in heart failure that is understandable it would be high. It is helpful to do periodically because it may indicate early failure not manifest in usual clinical symptoms.

Pericarditis is a form of inflammation. But PPCM is also a form of inflammation. Pericarditis can be from a viral or autoimmune cause and other less frequent causes. You are assuming it is due to placement of the pacer, and you may be right. It may also be seen with PPCM,--in addition to the inflammation of the heart muscle, called myocarditis-- but that is not common. Usually antibiotics are not helpful or indicated in pericarditis because most causes are not bacterial, for which antibiotics are indicated. What I am saying is that your pericarditis in 2000, when you were postpartum, does not exclude PPCM.

You are on good medications. Many times at your stage the lasix dose can be titrated according to AM weights, reflecting fluid loads. I assume your blood potassium is normal. The 50 mg dose aldactone makes periodic checks of potassium important because that medication blocks potassium loss, compared to lasix that increases potassium loss, and you don't want either high or low levels. I'm sure your doctor has his/her eyes on that.

You definitely are not boring! Pardon me for expressing interest, but your story excites me because it seems to lend support to several of the points I keep trying to make about PPCM:
1)PPCM can be, and sometimes is, unrecognized (which makes a subsequent pregnancy more hazardous, to say nothing of long-term heart function even without pregnancy).
2)IDCM and PPCM and post-viral DCM may all be variants of the same disease.
3)Healing in PPCM may take much longer than the first 6 months, so one should remain hopeful even in the 2nd, 3rd, and 4th years post diagnosis--maybe longer.
4)Early treatment of PPCM with effective medications (beta-blockers and ACE-inhibitors) translate into quicker and more complete healing of the heart, and is essential to end the process that causes PPCM.


James

[ibvalerie]

Any advice, and help I receive on understanding this disease, is wonderful!

I am happy to help in anyway for you or anyone else to learn more. I am a open book! :)


-Valerie Hanson

[melissamph]

Here is what I know about a BnP. Also what needs to be mentioned that isn't in this article is that the doctor takes into acct.meds and symptoms and such before interpretting the test value. Also be aware of what value is being used (Unit) to measure. Not all are the same and the values can be wildly different. Melissa


(BNP) Test

Test Overview

Brain natriuretic peptide (BNP), or B-type natriuretic peptide, is a hormone produced by the heart. A BNP test measures the amount of this hormone in a sample of blood. Normally, only low levels of BNP are found in the blood. However, if the workload of the heart increases, such as from heart failure, the heart releases additional BNP.

The level of BNP in the blood rises when heart failure is present or gets worse and drops when heart failure is successfully treated.

This test is done on a sample of blood taken from a vein.

Why It Is Done

The brain natriuretic peptide (BNP) test is used to:

Diagnose heart failure, especially when symptoms, such as difficulty breathing and swelling in the extremities (edema), are present.
Determine the severity of heart failure.
Monitor the effectiveness of treatment for heart failure.
This test is not done routinely because a physical examination and other tests also can provide information about the condition of the heart.

How To Prepare

You may be instructed to avoid eating or drinking anything except water for 8 to 12 hours before having a brain natriuretic peptide (BNP) test.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, or how it will be done. Complete the medical test information form to help you understand the importance of the test.

Results

Normal values of brain natriuretic peptide (BNP) vary widely among labs and methods used.

Brain natriuretic peptide Normal: 0–99 picograms per milliliter (pg/mL)

Abnormal: 80–100 pg/mL indicates possible heart failure

100 pg/mL or greater indicates heart failure


Greater-than-normal values

An abnormally high level of BNP in the blood:

Indicates the presence and severity of heart failure. The severity of heart failure increases with the level of BNP.
Indicates an increased risk of death in people with heart failure.
May indicate early heart failure in people on kidney dialysis.
What Affects the Test

People who have advanced kidney disease or who are on kidney dialysis may have higher-than-normal levels of brain natriuretic peptide (BNP).
Certain heart medications, such as cardiac glycosides and diuretics, can affect test results.
BNP may be elevated when a person has a heart attack.
Rough handling, contamination, or inadequate refrigeration of the blood sample can cause inaccurate test results.

[ibvalerie]

Thank you Melissa, that was interesting.

_Valerie