Question for Dr. Fett

[KellyDL]

I am new to this board. I am 29 years old and just gave birth to my third child 5 1/2 months ago. I had postpartum pre-clampsia and about a month later started having chest pressure, shortness of breath, palpitations, & discomfort in my throat that comes and goes. They ruled out blood clots. I had chest x-rays and ct scans of my chest done, both normal. No fluid or masses or anything. I've had stress tests with pictures, holter moniter, blood work,and numerous EKG's. The only thing showing was an inverted t-wave. I had an echo done that did reveal a small amount of fluid around my heart and an EF of 52%. No enlargement of the heart. At first, the cardiologist said this was not heart related. The first echo was done in June, then in September he did a second one. The EF was 50%, no enlargement. I am still having symptoms. I don't feel I'm getting direct answers. One cardiologist has said that I do not have PPCM. Now the other is saying he thinks that I may have a mild case but doesn't plan to treat it because he thinks I'll heal on my own. Does this mean I'm not in that normal dreadful prognosis? What is the criteria for PPCM? Do you think that I meet it? I do plan to see yet another cardiologist to get another opinion. I would like your insight. When can I stop looking at my children and feeling like crying?Please just be straight with me. Thank You for your time.

[JAMESFETT]

See my comments on the other side too. You have an excellent prognosis. These days, even severe PPCM patients have a 95 + percentage for survival and in excess of 50 percent for full recovery. From what you have told me, you do not meet the criteria of PPCM diagnosis:

1)new onset heart failure in last month of pregnancy up to 5 months postpartum
2)no other explanation for heart failure
3)echo with systolic dysfunction, EF less than 45 percent.

You can be very optimistic, you have a wonderful prognosis.

JD

[KellyDL]

Please excuse my ignorance on this subject, this is all new to me. You had mentioned something about my blood BNP? I'm not really sure what that is. Maybe if you could explain it to me I could ask the cardiologist. Also, if you don't think that I meet the criteria for PPCM, where does that leave me? I do know that my heart is slightly weak after giving birth. What they can't figure out is why I'm having these symptoms when I have no fluid on my lungs and my EF is 50-52%. Do you think that they should be medicating me? We live in a very small town and I'm just not sure that I trust the dr's here. The cardiologist that I saw in a nereby city that is known for their heart treatment told me that I did not have this and wasn't even going to bring me back for another check-up! He basically said this happens sometimes in pregnancy and he didn't see anything major on my echo or elswhere. I've got 2 extremes. I'm going to see another cardiologist on the 7th. You said prognosis is good, but I keep reading some awful things. Can you just have a weakend heart from pregnancy that doesn't necessarily fall into the PPCM category? Should there be good prognosis for this also? Would this cause my symptoms?

[Delores]

Kelly. I can see that you are really scared over this, and I don't blame you. I went through the same thing with an EF of 50-55% From what I understand this is an auto immune response. If this is the case then you will get better day by day because the baby is no longer an issue. Your body is probably very tired and stressed out after a third pregnancy. You will start to feel better as your body heals. I did have some moderate enlargement and fluid retention, which was mild compared to what some of these other women have suffered. Now any heart failure is scary, but fortunately, our recovery time and end results may come more quickly. We also do not need to be on the "big" heart drugs for recovery. Your body is a magnificent machine that really wants to work for you. Give yourself time to heal. If you become symptomatic - fluid buildup, dizziness, extreme fatigue, head back to the doctor. However, be wary of imagined symptoms. I did plenty of this 'imagining' myself. It is sooo terrible to even think that you won't be around to take care of your kids. However, you have been very proactive in your care, and you should feel comfortable that with your numbers, and physcial health, you are well on your way to recovery. It sounds as if your shortness of breath may be a part of your being anxious over this health scare. I have the exact same thing. I really have to concentrate on calming myself at times. If your anxiety persists talk with your doctor about an anti-anxiety med. I take Prozac for my anxiety as well as having Clonazapam for acute moments of panic. The best advice I ever got was to put it in your doctor's hands, and then really, put it in God's hands. Prayer does help. I wish you the best. Remember to rest your mind and body. They go hand in hand in returning you to you.

[Delores]

My doctors didn't take a bnp either. I called and asked. They didn't think it was necessary. Evidently, the number can indicate the severity of the heart failure one experiences. :)

[JAMESFETT]

What will help you the most is to find a cardiologist you trust and work out your plan with him/her. A normal pregnancy does not weaken the heart. The heart adjusts to increased demands of pregnancy, and in a normal pregnancy there is no decrease in EF, in fact a slight increase (around 3 percent). Clinical symptoms do not follow a neat pattern according to EF, there is great individual variation. Only your personal cardiologist can really sort this out for you. Doctors are still getting used to utilizing the relatively new tool of blood B-type natriuretic peptide (BNP). It is a hormone that is secreted in response to a failing left ventricle, and may be elevated long before clinical symptoms. In a person with shortness of breath (not anxiety hyperventilation) with or without exertion it is helpful to sort out lung problems from heart problems, and it is helpful in following progress of persons with known heart failure so far as response to treatment and relapse. Mild decreases in left ventricular systolic function (such as EF 50 to 55) may be due to other conditions, since there are many different causes of dilated cardiomyopathy, including familial dilated cardiomyopathy. Sometimes only time sorts these things out. Best to you.

JD