Congestive Heart Failure

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Nancy

Well-known member
Joined
Jun 9, 2001
Messages
9,896
Location
upstate New York
Just wanted to start this thread because it's such an important subject and so many folks have it in one degree or another.

Joe's had CHF for many years. There are four stages to CHF, Stage I being the least serious, and Stage IV being the most serious.

Joe's been in all stages of this condition. It's something he will always have, and it is something that ebbs and flows, depending on many things.

Last year at this time, he almost lost his life to Stage IV CHF. He was very close to some kind of systemic shutdown, and was starting to slip into a coma. He ended up in kidney failure, severe liver and spleen congestion, ascites, lung congestion, edema in his extremities, severe anemia, severe pulmonary hypertension and his Troponin (heart enzymes) levels were elevated. He could do nothing but sit on the sofa. He couldn't breathe lying down and could hardly walk from one room to another.

I got him to a specialist in CHF and PH, and he spent a month in the hospital, straightening out all of these serious problems. The regimen the cardiologist put him on worked, and this past year has been a huge period of healing for Joe. He is feeling much better now. He still has serious disability from many heart and lung problems, but is now able to do many things that he wasn't able to do before, and the most important thing is that he's alive. Last year at this time, neither of us thought he would survive.

His diet is very strict and he cannot eat sodium at all. It's almost impossible to eliminate all sodium because some things just have it naturally, but I've made a very concerted effort to cook everything from scratch, including bread and other baked goods, I soak any seafood to eliminate sodium as much as possible, and I even soak chicken because that can contain injected sodium. He cannot drink milk because it contains so much sodium. So Joe has made great sacrifices, but the results are worth the effort.

His oxygen levels are normal in room air, and he doesn't need oxygen.

He takes Lasix (and K-Dur) each day, twice a day. He weighs himself each morning w/o clothing before eating, and it's recorded in a book along with his temp. If he gains 3 pounds in a day or 5 pounds in a couple of days, he goes to the next level of diuretics. If that doesn't work sufficiently, we call his cardiologist for further instructions. It's a great balancing act keeping his heart healthy and keeping his kidneys from going into failure from too much diuresis.

It's not something that will ever go away, but it is something that can be controlled, at least for now.
 
Thanks for sharing, Nancy. I see now how the condition can change quickly, and varies in intensity. What are the stages? I'm sure I've seen a link before but can't locate it.

What is Joe made of? What a will to live. You both are an inspiration to all of us.

Warm regards,
Kim
 
Here are some links about CHF:

http://www.chfpatients.com/index.html
Very comprehensive. A site put together by a man who has CHF. Written in an understandable way.

http://www.americanheart.org/presenter.jhtml?identifier=1486

http://heartdisease.about.com/cs/heartfailure/a/CHF1.htm

Like a lot of other people on this site with severe heart and sometimes lung problems, it's hard to define how a person can survive these things and others cannot. I can only speak for Joe and I guess for myself, because I am his caregiver.

He was a fantastic athlete in his younger years. His body benefitted from this, even though he had these medical problems, although early on, he was in very good health considering his rheumatic fever. He has a strong will to live, and he doesn't care what kinds of treatments he has to endure, and there have been some doozies. Pain doesn't bother him too much. He's very disciplined about taking his meds, and is willing to adjust his lifestyle to accommodate his conditions. His attitude is pretty darned good with all he has to endure, and keeps his sense of humor.

I am very careful with his health, and will not let things slide too far without a call to the doctor. I am also VERY proactive with his care. I didn't use to be that way, but have developed this over the years. I have also made it my business to research everything that he has. I am willing to help him maintain his health by cooking nutritious meals, and checking him every day for any potential problems.

Joe has been so fortunate that he has had the care of brilliant doctors.

We are not much different than other people in this situation. You just learn as you go along. Some of the lessons are brutal.
 
I have DCM/CHF.

DCM is "dilated cardiomyopathy," the most common kind of cardiomyopathy, according to what I've read.

In my case it is "ideopathic," which, as far as I have been able to find out, means the doctors haven't a clue as to why I have it. I had only one of the risk factors: high blood pressure, for which I'd been taking medication for about 18 months. I had no weight problem, didn't have high cholesterol, never abused alcohol or drugs, don't smoke; my arteries (per the cath cardio) are "pristine." I was pretty much asymptomatic at the time of the diagnosis.

All this came out of the blue: I went to see my primary physician mainly because I was having trouble sleeping after my mom died this summer. Hmmmm .... you have a murmur, sez he. He referred me for an EKG and an echo. On a return visit he said: the echo shows you have mitral regurgitation. What the heck is THAT, sez I. Had never even heard of a "mitral valve" before. (Alas, I now know more than I could possibly want to know about heart valves.) After that it was on to the cardiologist's office.

I wasn't too worried. I guess I had assumed that mitral regurgitation was one of those things -- something that modern medicine could surely "fix." So I was pretty stunned when the cardio said: You have congestive heart failure. Moi? I HAD heard of congestive heart failure: it was on my father's death certificate -- but he died at 96. It still seems unreal -- especially since I am still mostly asymptomatic.

I seem to be in Stage 1 according to the NYHA CHF classification, which is based on symptoms -- although my EF (30-35 according to an echo in October; 29 according to the cath doctor) is pretty low.

I'm still unclear about the relationship between the mitral regurgitation and the CHF. In addition to the mitral regurgitation -- which is at 3+ according to the cath doctor -- I have "systolic dysfunction of the left ventricle," described as "moderate to severe." Nobody seems to know which came first -- whether the MR caused the LV damage or whether the MR is "secondary" to the LV dysfunction. "Chicken and egg," they say. And at this point it really does not matter, because the damage is done.

At this point all I am taking in the way of meds is a beta blocker, coreg (aka carvedilol) and an ARB, cozaar. (They tried me on an ACE inhibitor, lisinopril, but I developed a truly horrendous cough, a common side-effect of ACE inhibitors.) I am being titrated up to the top dose of the coreg and am being carefully monitored -- I take my blood pressure and heart rate and weigh myself daily, and call in every day to report any symptoms to a Heart Failure Management Program. So far, no swelling, no weight gain, no breathing problems, so I am not on diuretics.

My surgeon does not want to wait around and see if my EF goes up in response to the meds. Some people's EF goes up on coreg; some people, however, do not. The damage to the LV that I already have is bad enough, in terms of complicating the surgery and adding to the risks.

The bottom line, apparently, is that mitral valve surgery (repair if my surgeon's confidence is not misplaced) will prevent further damage from that source and thus relieve some of the pressure on my poor old heart muscle.

I know, however, that the surgery, even if completely successful, will not "CURE" the CHF. I'll always have that.
I will have to continue on my CHF medications and follow the heart failure guidelines (low salt diet -- not "no salt," at least not at this point! -- exercise, etc.) for the rest of my life. I don't know how the disease will progress, or how fast. However, I do hope to delay the onset of the really bad symptoms. I want to live as full a life as possible as long as possible. (And travel again -- I want to go back to Paris in the not too distant future -- !!!)
 
Incidentally -- if anyone here has had experience of something similar to my particular combination of problems (CHF with systolic dysfunction of left ventricle AND mitral regurgitation) and has had valve surgery to correct the regurgitation -- I'd be really grateful to know whether or not your surgery did improve your left ventricle function, and, if so, in what way.
 
Thank you for the link to the article, Nancy.

Yes, I have read SO MANY articles about mitral regurgitation in the last few months! -- including that Merck on, which was already in my bookmarks, as a matter of fact. I think I now understand the process quite well.

What none of the articles have really told me is what effect the surgery will have on the LV function. Or the talk in general terms.

For instance, the Merck article says:

<<However, in people with moderate regurgitation, surgery increases the chance of a good outcome and reduces the risk of worsening heart failure.

If regurgitation is severe, surgery is needed. Surgery must be performed before the left ventricle becomes so abnormal that the problem cannot be corrected. >>

So, yes, I DO know I have to have the surgery. I also know (because my surgeon has told me) that the risk of not surviving the surgery goes up from five per cent (the average) to seven per cent (the average for folks with my level of LV dysfunction). Although he hastened to add, "That is the average, not the risk at this hospital, or with me."

I have been told that I have both "severe" mitral regurgitation and "severe" LV dysfunction. (The cath cardio wrote "moderate to severe," but when the surgeon looked at that, he laughed and said, "Some people don't like to come right out and say what needs to be said.")

What I haven't been able to find out is what happens to people with my level of LV damage, after mitral valve surgery (even assuming the operation is a technically successful one).

A number of the articles seem to suggest that if you have "severe" LV dysfunction, the prognosis after surgery is not particularly good -- not markedly different than among people who didn't have the surgery, as a matter of fact -- even though the regurgitation has been arrested.

My impression is that these articles may be based on OLD data, which is why I'd like to hear from people who may have had my combination of problems and who have had the surgery recently.

And, yes, I will bring these issues up with my doctors too, but input from people who've actually been there is really really helpful & much appreciated.
 
Unfortunately there aren't a lot of absolutes. Some people's hearts remodel well after surgery, and things return to almost normal, some people's do not. My husband's did not return to normal after his mitral surgery in 1999, and the redo in 2001. However, he was very ill prior to surgery, both times. He did feel much better after surgery, but his heart will never be normal. Perhaps if he had had the surgery earlier it would have been different. But how could anyone predict that. It is so terribly complicated. Every body system is involved from soup to nuts, plus overall physical condition plays a big part. All of the damage that goes on inside a body from a heart that isn't pumping properly would be impossible to figure out.

It's safe to say that without having had those surgeries, plus Joe's aortic surgery, and his two lung surgeries, he wouldn't be here. That's the only absolute that I can say for Joe.

That's why so many people here urge others to get things done before it goes too far. Waiting to see what happens can sometimes be permanently detrimental to the heart.

Getting his CHF and Pulmonary Hypertension under control was one of the MOST important things in his post-surgery phase. That really saved his life. We are awaiting the results of his echocardiogram which was recently done. That will show me if there is any improvement in his heart function a year after his hospitalization, and rearranging medications.

So it's really a combination of surgery and medicine that will give most people the best results.

What are your doctors answers to the questions?
 
Hi Nancy, just in case you haven't found this book yet, I thought I'd mention it to you..."the No-Salt, Lowest - Sodium Cookbook by Donald A. Gazzaniga. It is full of recipes to keep your total daily sodium intake at below 400mg ....very difficult but it sounds like you are already doing that.

In terms of eating out, he makes the same suggestions others already did on your query about how to eat out low sodium style...but adds that he brings his own homemade roll to fast food places and orders a hamburger "dry" (with lettuce and tomato) and slips it into his own roll...he estimates about 40mg. of sodium.

Have a very Happy New Year!
 
Hi Nan-

My daughter gave me a copy as a gift. I should have looked in there for dining out ideas. Are you no salt also?

Got any ideas for accommodating restaurants in Albany? Nice places.
 
Hi Nancy, glad you have that book!!!

As I am a vegetarian, it complicates my low salt eating..... when we are out, I usually stick with salads with oil and vinegar (try to keep greens at same level every day), or pasta with olive oil and garlic.... or a veggie plate (but Gazzaniga warns about food prep with veggies sometimes including baking soda) not a heck of a lot of choices....almost any good restaurant in Albany can usually handle that! We have gone to places like The Olive Garden, Ruby Tuesday's (salad bar) and Pizzeria Uno (I have managed their veggie burger without a problem, also salad bar). Sorry I don't have too much more info. I think Joe has to be more careful than I do.

My CHF is under much better control now, I think it was the Avandia that I was on for diabetes that pushed me over the edge.

Good luck and I am so glad that you and Joe are dining out! That is great!
 
Nancy,

Pointing out the different stages is important. "Heart Failure"sounds terrible, but we all have it on this site. Obviously, the heart does not stop working. It just means that the heart is pumping weaker than normal.
I just had a Stress Echo completed and my valve is doing great, but it appears my LV is abnormal. The walls have thicken and my doctor has put me on Altace. While this was not what I wanted to hear. I believe by taking my meds, diet and excerising it shouldn't get any worse (it may even reverse the damage) So, it is important has you have pointed out...do what you need to and it means changing your life style....so be it.
 
CHF Classifications

CHF Classifications

Here are the CHF Classifications:

They're called Classes here, but I have also seen them called stages.

"New York Heart Association (NYHA) Classification:

A functional and therapeutic classification for prescription of physical activity for cardiac patients.

Class I: patients with no limitation of activities; they suffer no symptoms from ordinary activities.

Class II: patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion.

Class III: patients with marked limitation of activity; they are comfortable only at rest.

Class IV: patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest."
 
I did some reseach on cardiomyopathy when my cardio did an echo to look for it. My understanding is that this does not reverse. Luckily, I didn't have it.

I am very interested in what my prognosis is now, after valve replacement. I will see the surgeon this week and plan on asking him how the rest of my heart looked, assuming they can tell by looking. My old cardio told me that I would die fairly young, maybe from emphezema, because of damage to the lungs. But if my heart is working good now with the new valve, and my left atrium should reduce in size with time, and there was no damage to the rest of my heart, should'nt I have a good chance of living a long life, free of CHF? I would guess I was Class 3 before surgery.

Marcia
MVR
 
Gee whiz, Marcia-

I hate those kinds of predictions, that maybe you'll die young from this or that.

Joe was supposed to die at 50, according to his old, old cardiologist who diagnosed his murmur. He told Joe to "live it up" because he wouldn't live long. Joe liked the "live it up" part. Well, he 72 now, and he's got more bad things wrong with him than I can remember, including lung problems too. I just did his medication list and it's over 14 drugs now.

Live your life, enjoy things, take good care of your health, go early rather than later to get medical things straightened out, and make sure you have very, very good doctors taking care of you. Make the necessary adjustments to your lifestyle.

There are many new drugs being developed right now that will make things a whole lot easier for heart patients.

And stay away from fortune teller doctors with crystal balls.
 
What Does This Mean?

What Does This Mean?

Hi Nancy,

I saw your post on classifications of CHF, and was wondering which one I really fit into...I went for a walk today, 1.2 miles round trip, and by the time I got 1/2 way, I was having chest pain, huffing and puffing, and my chest was feeling pressure and just generally uncomfortable. I have also been having really bad dizzy spells from time to time (none today though). What would your thoughts be on which level of CHF I might be at? Thanks for the help in advance, Harrybaby666:D :D :D
 
It's hard to tell, Harry, because some of the things you mention could come from the valve problem itself, or from other things. I guess you would have to find out if you were having a bout of CHF at the time. It comes and goes. But if you are still able to exercise, you aren't in Class IV, that's for sure.

The best thing to do is to call your card. if you are feeling symptoms, and let him/her take a listen and check you out.

Take care,
 
I think that I may have been unclear in a previous post.

When I asked about "prognosis" after valve surgery for people who have both mitral regurgitation and a damaged left ventricle, I was not thinking so much of "survival" rates, but of what in the medical literature is called "QoL issues" (quality of life).

What I'm really interested in is what kind of life those of you who may have undergone the surgery with an already seriously dysfunctional heart muscle are leading now, post-surgery.

I really do appreciate all the replies and comments. You can get a lot of information from the literature and from the doctors and surgeons but nothing that can possibly take the place of input from "those who have BEEN THERE .... "

Actually, for myself, despite my CHF and my supposedly "severe" dysfunction, I feel pretty darn good. I'm not sure that I am supposed to feel that way with an EF of 30 -- but, I do. I do not anticipate the heart "remodeling" much after valve surgery. (If it does, well, that's cool.) But if it doesn't get too much worse, I will not be at all unhappy & of course the surgery must be done NOW rather than wait to see if the EF goes up or down.
 
Yikes, gonna have to go back and read through all of the above a little moce closely here....


Just one point though:p

Marcia, I THINK I'm close towhat you're looking for. Enlarged left ventricle and valve regurgitation, but it was my tricuspid valve and the underlying cause of it all was/is a congenital heart defect....

I don't know specifics (like ejection and flow rates and all that) and I'm still a little "sketchy" about the anatomy of it all, but what you described sounds pretty similar to where my heart's at right now (not including my CHD)


I've got Stage I heart failure (I read the classifications and I is what best describes me) and I was at stage IV about 11 months ago. About the only "overt" sign of my heart failure now (besides all the meds I take of course) is an annoying coughing fit I seem to have just about every morning a few minutes after I get out of bed. I think it's just from congestion that builds up through the night and needs to get cleared out when my body's "attitude" is adjusted, going from laying flat to being upright. I don't cough like that at any point through the rest of the day.


I'm curious about the weight thing. My weight when I got home from the hospital was about 125-130 lbs. It came up rather steadily to where it is now at 155lbs through the summer and fall but it's never really fluctuated like Nancy described on a day to day or week to week basis.

I'm on a fluid restriction (which I follow "in spirit" at least) and I try to cut back as much as I can on sodium intake, though I've never been told to do that by a physician.

One thing I have noticed is that if I'm late on taking my diuretics, my coughing picks up. Within half an hour or so of taking them (if I was late) the coughing subsides.
 
Just for fun (and because I'm a nut) I did a little over 50 jumping jacks this morning while doing up breakfast for the wife and kid...

Ok, stage I heart failure, artificial tricuspid valve, transposition of the great vessels and 50+ jumping jacks with minimal effort and an only very slightly elevated heart rate.....


Not bad.



Anyways. I think a LOT of heart failure issues can be very specific to the individual. All these different factors like deficiencies in a ventrical and ejection factors and hypertension and lifestyle and previous medical history and and and.... add up to make very specific cases with very specific responses to treatments.

Just because you and I have heart failure doesn't mean we're both getting treated the same way. Granted, there can be a lot of similarities and some modes of treatment and a patient's experiences are helpful in relating to eachother's conditions, but wwe all resond differently to things too.

I'm on lisinopril. I have been since March. When I first got "sick" (the only evidence was a leaky baffle that showed up on an echo back when we were trying to diagnose a "chronic cough") my cardiologist set me on lisinopril which I took for several months. I had the nagging tickle cough, but it was managable and didn't really affect me. My primary physician decided to switch me to diovan, another ACE inhibitor, thinking that would clear up the nagging cough (nevermind the cough is what put me on lisinopril in the first place...) and I was on that for several months before I got to Cleveland Clinic.

I have a slight cough, it's not the congestion cough that CHF can cause, it's a side-effect of the ACE inhibitor...

Now for other people, that side-effect might be too much to handle so they find another med that will do the same job.

Listen to what others have to say about their experiences, ask questions and all that. Talk to your docs too.


Nan:

Donald Gazzinga's book is great. I ordered that when I got home from Cleveland and I've been trying recipes as I can, and learning to cook too!

I'm getting pretty good now and my family's actually willing to eat it, well except for fussy 3 year old Patrick who won't eat anything other than chicken nuggets and french fries, OY!

Well, he's better than that...

For Thanksgiving I cooked up a big, heart healthy meal. I did cornish game hens instead of turkey (though I had a turkey recipe, just chose the game hens since they were already in the freezer)
No salt stuffing, garlic mashed potatos, peas and corn, homemade cranberry sauce....

All good stuff.

Check out the recipes forum here...
 
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