Diastolic Heart Failure

[farmgirl]

Hello. I have been lurking for awhile. I have read a lot of the posts and gained a lot of knowledge from all of you. Thank you.

I had a mitral valve repair and ASD/VSD patch done in 1985. I did very well after that. Knowing that someday I would have to have the valve replaced.

In September 2002, I had surgery to replace the valve with a 33mm Carbomedics valve. Prior to the surgery, I had symptoms of CHF and was feeling pretty miserable. I also went into chronic afib.

After having such high hopes of recovery after the valve job, I have been disappointed that I still get tired, and still having shortness of breath.

I went to my cardiologist last week and they did another echo. He said that my right atrium is now enlarged and he does not know why. My tricuspid valve does leak some. He is also questioning if I have a leak again over the VSD. The surgeon had to attach the valve to the patch when he placed it. When he originally told me that, I wondered in my drugged state if that was going to hold up in the long run. He also told me that he would not consider surgery at this point. The second surgery was much harder for me to recover from. I honestly don't know if I would make it through a third.

He said that now I have diastolic heart failure and placed me on lasix again. I am pretty bummed about this. Is this heart failure common with valve surgery? In reading about it, it sounds like this failure is more due to the heart not being able to fill properly due to enlargement and not being able to push the blood around good enough.

But, overall, I have to say that even with my limitations, things are better than they were before my surgery. Just not as good as I would have liked. Maybe part of it is getting older...

Thanks for listening.

Diane

 

[ALCapshaw2]

Hello Dianne,

Sorry to hear that you are having continuing 'issues'.

I suspect it would be good to have a visit with your surgeon to discuss those issues. Take a copy of your echo tape, or at least the echo report, when you go. Ask your surgeon for his assessment of your condition, the impact of the valve attachment to your patch, and about the risks and potential benefits of another surgery.

Best wishes,

'AL'

 

[tobagotwo]

Tricuspid et al

Tricuspid et al

I'm sorry to hear that you've gone through so much for such a mediocre result. Age may affect your general recovery, but should not be the cause of the rest of your heart woes.

Surgeons have to make some difficult judgement calls that might not have been expected when they open us up. And there is a time constraint, as we're "on the pump." There are going to be times when those judgement calls turn out better than others. That might be the case with you right now.

I think Al makes an excellent point. As you have probably read, when we're not happy with a physician's response, most of us are very favorable to second opinions. Al sagely points out that the surgeon has the best actual knowledge of your heart's physical status.

It doesn't mean you are going there to arrange for another surgery. It means he has specific, first-hand knowledge that no one else would have. As your predicament is an unhappy one, you probably want to know all that you can that may work toward improving it.

You also want to be sure that, even if it is not what you wanted, your heart situation is stable, and that the possible VSD leak either does not actually exist, or if it does, that it is not a deteriorating situation.

My understanding of it (possibly flawed) is that the tricuspid valve is like the mitral valve in function and appearance, except it is in the right side of the heart, between the right atrium and the right ventricle. Tricuspid leakage can aggravate right atrial problems, as well as ventricular issues. The blood being pumped out of the right ventricle through the pulmonary valve can leak back into the right atrium through the tricuspid, under the pressure of the squeeze (beat) of the heart. This makes the ventricle empty too fast and work too hard, and the atrium gets more pressure than was intended. Valve leakage is usually referred to as regurgitation.

That can also have the effect of causing the blood to not get out to to the lungs for oxygenation in sufficient volume with each pump, as that is the primary destination served by the right ventricle. This makes the heart work harder to keep up with oxygen demand.

One other possibility mentioned in a recent post is scar tissue, which could possibly be using up some of the atrial capacity. However, that would likely have shown up in the echo exam.

Again, I am sorry to hear that you have not had the level of improvement we all look for after surgery.

Best wishes,

 

[farmgirl]

Thank you Al and Tobagotwo for your replies.

I have been with my cardiologist for many years. I think the world of him. He has always been very honest with me, so it kind of threw me for a loop when he brought up the heart failure. I thought the valve was supposed to fix everything. But, in reality, the new valve can't fix it all. It can help, but not make it brand new. I am sure many years of stretching and scar tissue and enlarging take their toll after while. I am 43 now.

It is a good idea though that maybe I should go visit with my surgeon. I haven't seen him since he did the surgery. He didn't indicate that I needed to follow up with him anymore. It would probably be worth a copay to go talk to him some afternoon. Thank you for that suggestion.

Thank you again. Have a nice weekend.

 

[ALCapshaw2]

One more thought Diane,

You mentioned that your RIGHT atrium was enlarged. This MAY be a sign of higher blood pressure on the right side of your heart which sends blood to the lungs. It is my understanding that Higher Pressure in the right side of the heart can cause fluid retention in the lungs. It might be a good idea to ask your Cardio (or the surgeon) to clarify that. It would definitely be a good idea to learn the reason for the enlargement (and possible higher blood pressure).

'AL'

 

[danielgilboa]

Hi Diane,

Sorry, no medical advice... it looks like a big enough job for the pro's.

All I can add is try to keep physically active, watch healthy nutrition and keep smiling. This will not cure your condition but may keep your spirits up. Don't forget, we are all here thanks to very advanced science and technology. Maybe they can keep us alive, make us better but not completely new.

Take care,

 

[tobagotwo]

43? Diane, you're not even middle-aged! You and your heart are not old, even if your heart has been run a bit hard for your age.

Please don't think that what is happening to you is from advancing age. Granted, eighteen has more energy, but 43 is still vibrant, and, well, young. Forty-five is the start of middle age, if you go by the age ranges on the marketing questionnaires.

I wish you good fortune in researching your heart's condition, and I hope another good answer comes out of it.

Best wishes,

 

[Mb]

Hello!

I just thought I would post, and add to your information!

My husband had aortic and mitral St. Jude valves installed in October of 2002. He was, and continues to be, in chronic a-fib. He has severe tricuspid valve leakage, and of course heart failure.

The right atrium enlarges from the a-fib. Over time, the valve opening stretches, causing regurgitation. He has had a TEE done, to rule out valve damage from the rheumatic fever, and the valve itself is fine, but the opening is enlarged from the a-fib. The a-fib causes the tiredness, and for him, exertional limitation.

This could very well be your problem as well. The tricuspid valve is rarely operated on, until it causes severe severe issues. You can live for a long long time with this leaking at a severe level. Drug addicts often have the valve removed completely when the get endocarditis.

I would certainly ask your cardio or surgeon for a more indepth discussion of the issue. By the way, the lasix lowers the volume of blood, allowing the heart not to work as hard to pump those cells to get the oxygen. Fluid control has been for my husband, the key ingredient to feeling as well as he can. So, take the lasix, honey, it will do your heart a whole heck of a lot of good.

Marybeth

 

[ALCapshaw2]

How are you doing Diane?

Regarding your Lasix treatement, I have found that Fluid Level control is VERY important. Too much fluid in you body causes your heart to have to work harder pumping the extra blood around and may lead to fluid in the lungs.

Too little fluid may lead to other difficulties such as arrhythmias or kidney stones if taken to an extreme. It's a difficult balancing act. My PCP advised me to chart my weight every morning, with little if any clothing. An increase of 3 pounds or more in one day is a good sign of fluid retention and is a signal to take your lasix (and a potassium supplement).

I hope you get to feeling better.

'AL'