Nancy, Betty, Ken, Bob, Harpoon, Marty or Ross

KimC · Jul 17, 2005

Hi,

I'm preparing for my visit with Dr. Pepine on Wed., and would like to be as educated and prepared as possible.

To recap, my last echo revealed "Mild RV Dilation and RV Systolic Dysfunction." I had the echo an hour after a stress test, and while I was off my heart medications, (an ACE and diuretic). I had stopped taking the meds about 72 hours prior to the tests, per the WISE study protocol.

1) When the right ventricle enlarges and systolic dysfunction ensues, is this technically "decompensated" heart failure or have I mixed this up?

2) What is the official criteria, i.e., numbers for diagnosing right-sided heart failure? Could anyone offer a reference? I will ask for my pressures, even if it means submitting to a right-heart cath.

Everything I've read about valve-related heart failure says that it can be reversed if caught in time, and that surgery is indicated when the heart begins to enlarge. At no point have I been told that valve disease is the primary pathology for my symptoms, but I am considering asking for a TEE if Pepine thinks this is warranted.

To date, I've been diagnosed with coronary arterial stenosis; aortic sclerosis with 2+ insufficiency; 1+ tricuspid insufficiency; and trace mitral insufficiency, as well as bronchial asthma. My EF was 50% a year ago and recently 60%. In other words, it doesn't look like the left side of my heart is causing the right-sided overload. It's probably the small vessel disease.

3) Nancy, is Joe prone to infections because of the PH? I ask because I wonder if my asthma is actually cardiac-related. Has he ever taken Prednisone? Ross, have you? Is Prednisone contraindicated with CHF?

4) If someone had an echo while on heart meds, would it show restored systolic function or would the dysfunction always be apparent, meds or not?

Any insights to prepare and help me sort this out would be appreciated. Don't hold back, please. Imagine that I'm a 350 lb. linebacker who's just looking for straight answers before the next game.

Thank you.

Best,

Nancy · Jul 17, 2005

Hi Kim-

Joe is NOT prone to infections because of his PH. He's a fairly healthy man cold-wise and seasonal type illnesses. Just a few seasonal allergies.

I can't ever remember Joe being prescribed prednisone, even a short course of it.

I do think a lot of folks on this site have been diagnosed with asthma prior to being diagnosed with CHF. And I know that a lot of PH patients have been diagnosed with asthma prior to being finally diagnosed with PH.

tobagotwo · Jul 17, 2005

You shouldn't need a right-heart cath to get your pressures. They can be gotten from a standard echo or a TEE. I would avoid repeated caths if I had arterial disease, especially if it tends to encourage plaques. While caths don't seem to be greatly damaging, your arteries seem to be tender, Kim. Less irritation is probably better. Save the caths for when you really need info you can't get any other way.

A normal size for the right ventricle seems to be the range of 0.7 to 2.5 cm.

I can't realistically offer much more on these topics, Kim, except my concern and my hopes that you find your answers.

Best wishes,

bvdr · Jul 17, 2005

Kim, I don't know how much of a help I can be because your history has not been at all usual. Your expression "decompensated" is not one I remember hearing very often but rather "compensated, partially compensated, or uncompensated". All of them are referring to changes the body goes through to try to make the end result "normal". If the end result is not normal then it would be partially compensated or uncompensated.

Unless the right ventricular dysfunction is associated with left ventricular dysfunction, such as in the case of MI or pulmonary edema leading to bi-ventricular CHF, then the usual causes are pulmonary disease, pulmonary emboli, or tri-cuspid or pulmonary valve disorders. Regardless of the root of the problem, the direct cause is (as a rule) a rise in the pulmonary artery pressure making the right ventricle pump into a higher pressure area. This is caused "increased afterload". All this leads to peripheral and venous overload and the symptoms of edema, increased girth, congestion of liver and even edema in the bowel. Pulmonary involvement sometimes presents itself with asthma symptoms....what is often referred to as cardiac asthma.

I had asthma symptoms prior to being diagnosed with valve problems. I am one of many on the board here who did. It hadn't gotten to the point where I was ever put on steroids though. I'm not sure they would be effective in that situation except by relieving any associated inflammation but that is just my thought on it.

As far as the "official criteria" for diagnosis of right-sided failure, I'll have to research that a little and maybe find a source. As far as having an echo while on medications vs. while off them .......I would think that there could be some differences in results of pressures, times, and even cardiac output but the chamber sizes and wall thickness and the general character of the heart would be the same.

I would definitely ask the Ws.........What is the main cause of the dysfunction as well as contributing causes?
Why are you having asthma type symptoms and what makes them believe they are not cardiac related?
Ask also if your small vessel disease is sufficient to cause your right ventricular dysfunction. Do press for a diagnosis other than just the statement of a symptom.

I hope all goes well for you and if I run into a good reference than I will forward it on to you.

Betty

bvdr · Jul 17, 2005

A decent reference for you to check is:

http://www.aafp.org/afp/20041201/2145.html

KimC · Jul 17, 2005

Nancy, Bob and Betty:

Thank you. I appreciate your thoughts.

This isn't stuff I like to think about. I'd rather keep that monster in the closet, as much as possible. But for better or worse, I need to know everything and feel like I'm in control. Control's a big part of my DNA, I'm afraid. It's also perhaps one of the reasons why I am where I am.

Bob, I'd have to say that my family agrees with you re: another cath. A cardiac MRI is more likely in my future.

All the best,