Postpartum CHF due to MV regurgitation?

[Samm1991]

Hello ~

I?m new here, but I?ve been reading this board since I gave birth to my first baby five months ago.

I had a very easy pregnancy with no complications whatsoever. I had to have an emergency c-section due to the baby?s heart rate dropping too low during labor (he is perfectly healthy, thankfully). I did begin to swell up some during labor, but postpartum I swelled up like a balloon all over my body, including my face. I had pitting edema from my thighs down to my feet. Then a couple of days postpartum, my lungs filled with fluid and I went into congestive heart failure.

After an EKG, chest x-ray, CT scan, and finally an echocardiogram, it was found that I have mitral valve prolapse with moderate regurgitation, moderate tricuspid regurgitation, and mild pulmonary hypertension (pulmonary artery systolic pressure of 46 mmHG). Everything else checked out fine. My ejection fraction was 60 percent and no heart enlargement besides a mild enlargement of the right atrium. I was given a course of Lasix and put on Altace and discharged from the hospital two days later.

Three days after I left the hospital, I ended up back in the ER because my blood pressure sky-rocketed to about 180/118. I was checked for preeclampsia, but I was not spilling protein and my reflexes were good. My BP stayed that high until I got good control with medications a couple of weeks later.

I was (and still am) puzzled about WHY I went into CHF over mitral valve prolapse. When I asked my cardiologist, he said it was a combination of my increased blood pressure (per my cardiologist, it was only a bit elevated during delivery and postpartum, not nearly as high as it got a few days after I was discharged from the hospital and not in CHF any longer). He talked bunches about fluid shifts, hemodynamics, none of which I understood. He also said that I could be looking at mitral valve surgery in the future.

Have any of you ever heard about this happening postpartum to a woman with only moderate mitral regurgitation whose heart seems to be in good shape otherwise (no enlargement, normal ejection fraction, etc.)? I?m just wondering why this happened and keep thinking there has to be something else wrong (I have a habit of looking for trouble ) Mitral valve prolapse, even with regurgitation, is a pretty common problem, so why doesn?t this happen to more women during pregnancy or postpartum? All the nurses and my OB-GYN seemed very shocked that this happened to me. I was quite the medical oddity during my hospital stay

Also, I have read that in mitral regurgitation, the ejection fraction is higher than normal. If I have that right, wouldn?t my 60 percent be on the low-end?

And, finally, about the pulmonary hypertension. Would this most likely be caused by the regurgitation? Can CHF cause or contribute to it, or, vice versa, could the pulmonary hypertension be a cause for my going into CHF in the first place? Will this likely get better if I have the mitral valve repaired or replaced? Is there a possibility it could progress the longer I go without the surgery?

I have a list of questions for my cardiologist a mile long, but I don?t go back to him until May, when I believe he?s going to do a repeat echo. I?m still pretty much reeling from all of this and wondering how it?s going to affect my ability to have any more children, wondering if/when I will have to have surgery, etc., and really how serious all of this is. I was just wanting to get some opinions on my situation from people who have been there/done that.

Thanks! And nice to meet all of you

~ Sam

 

[Nancy]

My husband has CHF and pulmonary hypertension, and yes, the PH and CHF combined do cause extensive fluid retention. It is a nasty combination, since they are so intertwined and both make the other worse. It is a vicious cycle.

In my husband's case, he has to stay at a severe sodium restriction (500mg or less per day) to try keep his fluid retention at bay, and sometimes that doesn't work.

He has been on heavy diuresis for many years, and does go into kidney failure because of this. They then have to reduce his diuretics, and that makes the fluid retention worse and worse.

With PH, the only course of action is to go to a PH specialist. They see people with PH all the time. Yor regular doctor may not see many people with PH, primary or secondary in all his/her years of practice, and may not know how to deal with it, or what meds will help. The specialist will know.

With my husband, his FORMER cardiologist ignored nis PH until it became severe and nearly cost him his life. We found a specialist in the nick of time, and Joe was put on Tracleer, which has helped tremendously. It reduced his PH from 75 to around 41.

Here is a site to go to for PH information:

http://www.phassociation.org/Message_Boards/main.asp?board=1

http://www.phassociation.org/

 

[Karlynn]

HI Sam and welcome!

Did you have a normal pregnancy and only had problems starting with delivery?

Many of us had pregnancy affect our valves. In my case, it was my pregnancy with my 2nd child. I started getting very annoying arrhythmias. My valve was replaced 5 years later. I would be cautious about another pregnancy.

I also agree with Nancy, get a PH specialist. You may also want to make sure that your cardiologist has experience with valve disease. Many cardiologists look at young women (and men) and find it hard to believe that they must be too young to have valve problems and then don't take their cases seriously. Although with the post partum issues you have, I'm sure most would take you seriously.

 

[Georgia]

Hi, Sam - I really don't know anything about your plight - just wanted to welcome you and to say that we want to see a pic of your baby - first things first!!!!

 

[Marguerite53]

Hi Sam. Welcome! And congratulations on your healthy baby......a blessing in and of itself.

I'm presurgery but post childbirth (times 3) with the 3 in college now. I remember those times as being ones that were so self protective and much more attuned to my body, due to the sudden awakening of my mothering instincts.

I sense that you are not getting experienced answers. That is not logical. In this country we have professionals who are imminently experienced and you need to seek them out IF you are not satisfied with what you are hearing. The USA is a big place. Are you near a large metro center? If not, I suggest you consider approaching some hospital connected cardiologists to get some better answers.

Also, if you are not comfortable waiting until May for your next appointment, call and reschedule it for sooner. I have gone with my instincts once my heart started showing up with problems, totally overdid the number of visits and echoes and am very glad and satisfied that I did. After all, I'm the one with the problem and I needed to be comfortable living with it. We each have our own unique medical history, and our own way of dealing with it. You may need more answers than most patients (I know I do!!). So be it!

I have also been able to locate a very responsive and highly educated nurse in most doctor offices who will respond to my non-emergency questions with grace and completeness.......search for one of those, too!

Best of luck and let us know what you find out.

Glad you found us!

Marguerite

 

[Samm1991]

Thank you guys so much for the welcome!

One thing that may have been misunderstood in my first post is that, thankfully, I am no longer in congestive heart failure. Once all the fluid was taken off by the Lasix, that cleared up before they discharged me from the hospital.

My cardiologist had mentioned to me the possibility of peripartum cardiomyopathy before he took the echo. However, I think my 60 percent ejection fraction ruled that out for him for the most part. He did say, however, that is one of the things he will be checking out in my repeat echo (?). My OB-GYN said that it's also possible I had a "mild" case of this, or she also said that it could have just been a simple case of fluid overload since they were pumping me quite full of fluids during and after surgery. She said even a healthy heart can fail with too much fluid. One of the resident OB-GYN's at the hospital gave me the impression that the CHF was caused by the high blood pressure. My son's pediatrician at the hospital practically called my cardiologist a liar by saying that mitral valve prolapse is so common that that couldn't be the reason I went into heart failure. This is what confuses me. It seems everyone is just "guessing" on what caused this to happen. The only one who seems pretty sure of what happened is my cardiologist, so I guess I should trust him since he's the expert.


Nancy ~

I'm so sorry to hear about your husband's problems with CHF and pulmonary hypertension. I'm glad that he was able to get it under better control with medication. Was your husband's pulmonary hypertension caused by valve problems?

I am going to look into a pulmonary hypertension specialist. The weird thing is is that the pulmonary hypertension was never even mentioned to me by any of my doctors, even my cardiologist. I only found that out by obtaining a copy of my echo report. So it does sound a bit like my cardiologist may be ignoring this, or at least not giving it the attention that it deserves (?)

Karlynn ~

Yes, my pregnancy was completely normal up until delivery. (That's what I get for bragging to everyone about my easy pregnancy

I really don't know how much experience my cardio has with valve disease. He seems to know what he's talking about, but that may not mean much. I live in Ohio and only about an hour away from the Cleveland Clinic, so I'm considering making an appointment with a cardiologist there after I obtain all of my medical records.

Georgia ~

As a new mommy who is completely in love with her son, I would LOVE to post a picture. However, I'm not quite sure how to do so. Let me check on that and see if I can figure it out.

 

[Samm1991]

Hi there Marguerite53 ~

Thanks for the congrats. My son is the best blessing in my life, and I would go through all of this again in a heartbeat (excuse the pun) for him. In my mind, it was a small price to pay for getting to be his mommy.

I do live near the Cleveland Clinic, who I have read are leaders in mitral valve surgery, so I'm lucky there. I am going to call them up and schedule an appointment. I'm calling today to get a copy of my medical records from the hospital. I'm more than a little curious as to what I will find in them.

I do feel comfortable waiting until May, as I feel do feel okay and don't feel like this is an emergency situation at the moment. I do live in fear of my lungs filling up with fluid again, as that was probably the most terrifying experience of my life. But my cardiologist doesn't seem at all worried about that possibility for the time being.

Thanks again for the warm welcome!

 

[Nancy]

You have found out medicine's dirty little secret, unfortunately. And that is that doctors routinely ignore pulmonary hypertension.

I am at a loss as to why that is, perhaps ignorance, since it is one of the rare diseases, and they don't have a clue.

But it doesn't matter why, you only have to know that it has happened to those with PH with great frequency. And it is one of the contributing factors in worsening symptoms. Sadly, these things can be helped. But your doctor has to be willing to refer you out.

We found out about Joe's PH from his echo reports also. We were flabbergasted that a doctor who should have been caring, was not.

Now that YOU know about it, take it into your own hands and find out exactly your PH status from a specialist.

Do not allow someone who has ignored your PH to give you any diagnosis for PH. Their ignorance speaks volumes about what they DO NOT know about this problem.

 

[KimC]

Become a Health Warrior

Become a Health Warrior

Hi, Sam.

Thanks for sharing your questions re: your diagnosis. I hope you're enjoying your new baby! It's such a joyful time. I'm sorry to hear about your difficult labor and postpartum ER trips.

Are you having any symptoms such as unusual fatigue, SOB, chest discomfort or palpitations? Are you taking any heart medications now?

I became symptomatic during my third pregnancy, and was reassured that the normal hemodynamics of pregnancy were the cause and to wait six months postpartum before any testing. During this timeframe I continued to be symptomatic but was told it was anxiety-related.

Finally, I had a thallium stress test (where they shoot dye into your vein and look for areas of your heart which aren't receiving proper blood flow). The test was abnormal, showing mild perfusion defects but the cardio attributed them to breast attenuation. I was put on nitro for the chest discomfort though.

Almost a year later, my symptoms became much worse and my cardiologist tried a calcium-channel blocker which I could not tolerate. He theorized I had coronary spasms. My echoes continued to show moderate aortic and tricuspid insufficiency, neither of which could explain my symptoms, according to the cardio. The right side of my heart was also mildly enlarged and dysfunctional which he said would get better over time. He couldn't explain the pathology, saying it was probably pregnancy-related and not to worry about it.

At some point, I bucked my local doctors and pursued answers from another cardiologist well-known for treating female-related heart problems. The change in treatment was profound. He scheduled a special cath, and started me on a diuretic and ACE-inhibitor.

The angina I had been experiencing at rest stabilized, and the cath provided answers: I had microvascular disease. My EF was between 50-60% but my diastolic pressure was too high.

My new cardio put me in an NIH study on this type of heart disease. The results of the study were just published in the major heart journals, and several national papers covered the findings.

My point here is be a health care warrior. Had I been treated seriously during my pregnancy or soon afterward, I believe I would be in a better place today healthwise.

All the best,