I'm a 51 year old who's recently been told he has heart failure.

My symptoms began months ago with some night-time wheezing, loss of endurance and breatlessness both during activity and while resting. Plus, my feet, legs and abdomen were badly puffed-up (swelling or edema). I also have strange discomfort in my abdomen.

Many test have been run and the results are mixed. I had an "advanced" blood test that indicated heart failure, as did an echo cardiogram. I've been put on a bunch of meds and over the last couple of months lost a boatload of water and regular weight. The Drs also suspected the med I use for management of chronic pain, methadone. They switched me to another med and I've experienced real improvement in sleep and a few other areas. They were looking to see if the methadone was causing something called prolonged QT intervals, as has received some press lately.

I spent a month working from home and have just returned to work since I'm feeling better. I believe my cardiologist put me on all these meds and recommended light work to get me more "stable" (his words) for more invasive tests (don't know what they might be).

They still seem at a loss to understand how a 51 year old could have heart failure. The cardiologist is suspecting a bad flu I caught just before the heart failure diagnosis, but he admits it's a reach.

I'd appreciate any thoughts you might have that might give me more insight into this disease and what kinds of treatment some of you have endured.

steve

Hi justsc,

My symptoms for heart failure 3 years ago were lung edema (congested heart failure) and system edema as well and shortness of breath, and a dry choking type cough and wheezing, etc.

Absent any evidence otherwise, it appears the condition developed, or it was exacerbated by compromising my respiratory system by breathing in a dusting environment for few days working on a home project. I thought it was a lung problem, but ER dr. stated I had had a heart attack after blood tests, ekg, x-ray (showed an enlarged left ventricle); a cath showed a completely blocked LAD artery and the RCA 98% blocked was stented. Heart's efficiency was an output of less than 29% with each stroke. An echo showed some heart muscle damage due to ischemia (lack of blood due to artery occlusion).

The stented RCA and a natural by-pass of the LAD (collateral vessels) provided more oxygen to the deficit area. Medication has reduced left ventricle size (reverse remodeling), and the reduction in size of the LV has reduced mitral valve regurgitation. The cardiac output is now normal (EF 59%) with the help of medication.

Heart failure symptoms, edema, wheezing, shortness of breath, dry cough, etc., happens when the cardiac output is decreased due to (usually) heart muscle damage. The decrease does not meet the oxygen demand causing shortness of breath, fatique, etc. With poor contractions, blood/oxygen supply is greater than the heart's ability to pump into the system and the blood backs up causing edema and described symptoms.

Medication to treat heart failure is an ACE inhibitor to dilate vessels, a diuretic to reduce fluids, a beta blocker to help dilate and slow heart rate. This reduces the heart's workload and the relief can return the heart's function to normal or slow down the failing process.

The *bad flu epidode" may have compromised your respiratory system as breathing in dust did for me.

justsc,

A virus or a bacterial attack can sometimes be the cause of myopathy/heart failure, but the agent is rarely found. It can be a hereditary malformation or bad valves or be caused by a heart attack. There are also several TYPES of heart failure. Sometimes they just never find the casue: idiopathic.

KK is the expert here.

Probably the test they are hoping to do as you improve is the angiogram via catheter for a look into the coronary arteries and a much closer look at the heart and it's valves and internal structure.

Did they ever make an estimate of your ejection fraction?

Controlling your blood pressure to a low level is VERY important for you.

Kenkeith & Lenin,

Thanks so much for the replies.

Seems like my symptoms match what you've described.

As for "ejection fraction," is that one of the results of am echocardiogram? I did undergo that procedure and was told the number spread ran from "20" to "60" or "80." Apparently my number is "20." I realize that's not a fraction, but it's all I was given. The "sensitive" blood test I mentioned I believe is referred to as a BNP.

Thanks again,

steve

steve,

The BNP test is a specific heart failure blood test. It measures the level of a certain hormone in your blood called B-type Natriuretic Peptide and both confirms heart failure and judges its progression. This hormone is produced when the ventricles cannot pump enough blood.
The higher your BNP level is at diagnosis, the worse your heart failure is likely to be.

I'm not surprised your EF was/is 20% That would be in the heart failure and 80% would/could indicate over compensation. When there is over compensation (50 to 75% is normal), the EF can very quickly drop into the heart failure range if the underlying problem isn't treated.

An EF is a virtual fraction and expressed as a percentage. Probably should be stated efficiency percentage.:)

Thanks again so much for your help, guys.

Looking for more info-

Since the diagnosis in mid early April I've lost an enormous amount of weight, clearly alot of it water. But I made serious diet changes and have realized weight loss there as well. The edema has almost gone away, as has the majority of breathlessness. At the OK of one of my Drs, I have resumed some exercise and am not resting nearly as much as originally ordered. I am on the meds kenkeith mentioned in his first reply to me.

Within the last 5-6 days I've noticed a slight return of some puffiness and some very minor breathlessness. I see the cardiologist this Thursday, but I was wondering what you think - why would I see a return of some symptoms? Could I be over-doing it too soon? Is it normal to have hills and valleys?

steve

When I went to ER it took several days to adjust to the system to the expected oxygen level. It appeared to me there was a minor or major? problem to get the normal ratio of oxygen to carbon dioxide.

There may be some retention of fluids and it may take awhile with a water pill to be effective. It is recommended to weigh yourself each morning for any quick and usual gain... probably 5 lbs. would be of some concern.

It is possible you are adding an extra burden to your heart at a time when the heart is still vulnerable to any additional workload that is excessive.