After learning I have 4 incompetent heart valves, I have been on 1 Ace Inhibitor and 1 Angiotensin Reuptake Inhibitor. Both have given a dry hacking cough and the last one caused hair loss. Now I am back to square one.
I have called the Cardiologist and awaiting further instructions. I see no need to continue with a scheduled echo in November if I have not been on meds to try to take the stress off the heart. I wonder what options I have as I am super sensitive to medications (long history)
Any ideas? Now I am afraid surgery will be more of a necessity. I really am not up to open heart surgery as I have other health issues and feel I won't be a good risk.
Thanks for letting me vent.
After learning I have 4 incompetent heart valves, I have been on 1 Ace Inhibitor and 1 Angiotensin Reuptake Inhibitor. Both have given a dry hacking cough and the last one caused hair loss. Now I am back to square one.
I have called the Cardiologist and awaiting further instructions. I see no need to continue with a scheduled echo in November if I have not been on meds to try to take the stress off the heart. I wonder what options I have as I am super sensitive to medications (long history)
Any ideas? Now I am afraid surgery will be more of a necessity. I really am not up to open heart surgery as I have other health issues and feel I won't be a good risk.
Thanks for letting me vent.
Hi goldyfm,
You will need an echo to help determine the extent of valve non-compliance. Also, the echo will establish a referrence for later examinations to determine any progression. You may never need an operation! Many people go through life with a valve problem without a need to operate.
Just curious, how, what was the procedure to diagnose your condition?
Thanks for your replies. I had posted earlier when diagnosed with the valve problems. I had an echo and was referred to a Cardiologist who did a Transesophageal Echocardiogram about 6 weeks ago. It showed mild to moderate regurgitation in the pulmonic, tricuspid and mitral valves and moderate to severe regurgitation in the aortic valve. Seems the report showed a left ventricular diastolic dysfunction although the EF was in the 55-65%.
The cardiologist was trying on ACE Inhibitor and the Angiotensin Reuptake Inhibitor to prevent preogression of damage. It was not a vegetative or structural defect. No stenosis was noted and the heart was not enlarged at that time.
I also had a negative echo in 2002 so all these problems have occurred over the last 5 years.
Thanks for your replies. I had posted earlier when diagnosed with the valve problems. I had an echo and was referred to a Cardiologist who did a Transesophageal Echocardiogram about 6 weeks ago. It showed mild to moderate regurgitation in the pulmonic, tricuspid and mitral valves and moderate to severe regurgitation in the aortic valve. Seems the report showed a left ventricular diastolic dysfunction although the EF was in the 55-65%.
The cardiologist was trying on ACE Inhibitor and the Angiotensin Reuptake Inhibitor to prevent preogression of damage. It was not a vegetative or structural defect. No stenosis was noted and the heart was not enlarged at that time.
I also had a negative echo in 2002 so all these problems have occurred over the last 5 years.
I'm curious as to what ace inhibitor you were prescribed? Was it Lisinopril? I had a horrid cough, gagging and vomiting several times daily and worse at night from lisinopril. My doctor put me on Atacand and the cough was gone completely within two weeks.
I was first given Benazepril. The nurse said doctor will do nothing (after I informed I just had a Thyroid test in July) until my next echo in November. I wondered if it was deemed necessary to prescribe a med for the valve problem and now as I was tried on two with side effects by both, they seem to think it was "unnecessary."
I do want the best care possible for this condition. I am puzzled as to why do a followup echo if they are not going to treat.
I was first given Benazepril. The nurse said doctor will do nothing (after I informed I just had a Thyroid test in July) until my next echo in November. I wondered if it was deemed necessary to prescribe a med for the valve problem and now as I was tried on two with side effects by both, they seem to think it was "unnecessary."
I do want the best care possible for this condition. I am puzzled as to why do a followup echo if they are not going to treat.
When I first read your original post I got the impression you were taking an ACE inhibitor AND an angiotensin Reuptake.
For a perspective, the ACE inhibitor blocks the production of angiotensin. Angiotensin enzyme contracts and narrows vessels.
Angiotensin Reuptake doesn't block angiotensin but relaxes vessels and both perscriptions treat high blood pressure by lowering the resistance the heart pumps blood against and lowers internal heart pressure as well. The reduced pressure provides some relief to the valves and regurgitation. Medication slows the process of valve non-compliance!
If your bp is normal, the medication may not be of much benefit.
The medicines you are taking are given to almost everyone with heart disease, especially those that have had a heart attack. Statistics show they help improve survival. They are not specific for heart valve disease at all. I am being brutally honest here.
Are you sure the Angiotensin Reuptake Inhibitor is not an Angiotension Receptor Blocker? No big deal, I just am looking for a new drug in this class myself, and have never heard of the medicine you mentioned.
Goldy, I know you are struggling with Fibromyalgia, same as myself, along with heart disease. It is a very nasty trick for you to determine which condition is effecting you. Here is why; the FM causes aches and fatigue, while a leaking aortic valve causes tremendous fatigue and possibly chest pain, fainting, etc proportional to the valve leakage.
At this point you must concentrate on the valve leakage. If it is moderate to severe, you cannot work or carry on normal activities. If you do so, you risk enlarging your left ventricle and suffering left side heart failure, which leads to right side heart failure.
These echocardiograms or TEE tests, are the gold standard for evaluating your valve leakage/condition, and will signify to your doctor when repair or replacement of your aortic valve is necessary. There is a "window of opportunity" that the cardiologist/surgeons look at to "fix" a heart valve.
Your EF or left ventricle ejection fraction is good, but what is the left ventricle end diastolic fill pressure? I would think that it is very high. You mentioned LV diastolic dysfunction in your post. That means your left ventricle end diastolic fill pressure (LVEDP) is >20mmhg already. I have diastolic dysfunction also.
Diastolic dysfunction can lead to pulmonary hypertension, pulmonary edema and pulmonary embolism.
When your heart rests after a contraction (diastolic phase), the aortic valve should close securely, and allow the LV to fill with fresh oxygenated blood from the lungs via the left atrium and through the mitral valve.
Instead when your heart rest the LV is flooded with blood leaking through the aortic valve. Consider what is above the aortic valve. It is the beginning of the aorta which leads to the aortic arch with a huge amount or volume of blood This blood, due to its volume and height above the aortic valve, exerts a lot of pressure on the aortic valve and when it leaks the force is exerted on the left ventricle that is trying to fill and pump blood from the lungs. The efficiency of the over all heart is greatly reduced.
So, your good EF really doesn't mean a lot at this time, except that your heart is still fairly strong and can be rescued with valve repair.
Have you seen your actual echo report? If not ask for it and give us your heart chamber dimensions. I would say that your LV is already approaching enlargement due to being so over worked by the leaking aortic valve.
Get ready to get that valve fixed and start feeling 200% better
I stand corrected. Cozaar is an Angiotension Receptor Blocker.
I don't really know what the measurements on the original echo mean, there were no measurements on the TEE other than est. LVEF of 55-60.
On the original echo:
LVD was 3.9 cm
LVS was 2.6 cm
Aortic valve area 1.9
aortic root 2.9
LVOT of 1.9
LV post wall and LV septal wall were 0.8
L atrium was 2.7
mitral valve area 3.1
First echo showed LVEF of 55-65 and stated LV diastolic filling pattern shows impairment of relaxation to suggest mild diastolic dysfunction.
No other values are included on either the echo or TEE reports.
The Cozaar is made by Merck, you can search by name and they have patient info and prescribing info.
Now it is hard for me to know whether I am so fatigued because of the heart or the fibromyalgia. I sleep more than I am awake. I guess my body needs the rest. But I can't slow down much more than I am at this time. I wouldn't be living if I slowed down anymore.
I know I don't really understand all that this entails but wouldn't all the valves need repair or at least the aortic and mitral for the left ventricle to pump efficiently?
Yes, Huck you and I are neighbors of sort, maybe there is something contagious about these maladies.
I am quoting you here, "It showed mild to moderate regurgitation in the pulmonic, tricuspid and mitral valves and moderate to severe regurgitation in the aortic valve." Except I made the most important part bold
Yes in a perfect heart all 4 valves need to open fully and close tight in the correct rhythm, in order for the heart to pump efficiently. Really all the left ventricle needs is the mitral and aortic valve to pump efficiently, BUT if the other 2 valves fail, it will lead to right sided heart failure which will lead to left side and total heart failure.
The heart is really 2 pumps side by side, the left, which consist of the LV and LA, the aortic and mitral valve, which pump fresh blood from the lungs to all parts, or cells and organs of the body, and back to the pulmonary valve, where the right pump circulates the blood through our lungs.
The right side, which consist of the RV, RA, tricuspid and pulmonary valve take suction on spent blood that has traveled through all of our cells and is returning through our veins back to the pulmonary valve, RA, RV and through our lungs to exchange CO2 for O2.
Many people our age have mild to moderate valve leakage in all but the aortic valve. This is the valve that can put an end to us quickest. I am sorry to say this. The aortic and pulmonary valve are totally different from the other 2 valves. They are exposed to the "system", and must be more tough and efficient.
Why does Goldy need to lay down a lot?
You know what a water tank is? You know, the huge ones we climbed and wrote whatever on (when our hearts were the last thing on our minds, lol)? They pressurize a cities water system. Pumps pump water up into them and keep them full. This is kinetic energy at work. 1 gallon of water weighs 8 pounds. Imagine what 250,000 gallons weigh? 2 million lbs.
The higher the tank, the higher the kinetic energy due to the force of gravity. This kinetic energy is converted to pressure and is felt in every pipe connected to the system. Every kitchen, bathroom etc. We have valves to stop the water flow.
Now lay this tank on it's side and see the effect on the system pressure (and in your case) the valves. The valves have much less pressure on them.
As you stand, your water tank is above your aortic valve......Exerting force as pressure and causing increased leakage, and most importantly, increased work load on your already over worked heart.
Have your doctors told you not to exercise until this valve is repaired? Are you seeing the dominant group of cardiologist in North Alabama? I have been to almost everyone of them. I think that is my problem. Instead of sticking with one, I have tried them all. I thought my care as far as my medical history would be the same, but boy it is not.
I will compare your echo readings to mine and the norms when I get the chance. Gee Goldy, my body has been aching all over for about 4 weeks, worse than ever. It is hard to take. Sometimes I wonder.... I know you understand.
My heart probs are different than yours. I have coronary artery disease or CAD. I have 5 stents. 4 are side by side in what is termed as a "kiss me" arrangement in my LAD.
I just got back from the Cleveland Clinic for an evaluation for minimally invasive coronary artery bypass surgery, MID-CAB. I was turned down and really do not know why. I was "under the influence" the last time I talked to my cardiologist, immediately after my TENTH CARDIAC CATHETERIZATION. This is against all medical standards, but I am supposed to receive all data in the mail. It was supposed to be here 6 days ago...I was a perfect candidate for this surgery. Politics are involved I am afraid.
I can't wait until UAB can do this type of surgery. I have been there guinea pig before.
For a different perspective, I had severe MVR, enlarged LV and an MI going on 4 years. With medication there has been reverse remodeling (normal size). The normal size LV has reduced MVR to moderate. Tomorrow another echo.
My ischemic LV led to an MI, dropped EF to below 29%. Left ventricle non-compliance (inadequate cardiac output) caused pulmonary edema and was hospitalize for several days. If cardiac output is compromised by a weak contractions of the LV, oxygenated blood from the lungs back up and leak fluids into the lungs (edema). That appears to be my experience.
If the right side fails, there is system edema for the same reason... reduced output causing an imbalance in output and supply. Right-side failure lacks sufficient blood flow to the left side and the left side chamber for lack of blood will compensate by enlarging the chamber thereby increasing contractional strength consistant with the Frank Startling phenomonom. There comes a time when the oversize chamber loses (over compensates) its contractional strength and as a result the heart fails to pump sufficient oxygenated blood to meet demand.
The mechanism for Frank/Starling can be compared to the expansion of a hand spring. There are specific cardiac cells that have this property. As it is stretched it springs back with more force. Over stretch and recoil is flaccid and heart failure. If and when the heart is compensating by remodeling, EF can be abnormally high!
I am seeing a group at Birmingham Heart Clinic at what used to be Med Ctr East. The cardiologist had only seen me briefly for an initial visit post 1st echo, so there was not a lot of history with him. Although he advised after the TEE that I could resume my normal routine the following day; my normal routine is anything but normal due to the fibromyalgia and some other issues. So basically he was telling me to do what I felt like which isn't much even on a "good" day. Huck, I am sure you can identify with that.
I don't see him again until November, for a repeat echo and consultation following. I am in a holding pattern as far as the heart goes until my next visit. After trying me on two meds (I have long history of medication allergies) that failed to be tolerable to me, I was told to wait til the next evaluation. In the meantime, I am trying to arm myself with any info so I can go in prepared this next time.
I have researched the Cleveland Clinic and definitely would seek a second opinion before any surgical suggestion. I also would like to know if you required a referral for the evaluation there or if they take patients without referral. I am lucky in that my health insurance allows me to pick my own physicians, so that is a plus for me that I am not limited to a certain hospital or doctor's group for treatment and possible surgery.
I have also been investigating the types of replacements available, and though the literature suggests that mechanical valves are used in younger patients, I find no definition of age criteria. I think if I had to have a replacement I don't want to think that I would have to undergo another one in a matter of x number of years. I am 55, so I should have a few years left.
Also Huck, on one website it was listed that connective tissue disorders can damage the heart valves. I wondered if you had seen that info and what your take is on the possibility it may be fibro related. Makes one wonder if there has been a study of how many with fibro have valve disorders of undeterminable origin. I know I never had rheumatic fever as a child, there was no evidence of stenosis or vegetation, and as far as I know there is no Marfan's in my background. Hmmm, maybe there is a relation between the two.
I know that all the symptoms for the two started about the same time. The thing is they only did some stress EKG's and Cardiolite studies in the beginning of my symptoms. And I was told those were normal. Your thoughts?
After answering OP you may want to enlighten readers regarding your comments:
Quote:
The right side, which consist of the RV, RA, tricuspid and pulmonary valve take suction on spent blood that has traveled through all of our cells and is returning through our veins back to the pulmonary valve, RA, RV and through our lungs to exchange CO2 for O2.
I find your description of the system's cardio/vascular anatomy interesting but where does "suction of spent blood" arise?
My information after reading about EECP the systematic venous system return consists of pressures and bicuspid valves to prevent back flow due to gravity, etc. as it relates to venous blood flow below the heart. As it goes blood flow to the heart involves the muscles. When muscles contract blood is sqeezed at the vessel cite pushing blood toward the heart; when muscle relaxes bicuspid valves closes. The muscle acts like a pump.
My friend, Lenin, stated suction was involved for venous return, but could not elaborate. So I put some validity to that comment, but I don't understand the mechanism involved? Do you have a source?
I am reading like the devil for you, lol. I am not through with what all I would like to cover, to really answer your post, but I have a few answers and questions.
I do not understand the question you ask here " I know that all the symptoms for the two started about the same time. The thing is they only did some stress EKG's and Cardiolite studies in the beginning of my symptoms. And I was told those were normal. Your thoughts?"
What do you mean by "symptoms of the two" (I am confused as to what the two are). Please forgive my foggy mind. I know that you understand. If I assume it is FM and aortic valve leakage, I am probably wrong
I have totally read the Birmingham Heart Clinic web site. I looked at each doctor's credentials. I don't think that any do valve repair? This is very important; have you asked them if you have a bicuspid or tricuspid aortic valve?
So glad to hear that your insurance is good. BCBS allows you to go to any state that has BCBS, and if that state's doctors/hospitals are in the preferred network, your coverage is exactly the same as if you were at home.
I just received my cath and other lab reports from the CC. I am very disappointed with an obvious mistake they made. I am going to fax them later.
I wanted to say that I know that you have been to many doctors for fibromyalgia, and any answers are often vague. Cardiology is different. You must demand and keep all of your medical records and test results. I surely hope that doesn't sound condescending
You don't need a referral to get an appointment at the CC. Just make sure you get it pre-certified with your insurance company.
There is no doubt to me that Fibromyalgia and connective tissue disorders could cause valve and other heart conditions. Remember the myofacial tissue or whatever. I have about forgotten about it but.....
Don't be worrying about valve replacements yet! Let's study valve repair the easy way....No open heart surgery I believe. That is what I wanted to cover before I answered your post. I have felt the worst that I ever have in my life for the last month or so. I think I am repeating myself here, lol.
I think I may have figured out that I have/or had drug induced lupus from a very potent heart medicine that I have taken for many years. I changed last night and some of the muscle pain has gone away already. (I was taking a beta blocker, atenolol (6 or 7 years) and switched to Coreg last night.)
Yes Ken, I really over simplified the function of the right heart when I said it "takes suction on spent blood".
I am using one of the basic laws of physics, which must take place in order for our blood to circulate. It is call delta p, or differential pressure.
You are most correct about the venous pump:
When you are in the upright position, the blood in your leg veins must go against gravity to return to your heart. To accomplish this, your leg muscles squeeze the deep veins of your legs and feet to help move blood back to your heart. One-way flaps, called valves, in your veins keep blood flowing in the right direction. When your leg muscles relax, the valves inside your veins close. This prevents blood from flowing in reverse, back down the legs. The entire process of sending blood back to the heart is called the venous pump.
I do not feel like putting my explanation of "taking suction" into my own words, so let me paste some info that I cannot supply references for, due to board rules. I will say that on an echocardiogram, it will note that in a healthy individual, the inferior vena cava collapses with each heart beat. This is due to negative pressure.
----------------------------------------------------------------------
Abstract
To investigate the effect of a sustained fall in intrathoracic pressure (Mueller manoeuvre) on blood flow through the right heart and on systemic venous dynamics, 16 patients were studied using thermodilution, cinevenograms and simultaneous pressure recordings with two micromanometric transducers. The reductions in airway pressure (median [rangeI) during two graded Mueller manoeuvres were 25 (20–30) and 42 (22–52) mmHg. Right atrial mean pressure decreased by 17 (2–25) mmHg during the former and 38 (0–49) mmHg during the latter, and simultaneously, pressure gradients of 23 (1–32) and 45 (1–82) mmHg developed between the inferior vena cava and right atrium (P<0.003 for all). Internal jugular venous pressure decreased by 16 (4–25) and 24 (4–43) mmHg (P<0.03 for both), respectively, and no pressure gradient developed between internal jugular and superior caval veins. The minimum diameter of the proximal inferior vena cava decreased by 69 (–49–84)% (P = 0.002) during the greater manoeuvre. Cardiac index tended to increase by 26 (–17–40)% (P<0.066) during the lesser manoeuvre but did not change statistically significantly during the greater.
In conclusion, during negative intrathoracic pressure caused acutely by the Mueller manoeuvre, right atrial pressure decreases and the inferior vena cava collapses partially at or below the diaphragm. Despite a significant venous obstruction between the lower body and right atrium, blood flow through the right heart increases or remains constant.
Abstract
Pressure in the right ventricle (RV) as well as the right atrium (RA) and pulmonary artery (PA) were measured in 80 patients with catheter-tip mlcromanometere and evaluated to determine If the pressures are compatible with the concept of RV diastollc suction. In 40 patients with normal PA pressure, minimal RV diastollc pressure that occurred during early filling, was negative (-2 ± 0.3 mm Hg) (mean ± SEM). In 29 patients with PA hypertension, minimal RV dlastolic pressure during expiration also was negative (-2 ± 0.7 mm Hg). In 11 patients with right ventricular failure, however, minimal RV diastolic pressure was positive (9 ± 2 mm Hg). These results indicate that the human right ventricle, in the absence of failure, has a negative early diastollc pressure, which may reflect RV diastollc suction.
Excerpt: "Blood flows through the blood vessels, including the veins, primarily because of the pumping action of the heart. However, venous flow is aided by the heartbeat, the increase in the negative intrathoracic pressure during each inspiration, and contractions of skeletal muscles that compress the veins (muscle pump).The pressure in the venules is 12–18 mm Hg. It falls steadily in the larger veins to about 5.5 mm Hg in the great veins outside the thorax. The pressure in the great veins at their entrance into the right atrium (central venous pressure) averages 4.6 mm Hg but fluctuates with respiration and heart action...."
Huck, sorry you are having such a hard time of it lately. I do know what kind of discomfort Fibro can bring and it is not a pretty picture. I do hope the medication change will bring some much needed relief for you.
I am aware that the Birmingham Heart Clinic does not have surgeons. First I don't think I would have surgery at Med Ctr East, as I do not feel comfortable with the knowledge that they are way down the list of hospital rankings for Cardiac surgery of any kind. (Same thing for UAB) I think as a diagnostic facility they are okay, but would have to decline their surgical services there.
To clarify, I started having episodes of shortness of breath and one incidence of passing out about the time I was finally diagnosed with fibromyalgia. I was sent for a stress test, which was not conclusive as they claimed "deconditioned" ( I was in the midst of terrible muscular pain and unable to stay on treadmill as long as they would have liked) so I was sent for the cardiolite stress and it was reported to me appeared normal. I have obtained copies of these as well. These were done in fall of 2004. I had previously had an echo in 2001 that was negative as well.
I do have to mention here that I had some nerve damage from a delay in a cervical fusion which I feel may have affected the vagus nerve due to manipulation. I have had horrible nerve pain, difficulty swallowing, and feeling of a tightness and like swallowing a golf ball since that surgery in 2000. Followup with the surgeon and assessment of the esophagus 1 year post op showed no logical cause of those symptoms. Hence my belief that the vagus nerve was somehow compromised which definitely could affect heart function. I was also under a false sense of security as I attributed these findings as post op trauma and Fibro.
Now to answer your question, the aortic valve appeared trileaflet on the TEE. So it is my understanding from all the reading I have been doing, that for these findings to appear all at once and for the valves all to appear normal that it may definitely be attributed to the connective tissue supporting those valves. (I do wish I could share a wonderful heart site with you that explains very well the anatomy and physiology of the heart, structural defects and treatments, etc as well as a wonderful fibro site) BTW I was a nursing student as an adult and have always been fascinated with medicine, so you see why I research and even though it may have been pesty of me as a student, I always asked questions! I guess I always will!
Add to the whole mix that I have familial heart disease, hypercholesteremia and a history of Vioxx use for over a year, and this is what I get. (on one Vioxx site it does mention heart valve damage as a possible side effect)
I have been "pesty" with my computer all morning, digging for info for you and I always find something to help myself. It is inevitable when studying heart disease.
Goldy, I swear it raised the hair on my body when I read your statement about the diagnosis of Fibromyalgia, after you had had episodes of shortness of breath and passing out. I think maybe that is where things may have went wrong, I just don't know. There are so many "conditions" and variations of conditions. FM to me is just a general diagnosis when your body is aching and fatigued.
I truly believe that some heart conditions and the powerful medications to treat them, combined, cause some of the same symptoms as FM.
At this point I am really confused. I guess more than ever about having FM and heart disease.
Anyway I was reading about aortic valve repair on the CC web site and found that it does take minimally invasive surgery at least to repair or replace an aortic valve.
I started to compare your echo results to the reference ranges on my echo test results. I suddenly realized that a women's reference ranges should be different from a mans.
So I journeyed into the land of totally non standardized, subjectively interpreted echocardiograms. It blew my mind. Looky here:
Conclusions
Despite the widespread use of echocardiography for diagnostic purposes, interpreting and reporting of echocardiographic measurements is seriously limited by a lack of standardization of reference values. Furthermore, there is no agreement among echocardiographers regarding the partitioning of reference values (by sex, ethnicity, or age), the anthropometric measure to be used for adjustment, or the choice of cut-points to categorize values within the abnormal range. The generation of a consensus regarding these controversial issues merits urgent attention to render more scientific and consistent the interpretation of echocardiographic measurements within and between laboratories.
Have you read the survival statistics on aortic valve repair and replacements at the CC? If not I have them. They are 0% mortality for repair.
I also studied up on the vagus nerve and most organs of the body it can effect. It is a powerful nerve. I have the feeling that some symptoms you mentioned could be due to your heart, as well as nerve damage.
I would stay focused on the heart though Goldy. I have learned to listen to my body when it comes to my heart. Your heart will try to signal, or warn you that you need to dial 911. I have done this several times, due to chest pain and each time my life was saved by the insertion of a stent, that cleared a large blockage in one of my coronary arteries.
Now I can have no more stents in my most importantly coronary artery-the left anterior descending (LAD). Bypass surgery is next for me. My doc has said no more stents in the LAD. I have 4 already.
I have been reading about connective tissue disease and all of the info seems to be dominated by Marfan's syndrome. Remember, these people have very odd physical characteristics such as being really tall and having very large hands. A doctor can diagnose this syndrome by just looking at the patient, I think.
I also have hypercholesterolemia and cannot take any statin. My numbers are unbelievable.
The Vioxx is a real terror for me to hear. Those with FM have searched for any and everything to relieve their pain. I cannot believe that people are still taking Celebrex!
I had a dear friend that was a nurse that took the Phen-Fen combination and died last fall.
Well, I must drive from Clements (Limestone county) to the far side of Huntsville for a doctor's appointment today.
I am also having a high BP crisis. The change to Coreg has caused it. It takes a while for the full effect to take place. On my on I took a 150 mg dose of Avapro, an ARB which I just stopped due to adverse side effects. To date, I have tried every ARB and cannot tolerate them. I am like you when it comes to being super sensitive to medicines. I believe it could be combinations that cause the adverse reactions.
The study goes on. I have so much to say and so little energy and time to say it. Yes, once I was on an FM board, but now cannot sign in due to a glitch. There is an FM board here
Huck, Hope your trip to doctor was a good one and you find a solution for your medication challenge. I know any new med I receive I instinctively take 1/2 of the dose before I bombard my body with some possible harmful substance, then slowly increase after a few days. You learn to be in self-preservation mode and put up your defenses real fast when it comes to chemicals added to your body.
I had the same problem finding standardized values for the echo. I did find probably the same chart and realized that all of my values were under those listed as norms. I dug a little further and saw the controversy over no standard values available, but I do agree that BMI and age, weight, statute and of course, gender would have to be considered so there is undoubtedly no way one could arrive at a chart that could encompass all these variables.
I do want to clarify, I had Fibro symptoms as early as 2001 but was given the brush off as it's probably just muscle strain, arthritis, etc. I started with some of what I consider the neuro side of fibro (blurred, double vision), funny twinges and lightning bolt pains. It took me until 2003 to get someone to take me seriously. I do think the insult of my cervical fusion is what brought on all my fibro related symptoms. I even demanded a MS workup as I was convinced there was something systemic going on. I finally decided to seek a Rheumatologist opinion on my own and now you know the rest of the story.
I have to reiterate that prior to my late husband's illness and subsequent death, I had worked a full-time job and attended college classes 4 nights a week for over two years. So I have never been a person who was non-energetic. I thrived on challenges, so the more challenge in my life, the happier I was. I was the kind that could do anything, from painting my two story house, to putting down ceramic tile, or sodding my own yard. I was always up to the task, and if I did not know how to do something, I learned. Most out of necessity from being alone but some just because I loved being creative and busy.
Now if I have the strength to fix 3 simple meals and take my meds and see my dog is fed, I feel I have been productive. My fatigue is killing me. I am bored as I never have been a stay at home person. I worked all my adult life until it became increasingly difficult to hold a full time job. I finally gave up after having to start and stop so many times. I even tried part time but still could not be dependable.
So is the life.. I do understand. I happen to know a 45 yr old male who had a quadruple bypass and a mitral valve replacement all at once and he did very well, despite the fact he is a brittle diabetic and had some nerve damage from that. So there is hope for us. I just feel like once one little health issue appeared, it started a huge cascade of issues and one never knows when it is going to end.
Yes Ken, I really over simplified the function of the right heart when I said it "takes suction on spent blood".
I am using one of the basic laws of physics, which must take place in order for our blood to circulate. It is call delta p, or differential pressure.
You are most correct about the venous pump:
When you are in the upright position, the blood in your leg veins must go against gravity to return to your heart. To accomplish this, your leg muscles squeeze the deep veins of your legs and feet to help move blood back to your heart. One-way flaps, called valves, in your veins keep blood flowing in the right direction. When your leg muscles relax, the valves inside your veins close. This prevents blood from flowing in reverse, back down the legs. The entire process of sending blood back to the heart is called the venous pump.
I do not feel like putting my explanation of "taking suction" into my own words, so let me paste some info that I cannot supply references for, due to board rules. I will say that on an echocardiogram, it will note that in a healthy individual, the inferior vena cava collapses with each heart beat. This is due to negative pressure.
I may not have made my comments clear. I was and am referring to differential pressure due to contraction and then relaxation and that would cause negative pressure if you will. It can be said it is a push/pull action to sustain motion of spent blood from the lower portion of the body to the heart. The "pull" would be due to gravity and differential pressure (or suction!). The orignal topic was right-side heart failure and peripheral edema caused by loss of suction and then left-side failure. That was my take-away.
I haven't researched the subject, but it seems to me it is the contraction and relaxation of the smooth muscles of the VEINS that is the predominant force, except small veins, and in sync with the heartbeat. Respiration and skeletal muscles may have an indirect role as it relates to the heartbeat not directly to vein pulsation.
Quote:
Despite the widespread use of echocardiography for diagnostic purposes, interpreting and reporting of echocardiographic measurements is seriously limited by a lack of standardization of reference values. Furthermore, there is no agreement among echocardiographers regarding the partitioning of reference values (by sex, ethnicity, or age), the anthropometric measure to be used for adjustment, or the choice of cut-points to categorize values within the abnormal range. The generation of a consensus regarding these controversial issues merits urgent attention to render more scientific and consistent the interpretation of echocardiographic measurements within and between laboratories.
The subjectivity of the tech doing the echo attempts to closely outline the borders of the chambers at the end of diastolic and systolic, etc. The first time I had an echo the tech walked me through the procedure. It was obvious and pointed out the borders of the moving chamber is fuzzy and difficult to with the transducer to be precise.
The anthropometric measurement is objective and that also has been referred to in prior posts. Generally males have a larger heart than females. Larger sized men and women generally have larger hearts than their counterpart, etc. To compare M-Mode values with another poster's values may be misleading.
You both have very serious medical problems. I feel fortunate to be virtually asymptomatic despite my medical condition. Take care.
Thanks Ken for your clarification. I am happy that you are asymptomatic, I definitely hope that no other has to walk in my shoes at this time.
I do remember from Nursing school that the venous system does get assistance from the skeletal muscles. For one if you have ever had a surgical procedure and on bedrest, the best way to prevent a emboli, which primarily are only a problem in the lower limbs, as those in the arms rarely break way into the circulation of the blood; is to do foot pumping exercises. It is one of the first things they teach you in nursing school. Kind of the principle that moving liquid will not coagulate; thus preventing a nasty embolus. As put simply by my instructors, the milking action of the muscles keeps the flow of venous blood going in the right direction. It really is amazing when you know the simple principle. The one way valves assist in keeping the blood advancing back to the vena cava enroute to the heart to begin the whole cycle of the oxygenation and then to be dispersed back to the aorta to start the whole process over. I know it is far more detailed if you get down to the cellular level and mix in the lymphatic system's part in gathering of all the blood exchange from the cells, but that would take a biologist to really explain in layman's terms.
I know I was amazed when I took biology and you start with that one cell and all of the parts of the cell, different cell types and their characteristics and then when you get to the hospital setting, you realize why it was important to know how the cells worked and what part of a cell is targeted by certain medications etc.
I find that a lot of the research available online is simply not in layman's terms. I don't know anyone else's background here, but I do know that reading and comprehending some of the research material is way over my head, even though I do have a foundation in anatomy and physiology and medicine; although limited.
Also I do believe that the fluctuation of pressure in the chambers of the heart affects filling and emptying of each chamber. Otherwise, there would be no need to measure those pressures as diagnostic criteria.
I am always looking for answers, even though I know some questions simply have no answers. I may never know why all four of my valves appeared to lose their competence at the same time. I just mainly now am searching for the most information on how to treat and/or deal with the damage.
Thanks so much for your contributions, I always appreciate anothers' take on the situation.
Now what? 
Re: Now what? 
