dad getting weaker

[LynneJW]

Hi,
I hope someone here can give me some help with my dad. I'll start by giving you a brief history of his heart problems. He is 65 years old.
Back in the 80's (he was in his late 40's early 50's) he develloped atrial fibrillation. His rhythm didn't respond to medication (digoxin, etc), and he was cardio-converted a total of 7 times. The first few times he would maintain a normal rhythm for a few months, but then would return to a-fib. The last few times the cardi-conversion never worked at all. He had rheumatic fever as a child, and consequently one of his valves is damaged. He also had 2 episodes of congestive heart failure.
Other health history includes polycystic kidneys, with cysts convering his kidneys and liver. In his 30's he was diagnosed with non-hodgkins lymphoma, found in his spleen. The margins were clear and so he required only a splenectomy. My mom smokes, so he surrounded by second hand smoke, and he smokes an occaisional pipe or cigar.
He is very good about going for his annual physicals.
His medications at this point:
vasotec
tenormin (atenolol)
Avapro (irbesarten) for his high blood pressure
plavix (to prevent clots due to his irregular heart beat)
daily low dose aspirin
effexor (for depression)
For the past few weeks he has been feeling progressively weaker and short of breath. Up to this point he has been very active, walking everywhere, and playing golf on a daily basis. He is now using a cane to help him walk. He went to the doctor yesterday, and his lungs were clear, no evidence of heart failure, blood pressure normal, but he had a resting heart rate in the 90's. Right now he is at the hopsital having a chest xray and an EKG.
Does anyone have any clue about this? What would cause an increase in resting heart rate without a subsequent increase in blood pressure? He seems to be deteriorating quickly.
Thanks for listening!
Lynne

[Jack51]

Lynne, so sorry to hear about you Dad. He has/has had, many serious problems. I am not a medical professional at all, but due to my heart disease, I have studied the function of the heart and circulatory system for 3 years. Docs don't have time to explain all to you, or they didn't for me. I love to be of some help to those afflicted with this most unpredictible disease, so take what I say with a grain of salt. Your Dad's heart may be pumping faster, but each stroke may be less efficient than it was previously (in the past). That may be why his BP remains unchanged. His left ventricle ejection fraction (EF) may have decreased recently. You didn't mention which valve is bad, but, his heart maybe pumping blood to places other than his aorta, or his supply of blood to be pumped, may be being limited, depending on which valve is damaged. The heart has 4 valves that work in unison, and have a special timing in opening and closing.

The sob could be from the decrease in the overall performance of his heart (decreased EF). The volume of blood pumped through his kidneys may have decreased, which can cause edema in general and pulmonary edema (fluid on the lungs, which I have had). It could be from occluded coronary arteries, that weaken the heart, but angina should be a symptom, in this case.

The heart is actually 2 pumps made together. The right side circulates blood received from the veins, through the lungs and back to the left side. The left side circulates blood thoughout the body and back to the right side. The left and right side are separated by valves, and the lungs. If the mitral valve between the left atrium and left ventricle, fails to close or is damaged and cannot close fully, instead of blood being pumped to your LV, by your LA, it is pumped back up through the left atrium into the pulmonary veins, interfering with blood coming from your lungs.

A damaged tricuspid or pulmonary valve can interfere with deoxygenated blood going to the lungs. A damaged aortic valve failing to close properly, can increase pressures inside the left ventricle (LV), which is the strongest chamber in the heart, and which pushes fresh, oxygenated blood throughout our bodies.

He should have an echogram or heart ultrasound to determine his EF. When he feels up to it, he should have a nuclear stress test, and depending on these test, he may need a cardiac catheterization. My best for a speedy recovery for your Dad, and try not to worry

[LynneJW]

Thank you Jack for your reply.
The results from my dad's tests so far:
ekg was normal, except his HR was still in the 90's, and his pressure was 140/100 (lower pressure a little on the high side). His chest xray was a little disturbing. It hasn't been read by a radiologist yet, but the family doc said she saw a spot that could be a small amount of fluid. He has an apointment later next week with his cardiologist, and he is scheduled for a stress-echo at the end of november. He has been self medicating , taking lasix (leftover from a previous bout of heart failure) and he says this helps him with his SOB. The only thing the doc did was increase his tenormin.
Thanks for listening, I will keep you updated.
Lynne

[Jack51]

Lasix is a powerful diuretic if a high enough dose is taken and it is not kidney friendly. It removes lots of potassium as well as sodium from our blood. Older folks can get low on potassium really quick, and it can be lethal. He should ask his doc about potassium supplements, and make sure the doc knows he is taking the medicine. I had a bout with pulmonary edema, and it caused sob. I took Lasix for a while and do occasionally now. The damaged heart valve could be causing fluid to build up in his lungs (pulmonary edema). The Doc should be able to hear a murmur, if he has a bad valve, and glean a lot from what he hears. Bad heart valves can over pressurize the chambers of the heart and create problems with blood circulation through the lungs, which is one cause of pulmonary edema. My best to your Dad

[started04]

I was diagnosed with congestive heart failure (May 04). Although I am in the same age bracket as your father, I have never experienced any chest pains or any symptoms of a heart failure, but med report states I had an unstable angina experience. My research and the med dictionary states, "angina is any disease marked by attacks of chocking or suffication." My experience was a choking, coughing and a suffication feeling due to fluids back up into the lungs. Problem existed when lying flat. My HR was 101 (unusual) and my BP was 110/80 (usual) when entering ER (2 nights prior extreme distress). Never had a noticable med problem nor any medications.

You state 2 episodes of CHF. CHF is not an episodic experience, but it is a chronic condition that can be slowed or stopped with medication. And because CHF is chronic and progressive, medications have to be adjusted from time to time. Feeling weak is an indication the muscles are not receiving enough oxygen. The SOB is a signal from the brain the system is not getting enough oxygen (could be respiration problem). Faster breathing, faster HB, etc. is the system's attempt to balance the need with supply.

Sorry to hear about your father and hopefully medications can be helpful. Unfortunately, I suspect there is a time for all CHFers when medication ceases to be benefical and/or medication is ineffective. The fact that your father experienced the current symptoms quickly after being fairly active may be in his favor. My understanding during the final stage there is long period of almost helpfulness due to getting out of breath and tired doing almost anything. Hopefully medication will put your father back to where he was just prior to the decompensation. I wish you all well.