Heart Failure

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Dianne,
Here is an excellent link for info on the diagnosis of heart failure from the American Association of Family Physicians:
[url]http://www.aafp.org/afp/20000301/1319.html[/url]

Absent the cough, I think heart failure is not your problem.
BUT persistent edema IS. There are a multitude of causes and if you search out "edema causes" you will find a week's reading.

Personally I think that Cozaar and a diuretetic work well together. I find the slightly hyperkalemic tendencies of losartan are more than balanced balanced by the stronger HYPOkalemic tendencies of most diuretics. I take Cozaar and HCTZ and ALWAYS have a slightly low, though symptomless, K+ (and low Na+.)

Make sure you ask your cardiologist to SPECIFICALLY rule out CHF for your mental well being!

[dianne12315]

Thank you for your explanation. I'm quite sure you're right that I don't have CHF although I have all the other symptoms except for the cough. As for the edema, well I guess I will just live with it then as well as the shortness of breath on exertion and feeling tired and weak.

Cozaar and a diuretic may work on some people but not everyone, Before I was put on Cozaar I was on Hyzaar 100/25 but it did nothing to lower my BP so Norvasc 10mg was added. My BP was still high so then Clonidine 1mg was added. In July of this year my feet and ankles started swelling up so every once in awhile I would take one of my mother's diuretics and the swelling seemed to go down.

However in August my feet and ankles swelled up and would not go down in spite of elevating my feet and taking the diuretics. On September 3 I went to my Cardiologist because of the swollen feet and ankles plus I was gaining weight. He discontinued the Hyzaar and put me on Cozaar plus Lasix 20 mg and that's when I ended up in the hospital with dehydration, low BP and an electolyte imbalance. They also found out that magnesium level was very low.

All of my blood levels are now normal. Norvasc was discontinued at the end of the September because one of the side effects was swelling of the lower legs. Lasix was increased to 40mg a day and I still gained almost 6lbs between Monday and Thursday. On Sunday evening when I went to my Internist because I didn't feel good and my feet hurt I had gained another 3 lbs. Since I left the hospital on 9/10 I have gained almost 15 pounds. It may be more now. I won't get on the scale anymore and I know it's not from what I'm eating.

I'm almost sure my symptoms are all in my head so therefore I'm not going to worry about anything anymore. I will just continue to go to work and push myself for as long as I can and ignore anything that is bothering me.

Thanks for your input.

[dianne12315]

Hi Everyone,

I saw the Cardiologist on Wednesday and after explaining everything to him that has been going these past few months he thinks it's either heart failure or my kidneys. I'm going for blood work and a urine test on Monday. At some point in the future he will do another echocardiogram and eventually a stress test. He also discontinued the Norvasc 10mg because he said it can cause swelling of the lower legs and feet. I don't know how long it will be before I see a difference in the amount of swelling but so far it's the same but then again it's only been three days since I stopped it.

I told him that it is very hard for me to take the Lasix while I was at work but he didn't seem to think it was a problem but it's a problem for me because if I don't take it then I get short of breath on exertion and I know I'm gaining weight. I had to buy new jeans because the ones I was wearing no longer fit. (I don't want to know what the scale says.)

I do have a question for anyone who might be able to answer it. When I went to the Internist he wanted me to go for an Abdominal/Pelvic CT Scan to rule out an abdominal obstruction. I looked up the symptoms of an abdominal obstruction on the computer and I have none of them. Why would he order the CT Scan if I had no symptoms? Would a CT scan show why my legs, ankles and feet are swelling up? Will a CT scan show if there are blockages in the arteries or veins leading to my feet? Sorry for asking so many questions but I couldn't understand his reasoning. I still didn't go for the CT scan because I don't think it will show anything.

Also when I was in the hospital when I was 19(minor surgery) I was told I had a heart murmur. Is it possible that it cleared up by itself and if I still had it wouldn't it have shown up on the Echocardiogram I had done last year?

Also in addition to the edema in my legs and feet I have noticed some in my arms and also in my face when I first get up in the mornings. The swelling in my face is mainly around my eyes and goes away after a few hours. Could that also be caused by the Norvasc?

Thanks for taking the time to read my post. I appreciate any information or advice that anyone has to offer. I'm about ready to give up on the doctors and just deal with the swelling but it's the shortness of breath and weakness that gets to me some days.

Dianne

[Fizzickle]

Dianne:

Although you're probably kidding, don't give up on the doctors. CHF is not something to ignore, and your symptoms certainly would indicate the possibility of CHF.

Your echocardiogram would sure 'nuff show valvular problems. The echo report you posted from two years ago talked of 'trace' regurgitation in the mitral and tricuspid valves. And this would probably be heard as a slight murmer. A new echocardiogram would be indicated, to see among other things if anything has worsened in this respect. And I would hope that ejection fraction would be estimated this time.

As I said in an earlier post, we Lasix takers always have an eagle eye out for the nearest bathroom. The effects on me seem to last about 3 hours. Is it possible you could take this after work and the effects be largely gone by bedtime? I know it's a problem, and there are several days in the week I can't take Lasix in the morning because of early appointments, but I still try to work it in later if I feel that it's needed.

I take 5 mg Norvasc, along with 20 mg Vasotec bid for blood pressure. It is true that Norvasc is not recommended for those with CHF. but it seems to give me better blood pressure control. Don't know how long it would take to reverse the fluid retention qualities of this medicine, but doubt that it would be longer than a week.

I have no idea why the doctor would call for an abdominal CT unless he's looking for an abdominal aortic aneurism. But don't think that would be described as a "blockage". So I plead ignorance on this one.

I really do sympathize with your frustration. But please follow up with at the tests that are being recommended.

Regards
Bill

[dianne12315]

Hi Bill,

Thanks for your response but I'm not so sure I was kidding about giving up on the doctors. I keep getting the feeling that they are not taking my sypmtoms as serious as I am. To look at me you would never think there was anything wrong with me until you ask me do something strenuous like climb a flight of stairs then you would notice the shortness of breath. I have been climbing the stairs in my house for the last 45 years and I never remember getting short of breath. That started about a week before I went into the hospital and it still continues. I know I'm overweight but I've been that way since I was 18. Climbing stairs was never a problem.

You are lucky that the Lasix wears off in 3 hours. That is not the case with me. I took it 9am this morning and it's now 5pm and I'm still running to the bathroom but then I have days that I take it and it doesn't work at all. I have no idea why. If I take it when I get home from work (3:30pm) I'm not so sure it would be worn off by the time I go to bed. (10pm). I get up at 4am so if it's not then I don't have much time to sleep. I get up 2 or 3 times a night without Lasix I can only imagine what my night would be if I took it late.

I did good on Hyzaar 100/25mg for awhile but then it was no longer effective by itself so in 2002 the Norvasc was started. I had slight swelling of my ankles and feet before starting it though but it was never as bad as it is now. A few months after the Norvasc was started I was put on Clonidine .1mg. This combination worked pretty good but my BP was never as good as the dr wanted and then with the swelling he added the Lasix. I have been off the Norvasc since Thursday and I don't see a difference yet.

I don't know why this doctor (my Internist) would want the CT scan either. I'm sure if I had an abdominal aortic anerusim I would have more symptoms than retaining fluid. I'm not going for it anyway.

I will go for the BNP blood test,the urinanalysis and the follow up appointment on the 17th but my faith in doctors is fading.

Thanks for your advice and I will follow up with the recommended tests.

Take care,
Dianne