Terry, I am sorry it has taken me so long to reply to your post. To tell you the truth, I have been researching Diastolic Dysfunction so that I might have more information for you. The latest and best info is hard to come by, because you have to pay for it, and I have not.
I was diagnosed with DD in May of this year, after I had an angiogram (cath) performed at the Cleveland Clinic and also had a "high risk" stent inserted in to the very beginning of my Lad. It protrudes out into my left main.
The diagnosis can only be made for sure through cardiac catheterization, where they measure the left ventricular end diastolic fill pressure (LVEDP). If it is >20mmhg, then DD is diagnosed. Mine was 24mmhg in May. It had increased to 27 mmhg in September, when I had another cardiac catheterization for a minimally invasive direct coronary artery bypass (MID-CAB) evaluation via another cardiac catheterization.
In Europe DD is diagnosed at >16mmhg. This is weird to me...
An echocardiogram can "suggest" and probably with good accuracy that one has DD, due to the pattern and characteristics of the flow through the mitral valve. The flow from the opening of the LV (diastolic phase) creates a suction which begins the filling of the LV and is called "E" flow. The fill flow from the contraction of the left atrium is called the "A" flow.
The E flow should be much more than the A flow, but during DD, there is a "flow reversal" measured by the echo. Echos are so non-standard; one I had was explained as a poor E/A ratio of <1. I had one 3 days ago at a different cardiology group and it was called E to A flow reversal.
DD can lead to Diastolic Heart Failure which can lead to Congestive Heart Failure as you probably know. In order to be diagnosed with this type of dysfunction or heart failure, your heart's Ejection Fraction (EF) must be good. (strange-eh?)
This is also the newest type of heart failure and it is really hard to figure out why the left ventricle does not relax during the diastolic filling phase. I have read "non-compliance" until I am sickened by the term. Loss of elasticity is another term, but whatever it is, it does not effect the contraction of the LV.
Since it doesn't relax, the pressure inside your LV and left atrium increases. The worse the "non-compliance" gets, the higher these pressures get. My cardiologist explained to me that if they approach 30mmhg, they can cause high pulmonary veneous pressure, which causes CHF.
The biggest problem I see is that it can and has caused my left atrium to become enlarged. It also causes low cardiac output which is hurting me. We are super sensitive to blood volume changes. Do not let yourself become dehydrated. This will cause low cardiac output. Your LV does not fill with the same amount of blood it once did.
I am taking Coreg CR (beta blocker), an ACE inhibitor, a "slow acting" calcium channel blocker, Norvasc, and fast acting nitrolingual nitroglycerin (pill under the tongue), about 7 or 8 times in a 24 hour period. This is supposedly better than time released nitroglycerin or any long acting nitroglycerin. The Coreg is not mentioned by name, but it is supposed to be the best beta blocker for heart failure in general.
There is a new beta blocker for heart failure that has been approved only for hypertension, so far by the FDA. It is a "third generation" (new) beta-blocker called Nebivolol. (proposed brand name Bystolic) The FDA said the production facility was dirty, so this med will probably not be on the market until January 2008. This may be the best BB for DD, from what I have read.
These are the most frequently mentioned meds I can find and my cardiologist agrees with the regime. I am also taking other heart meds, but these I mentioned are recommended for DD.
It is also recommended to try to stay away from diuretics as much as possible, so I do not use salt and I try to watch the amount of liquids I drink. Most importantly I do not want to become dehydrated, but I do not want to "swell up" either lol.
CAD is one of the most common causes of DD, and I have plenty of that going on. There are also some other strange conditions that can cause DD. "Amyloidosis" is one of them.
If I learn anything else about DD, I will let you know. It is very, very important to maintain good posture. Do not slump forward!
Linear Mode
