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    Old 06-22-2007, 03:50 AM   #1
    kimberlye
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    Enlarged heart questions

    I've been having issues for about a year. My BP went through the roof in May 2006. 202/120. They said I was at stroke levels. anyway I went to the emergency room about 6 times, thought I was having a heart attack. They ran EKG said no heart attack that I was having anxiety attacks. Went to the doctor and he gave me Lexapro and BP medication.. atenolol and Benicar with a water pill in it. Ran blood work and ekg and some other tests and said I was fine. About a month later I complained of shortness of breat, dizziness and weight gain. I had at that point gained about 30 pounds in that month. My legs and feet and hands were swelling. They always swell before when it was real hot but now swelling when it was hot and if I sat for long periods of time. Which I do everyday for my job. ANyway... got a new doctor. Went in told him I can't breathe very well. I mean I can't walk upstairs to go to bed without being out of breathe. Seemed to get worse when I lay down. BP going up sometimes but worse when I lay down to go to sleep. First told me that my BP was up and upped my Benicar. Then told me I couldn't breath because I had bad lungs. I am 38 years old and a smoker. They ran more blood work and a CT scan of my lungs. He said everything was normal. Cholesterol a little high but not outrageous. CT scan normal no lung cancer or anything like that. He said you have bad lungs. Then the heart echo came back. The doctors office didn't call me they sent a letter saying I needed to make an appt to get the results. Luckily I had called them and got in the next day. This was three days ago. If I had waited for the letter I'd probably be dead right now! LOL So I went in and he said my LBH was severly enlarged. I knew I had an enlarged muscle in my heart but it was never said to be SEVERELY enlarged. He said severely enlarged and my BP was 162/96 which he said was way too high. He upped my atenolol this time to lower my BP and for the enlargement. He said your on the verge of a stroke or CHF if your not already in heart failure. He ran a blood test to see if I was already in failure and is sending me to a cardiologist. I've been having alot of swelling in the feet and hands but not any real heart or chest pains.

    I guess at this point my question is can this be reversed? Will the medication reverse the enlargement? I do feel better already just since he upped my atenolol and my BP has come down. IS my BP up because of the enlargment or the enlargement is caused by my BP being up? ALso he prescribed me a diuretic or water pill. I don't think it is working. Its only 25 mg and my Benicar as 12.5 mg. I dont' go to the bathroom any more often though. I seem to only go a few times a day. Should I ask him to up the diuretic? My feet are still swelling and I guess thats a sign of CHF... right?

    I know the enlarged heart muscle is hereditary..... they told me that when I was 24 and my father has been in CHF for 25 years. My sister also has an enlarged heart muscle. They tell her its no big deal like they told me years ago. If I had kept taking the atenolol when they prescribed it to me when I was 24 would that have kept this from happening? Any advice would be appreciated.

    Thanks!

    Kim

     
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    Old 06-22-2007, 04:20 AM   #2
    Lenin
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    Re: Enlarged heart questions

    Hi Kim,
    Sorry you are going through this problem.

    A couple thoughts.
    First and almoost foremost, make TODAY your last day of smoking...for you it might save your life.
    Make sure your cardiologist is the best in Ohio.
    Your severely enlarged heart is a most serious matter, and it MAY signify heart failure. A lot of your symptoms will come from edema and it seems that 12.5 mg. HCTZ is really NOT enough to relieve it. I would think something like 50 mg./day at least until you see your legs deflate and you pee out that 30 pounds. My diuretic of choice would be 40 mg. Lasix <furosemide> every day with a big potassium supplement (20 MilEquivalent horse pill.)

    You MUST keep your BP down to ease the load on your heart but don't up the Benicar any until you are at DRY WEIGHT with diuretics and you can see what's what. When you reduce that water load, you may find your BP behaves and your symptoms abate.
    PLEASE, though, no more smoking...your lungs and heart WILL NOT handle much more of it.

    You need a good caring, cardiologist and as soon as you see him, consider yourself entirely in his hands...ignore anything your GP told you. Lay out very clearly that you gained all that water weight in a month, that you think your diuretic is inadequate, etc. He will be earning good money off you so make him earn it. Make sure he gives you a good estimate of your ejection fraction...that's an estimate of how efficiently your heart is pumping and is a number you need to know.

    Quote:
    He ran a blood test to see if I was already in failure and is sending me to a cardiologist.
    That was most likely a test for a protein called BNP (a marker for heart failure)...what was the result? If he got the result and didn't tell you, give him a call and ask. In fact, when you call, ask him if he can call in an Rx for 40 mg. furosemide. He can say YES or NO. (If he says you must come in and pay for anotther office visit to get the script, ask him if greed runs in his family or his is an isolated case. )

    When is your cardio referral?

    Last edited by Lenin; 06-22-2007 at 04:24 AM.

     
    Old 06-22-2007, 09:26 AM   #3
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    Re: Enlarged heart questions

    Kim, did you make a typing error? The area of interest is the left ventricle (LV) and the condition is hypertrophy (enlarged) LV...LVH.

    It appears there may be LV contraction impairment. The blood test will include a test for troponin I level and if high could indicate a heart injury. Also, a CK-MB level, if high, would indicate dead heart cells. It is a protein released from dead cells.

    I agree with your doctor and based on your information (symptoms) it appears you may have some congested heart failure.

    The progress of your present condition is first the narrowing and some blockage of vessels. This will increase bp and the heart works harder. The LV will continue to enlarge in response to low cardiac output but eventually an oversized ventricle reduces the strength of contractions. This can result in heart muscle damage due to a deficit of oxygenated blood. Low cardiac output backs up blood to the lungs and fluids leak out into the lug tissues (pulmonary edema).

    Yes, it can be reversed if the heart cells are not dead (negrosis). The protocol would be meds, bypass or stent implant, thereby decreasing the heart's workload and after period of time the heart can reverse remodeling. The decrease in size (less work) will increase contractions, and increase cardiac output. The additional blood supply to areas of damage can sometimes revitalize (stunned not dead) heart cells.

    Two years after my CHF the heart size has returned to normal.

    Last edited by started04; 06-22-2007 at 09:44 AM.

     
    Old 06-22-2007, 06:46 PM   #4
    kimberlye
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    Re: Enlarged heart questions

    Quote:
    Originally Posted by Lenin View Post
    Hi Kim,
    Sorry you are going through this problem.

    A couple thoughts.
    First and almoost foremost, make TODAY your last day of smoking...for you it might save your life.
    Make sure your cardiologist is the best in Ohio.
    Your severely enlarged heart is a most serious matter, and it MAY signify heart failure. A lot of your symptoms will come from edema and it seems that 12.5 mg. HCTZ is really NOT enough to relieve it. I would think something like 50 mg./day at least until you see your legs deflate and you pee out that 30 pounds. My diuretic of choice would be 40 mg. Lasix <furosemide> every day with a big potassium supplement (20 MilEquivalent horse pill.)

    You MUST keep your BP down to ease the load on your heart but don't up the Benicar any until you are at DRY WEIGHT with diuretics and you can see what's what. When you reduce that water load, you may find your BP behaves and your symptoms abate.
    PLEASE, though, no more smoking...your lungs and heart WILL NOT handle much more of it.

    You need a good caring, cardiologist and as soon as you see him, consider yourself entirely in his hands...ignore anything your GP told you. Lay out very clearly that you gained all that water weight in a month, that you think your diuretic is inadequate, etc. He will be earning good money off you so make him earn it. Make sure he gives you a good estimate of your ejection fraction...that's an estimate of how efficiently your heart is pumping and is a number you need to know.


    That was most likely a test for a protein called BNP (a marker for heart failure)...what was the result? If he got the result and didn't tell you, give him a call and ask. In fact, when you call, ask him if he can call in an Rx for 40 mg. furosemide. He can say YES or NO. (If he says you must come in and pay for anotther office visit to get the script, ask him if greed runs in his family or his is an isolated case. )

    When is your cardio referral?
    Wow you sound like you know what your talking about LOL I just smile and nod at the doctor because i don't have a clue. I did take a friend with me though that has been through alot of this with her dad. Anyway... I am only on 25 mgs hydrochlorothiazide? Thats what my water pill bottle says. Then theres the 12.5 included in the Benicar pill. He already upped my Benicar last week from 20-12.5 mg to 40-12.5 mg. Then of course the 50 2x a day atenolol and he did give me a 10 meq potassium pill. Its pretty huge! I have a stage 4 airway and its pretty hard for me to swallow all these pills everyday.

    They have not called me to give me my appointment date yet for the cardiologist. And you were absolutely right the test was for BNP and as far as I know he doesn't have the result yet. He may have gotten it today but if he did he didn't call me. I will call him first thing monday morning and check on the results, the appointment and to see if I can get that prescription. This is day three on the water pill and I've peed about 3 times today. I am thinking of doubling them over the weekend..... would that hurt anything?

    What about stress? I feel like I fly off the handle and I'm stressed all the time. Of course my immediate family (the ones living in the house) don't seem to care that they are stressing me into death!!!! Someday when I'm gone they will decide they give a crap I guess. Anyway thanks for the info and I'll check back as soon as I get more info.

    Thanks

    Kim

     
    Old 06-22-2007, 06:55 PM   #5
    kimberlye
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    Re: Enlarged heart questions

    Quote:
    Originally Posted by kenkeith View Post
    Kim, did you make a typing error? The area of interest is the left ventricle (LV) and the condition is hypertrophy (enlarged) LV...LVH.

    It appears there may be LV contraction impairment. The blood test will include a test for troponin I level and if high could indicate a heart injury. Also, a CK-MB level, if high, would indicate dead heart cells. It is a protein released from dead cells.

    I agree with your doctor and based on your information (symptoms) it appears you may have some congested heart failure.

    The progress of your present condition is first the narrowing and some blockage of vessels. This will increase bp and the heart works harder. The LV will continue to enlarge in response to low cardiac output but eventually an oversized ventricle reduces the strength of contractions. This can result in heart muscle damage due to a deficit of oxygenated blood. Low cardiac output backs up blood to the lungs and fluids leak out into the lug tissues (pulmonary edema).

    Yes, it can be reversed if the heart cells are not dead (negrosis). The protocol would be meds, bypass or stent implant, thereby decreasing the heart's workload and after period of time the heart can reverse remodeling. The decrease in size (less work) will increase contractions, and increase cardiac output. The additional blood supply to areas of damage can sometimes revitalize (stunned not dead) heart cells.

    Two years after my CHF the heart size has returned to normal.
    I could have swore he said LBH. maybe he did say LVH. They haven't said anything about me having any blockage. I thought they could tell that from the ekg or the blood test that they ran. They have been telling me for a year that there is no blockage and my heart is fine except for this enlarged muscle. Blocking of arteries did not cause the muscle to enlarge.... it has always been slightly enlarged.... they keep saying it is inherited. That its always been like that I just didn't know because I didn't have any issues with it. I guess it became more enlarged and thats when I started having issues. Anyway I guess I'll know more once I see the cardiologist. I'm sure he will explain it to me thoroughly. I'm not sure my GP knows exactly what its all about he just knows its not right LOL anyway I'm trying to keep my spirits up and not get too depressed about this situation. It didn't hit me very hard at first but it is now. I've been depressed all evening and I think thats only making it worse. I think my BP is oging up with all the crying and being upset. I'll post more once i get more information.

    Thanks!

     
    Old 06-23-2007, 07:33 AM   #6
    Lenin
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    Re: Enlarged heart questions

    kim,
    Quote:
    I am only on 25 mgs hydrochlorothiazide? Thats what my water pill bottle says. Then theres the 12.5 included in the Benicar pill
    That total of 37.5 mg. is pretty good, is your weight falling? Sometimes with a LOT of water retention they may prescribe as much as 300 mg.HCTZ to get it down quickly. Your dose should work but it may take a few weeks.
    Keep that huge dry 10 MeQ potassium pill in your mouth with water dor a second or two til you swallow it...it makes it slipprier. I learned that lesson when I gulped a handful of pills and the damn KCl must have gone down sideways and lodged in my throat...it left like someone was trying to open my throat with a can opener for about 10 minutes. Splitting them in two helps.

     
    Old 06-23-2007, 11:45 AM   #7
    kimberlye
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    Re: Enlarged heart questions

    Quote:
    Originally Posted by Lenin View Post
    kim,


    That total of 37.5 mg. is pretty good, is your weight falling? Sometimes with a LOT of water retention they may prescribe as much as 300 mg.HCTZ to get it down quickly. Your dose should work but it may take a few weeks.
    Keep that huge dry 10 MeQ potassium pill in your mouth with water dor a second or two til you swallow it...it makes it slipprier. I learned that lesson when I gulped a handful of pills and the damn KCl must have gone down sideways and lodged in my throat...it left like someone was trying to open my throat with a can opener for about 10 minutes. Splitting them in two helps.
    I've only been taking the water pill since wednesday. I haven't noticed my weight going down. I weighed myself friday I will stop again monday and do it again. THat potassium pill is so huge and nasty LOL I will try that to see if slippier makes it go down easier. I am so freaked out. I don't know if I am feelings things or if they are in my head. I would swear that my left arm and hand is tingling. I had to walk up town a bit today and i would swear the more worn out I got the more my left arm and hand tingled. But its such a dull feeling that I don't know if I am feeling it or if I am imagining it. My chest feels ...... I won't say tight or even hurts... maybe full. It feels full sometimes. and sometimes I swear I am having soreness...... not pain but like if your ankle is sore. Does that make sense. It doesn't hurt it just feels sore almost like if you could touch it it would hurt to the touch. I am feeling this on the left side like at the top and maybe right behind my breast. I was under the idea that if your heart really hurt it would hurt more in the center of your chest. I have a lot of actual pain in my shoulder but it doesn't like radiate down my arm or anything. I deliver newspapers and I throw most of my papers with my left arm. My old doctor has been telling me all along that the pain I'm feeling across the top of my chest and in my shoulder is from throwing the papers. But I'm not so sure anymore. I also feel alot of pain in the left side of my back like around or above my shoulder blade. but again thats been going on for most of a year. I guess I just need to get into see the cardiologist as quick as possible so I don't drive myself crazy with every pain or ache I have.

     
    Old 06-25-2007, 05:00 PM   #8
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    Re: Enlarged heart questions

    I called the doctors office today to see if they made my appointment with the cardiologist....... They said and I quote... its on the stack of things to do we'll call you when we get to it. Can you believe that??

     
    Old 06-28-2007, 11:09 AM   #9
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    Re: Enlarged heart questions

    Kim,

    I have LVH actually it is at least mine is Left Ventricle Hypertrophic Cardiomyopathy. And is very serious. the enlargement is on the INSIDE of the left ventricle and what happens is if it keeps growing the thickness starts to constrict the veins around the heart and can cause what I am enduring is a almost constant and alot of the time very painful chest pain. I was good for a long time. Then a year after i had a pacer/defibrilator implanted the pacer wire fractured in the vein and caused a whole lot of problems. that was 2002
    I have not been able to work since 2003. I have been in & out of the hospital with congested heart failure, Bouts of uncontrolled chest pain....
    Some days i can barely get out of bed. I have a great husband that cares for me. I am 46. Preparing to get on the heart transplant list & wait, And Pray that one day i will function again. Play with my grandchildren,yes 1 have 2.
    Sometimes they don't get that Grandma looks okay,and i, do but i am unable to really play with them for more that a few minutes. It will take your family a
    bit to understand your plight but keep your chin up its hard for them too. Having an ill person in there lives might be hard for them to take.
    It is now trying to get help,all our savings are gone and the dr bills don't look like they will ever stop.
    And meds changing trying working with the drs to get to feeling a little better,
    tryin to find that working combo.
    What a JOY ride..
    My best advise....Be sure to get an echocardiogram(ultrasound of the heart)
    this is the test that will give the answers, Ask for it, be your own advocate.
    Don't let the Dr settle for just an ekg. get the echo, this is also the test that should be given to all and any athlete as part of the Sport exam. It is the only way to be sure.

    Cleveland has an excellant
    heart clinic.

    I will keep you in my thoughts and prayers.
    God Bless ,
    Laura

    Last edited by moderator2; 06-28-2007 at 11:29 AM. Reason: Please do not post websites except as described in the posting policy section titled "How to share information".

     
    Old 06-28-2007, 04:36 PM   #10
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    Re: Enlarged heart questions

    Laura, the LV enlargement you are referring to is restrictive cardiomyopathy of the left ventricle. This enlargement of the internal wall has a direct effect on the filling phase (diastole) as the chamber size is reduced as well as a thickening of the heart wall that affects contractions.

    The end result is less oxygenated blood is available with each heart beat and consequently reduced tolerance for activity. And of course there is a crowding out of vessels that can be painful. Very serious and requires a heart transplant. I hope it goes well for you.

    I, from my previous post, am suggesting Kim's doctor is referring to dilated LVH. An enlargement of the LV chamber size (internal) will after increasing cardiac output (compensation) will eventually dilate to a size that hinders contractility and reduce the cardiac output. Less serious and may be controlled with medication by reducing the heart's workload.

     
    Old 07-01-2007, 08:51 PM   #11
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    Re: Enlarged heart questions

    I got the blood test back. The doctor said I was not in heart failure at this point. He said my BNP I think was what the test was for..... was 20 which he said was good. I still haven't gotten the call from teh cardiologist for the appointment yet. I feel alot better then I did but not great yet. I'm still short of breath sometime but not as often as I was before. My blood pressure was down to almost perfect wednesday when I was at the drs. It was 122/83. He said hopefully with the blood pressure down and the medication the enlargement will correct itself. I hope thats true. Sometimes I feel pretty good and then wham I feel like crap again. Maybe its the medicine making me feel like crap.

     
    Old 07-23-2007, 08:26 PM   #12
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    Re: Enlarged heart questions

    Kim,
    Water pills work best on an empty stomach and you can ask for the potassium to be prescribed in a liquid form. It is a powder you mix with water. i take it that way.
    Lee

     
    Old 07-24-2007, 04:54 AM   #13
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    Re: Enlarged heart questions

    kimberlye,

    Sorry I didn't see your last post til now. That 20 BNP is WONDERFUL and it really indicatews that you are not in heart failure.
    Are you getting rid of that edema? If not, consider that switch to Lasix.

    Lee,
    I've even looked into buying the KCl powder in bulk from a manufaturere (they're all in CHina ) but you;ve got to buy a gazillion pounds to save much money...and the shipping charges are horrendous.

    Last edited by Lenin; 07-24-2007 at 04:58 AM.

     
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