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Does Water Retention Lead To Heart Failure When Diagnosed With PVC-induced Cardiomyopathy?
Question: Dear Dr.,
Last year I was diagnosed with PVC-induced cardiomyopathy. I was cured with an ablation procedure but I am haunted by the words of former cardiologist who told me that water would kill me and that I could never be cured. I constantly monitor my intake and output of fluids and am terrified when it seems output is low. My current doctors tell me pathological water retention is impossible with normal heart, kidney, and liver function, but I am constantly terrified and scared that I will retain water and go back into heart failure.
Is it normal for urine output to be quite variable even when input is the same and activity levels, sweating, food, are all the same too? I understand that there are insensible losses but it seems that with the way I monitor fluids, output should be the same. I am just frightened all the time that I am going to go into heart failure from water retention.
Echocardiogram from just last week attached as well as bloodwork.
Thank you very much,
XXXX
Last year I was diagnosed with PVC-induced cardiomyopathy. I was cured with an ablation procedure but I am haunted by the words of former cardiologist who told me that water would kill me and that I could never be cured. I constantly monitor my intake and output of fluids and am terrified when it seems output is low. My current doctors tell me pathological water retention is impossible with normal heart, kidney, and liver function, but I am constantly terrified and scared that I will retain water and go back into heart failure.
Is it normal for urine output to be quite variable even when input is the same and activity levels, sweating, food, are all the same too? I understand that there are insensible losses but it seems that with the way I monitor fluids, output should be the same. I am just frightened all the time that I am going to go into heart failure from water retention.
Echocardiogram from just last week attached as well as bloodwork.
Thank you very much,
XXXX
Brief Answer:
Following answer to your query.
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.
After reviewing your data especially cardiac echo, pro Bnp test results and chest x ray I would like to say that you have a normal functioning heart. The only abnormal findings are:
- mild mitral regurgitation
- trace aortic regurgitation
- mild tricuspidal regurgitation.
Please keep in mind that fluid retention is related to the following disease:
- heart failure
- severe valvular leakage (regurgitation)
- renal failure
- liver disease
As long as you don't have one of the above mentioned you shouldn't worry about water retention.
However, cardiac echo and blood work should be done every year in order to evidence if there's any progression of heart failure or valvular leakage. Please keep in mind that progression from mild to severe valvular leakage and heart failure needs many years. There's no need to make the check up more frequently (than once a year).
When this thing will happen (if it will) than mantaining a negative water balance is important and should monitor strictly every day. Otherwise you don't need to monitor it.
In theory water balance is depended on:
- water intake
- urination
- loosing water by other ways (sweating, diarrhea etc)
- electrolyte blood levels
- renal function
- Cardiac function
In patients will normal renal and cardiac function even if there's an electrolyte imbalance or you drink plenty of water it needs a maximum of 24 hours to restore the water balance and to avoid water retention. This is done by lowering or raising urine quantity and concentration.
The difference in urine output day by day is common, because urine quantity is essential to mantain normal electrolyte levels especially sodium levels.
Hope this will be of help!
Wish you health!
Dr. Shehu
Following answer to your query.
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.
After reviewing your data especially cardiac echo, pro Bnp test results and chest x ray I would like to say that you have a normal functioning heart. The only abnormal findings are:
- mild mitral regurgitation
- trace aortic regurgitation
- mild tricuspidal regurgitation.
Please keep in mind that fluid retention is related to the following disease:
- heart failure
- severe valvular leakage (regurgitation)
- renal failure
- liver disease
As long as you don't have one of the above mentioned you shouldn't worry about water retention.
However, cardiac echo and blood work should be done every year in order to evidence if there's any progression of heart failure or valvular leakage. Please keep in mind that progression from mild to severe valvular leakage and heart failure needs many years. There's no need to make the check up more frequently (than once a year).
When this thing will happen (if it will) than mantaining a negative water balance is important and should monitor strictly every day. Otherwise you don't need to monitor it.
In theory water balance is depended on:
- water intake
- urination
- loosing water by other ways (sweating, diarrhea etc)
- electrolyte blood levels
- renal function
- Cardiac function
In patients will normal renal and cardiac function even if there's an electrolyte imbalance or you drink plenty of water it needs a maximum of 24 hours to restore the water balance and to avoid water retention. This is done by lowering or raising urine quantity and concentration.
The difference in urine output day by day is common, because urine quantity is essential to mantain normal electrolyte levels especially sodium levels.
Hope this will be of help!
Wish you health!
Dr. Shehu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Shehu,
When you say "progression of heart failure" are you saying that because I once had cardiomyopathy, I will always have it, or that I am susceptible to a relapse? When I had cardiomyopathy, the mitral valve leakage was moderate and cardio says now trivial to mild and just trace tricuspid and aortic regurg. I was told it was extremely unlikely that valves would get worse and that echo every 5 years was all that was necessary.
Before my ablation, I had a cardio who told me water would kill me, that I would need to be on medication forever, and that I would never be cured. My current doctors all tell me I'm cured but his voice always stays in my head and it's why I am so obsessive about water.
As for medication, I was on Lisionopril for two months, but have been off for 10 months now. I had been on 9.375 bid of carvedilol but now down to 3.125 and it will be stopped completely at end of year. Do you think this is not the right plan?
My last echo, from last week shows EF Teicholz as 82, and Cardio's interpretation as 60. Why would the two values vary so much? Somehow now I worry both that my EF could be too high or too low.
So I shouldn't focus on differences in urination because it's a longer cycle? I panic when I take a drink and don't need to urinate within an hour or two. My weight is stable, no visible edema.
Thank you so much for your help.
XXXX
When you say "progression of heart failure" are you saying that because I once had cardiomyopathy, I will always have it, or that I am susceptible to a relapse? When I had cardiomyopathy, the mitral valve leakage was moderate and cardio says now trivial to mild and just trace tricuspid and aortic regurg. I was told it was extremely unlikely that valves would get worse and that echo every 5 years was all that was necessary.
Before my ablation, I had a cardio who told me water would kill me, that I would need to be on medication forever, and that I would never be cured. My current doctors all tell me I'm cured but his voice always stays in my head and it's why I am so obsessive about water.
As for medication, I was on Lisionopril for two months, but have been off for 10 months now. I had been on 9.375 bid of carvedilol but now down to 3.125 and it will be stopped completely at end of year. Do you think this is not the right plan?
My last echo, from last week shows EF Teicholz as 82, and Cardio's interpretation as 60. Why would the two values vary so much? Somehow now I worry both that my EF could be too high or too low.
So I shouldn't focus on differences in urination because it's a longer cycle? I panic when I take a drink and don't need to urinate within an hour or two. My weight is stable, no visible edema.
Thank you so much for your help.
XXXX
Brief Answer:
Following advice...
Detailed Answer:
Hi back,
First of all the progression into the heart failure after 20-30 years is the worse scenario and it may happen in around 15-20% of cases. The risk of progression is increased with:
- Aging
- The previous positive history for cardiomyopathy and
- The presence of valvular regurgitation
- The presence of stress and depression
However, as I said above this may happen after to many years from now and you shouldn't worry to much for the moment. In order to relieve your concerns I would like to recommend cardiac examinations once a year (cardiac echo and biochemical blood work). As long as your heart and kidney will be normal there's no way to develop water retention and edema (you may have misunderstood the doctor).
The measurement of cardiac EF is based on to many methods and Teicholz is one of them. The cardiologist interpret all these methods and the exact EF is 60% which is normal and you shouldn't worry about it.
As long as you are reducing the dose of cardiac preparations, your test results are normal and you are clinically healthy (no signs of water retention), then you shouldn't worry for anything. Please try to live a healthy life and try to be calm and relaxed. This is the best thing to do in your case.
Hope this will be of help!
Wish you health!
Dr. Shehu
Following advice...
Detailed Answer:
Hi back,
First of all the progression into the heart failure after 20-30 years is the worse scenario and it may happen in around 15-20% of cases. The risk of progression is increased with:
- Aging
- The previous positive history for cardiomyopathy and
- The presence of valvular regurgitation
- The presence of stress and depression
However, as I said above this may happen after to many years from now and you shouldn't worry to much for the moment. In order to relieve your concerns I would like to recommend cardiac examinations once a year (cardiac echo and biochemical blood work). As long as your heart and kidney will be normal there's no way to develop water retention and edema (you may have misunderstood the doctor).
The measurement of cardiac EF is based on to many methods and Teicholz is one of them. The cardiologist interpret all these methods and the exact EF is 60% which is normal and you shouldn't worry about it.
As long as you are reducing the dose of cardiac preparations, your test results are normal and you are clinically healthy (no signs of water retention), then you shouldn't worry for anything. Please try to live a healthy life and try to be calm and relaxed. This is the best thing to do in your case.
Hope this will be of help!
Wish you health!
Dr. Shehu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Shehu,
So it is simply impossible with my current good cardiac conditions and overall good health, to be retaining water? There is no need to track input/output and monitor weight?
Thank you very much,
XXXX
So it is simply impossible with my current good cardiac conditions and overall good health, to be retaining water? There is no need to track input/output and monitor weight?
Thank you very much,
XXXX
Brief Answer:
Following advice
Detailed Answer:
Hi back,
This is exactly what I'm saying to you. As long as you have a normal heart and an overall good health you shouldn't worry about anything.
Moreover there's no way that you retain water and you shouldn't monitor water intake and urination at all.
Wish You health!
Dr. Shehu
Following advice
Detailed Answer:
Hi back,
This is exactly what I'm saying to you. As long as you have a normal heart and an overall good health you shouldn't worry about anything.
Moreover there's no way that you retain water and you shouldn't monitor water intake and urination at all.
Wish You health!
Dr. Shehu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Shehu,
Thank you so much for your kindness and all your knowledge. I am trying very hard to be grateful for my recovery and not worry so much but I had one doctor tell me some very scary, inaccurate things so I am tryinf to get better.
Would lowered urine output be quite an advanced symptom of cardiomyopathy/heart failure? I ask this because even with EF of 25, I had very few symptoms and would never have known I was sick had I not gone to the dr for an allergy. I was told by the dr to watch my urination patterns and that any change meant I was in heart failure. As I have been doing this, of course every day is different and so I am afraid I am instantly going into heart failure. Would I have other symptoms before anything like CHF with watet retention occurred?
Many many thanks and wishing you a wonderful weekend.
XXXX
Thank you so much for your kindness and all your knowledge. I am trying very hard to be grateful for my recovery and not worry so much but I had one doctor tell me some very scary, inaccurate things so I am tryinf to get better.
Would lowered urine output be quite an advanced symptom of cardiomyopathy/heart failure? I ask this because even with EF of 25, I had very few symptoms and would never have known I was sick had I not gone to the dr for an allergy. I was told by the dr to watch my urination patterns and that any change meant I was in heart failure. As I have been doing this, of course every day is different and so I am afraid I am instantly going into heart failure. Would I have other symptoms before anything like CHF with watet retention occurred?
Many many thanks and wishing you a wonderful weekend.
XXXX
Brief Answer:
Following advice
Detailed Answer:
Hi and thank you for your compliments!
Lowered urine output it's not an advanced sign for heart failure. Dyspnea and lung congestions are more typicall for heart failure.
Moreover, if you will ever suffer from heart problems, you will have other signs before developing heart failure.
As long as cardiac echo and other examinations were normal you shouldn't worry about anything and you shouldn't nonitor urine output.
Wish you health!
Dr. Shehu
Following advice
Detailed Answer:
Hi and thank you for your compliments!
Lowered urine output it's not an advanced sign for heart failure. Dyspnea and lung congestions are more typicall for heart failure.
Moreover, if you will ever suffer from heart problems, you will have other signs before developing heart failure.
As long as cardiac echo and other examinations were normal you shouldn't worry about anything and you shouldn't nonitor urine output.
Wish you health!
Dr. Shehu
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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