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Suggest Treatment For Diastolic Cardiac Dysfunction And Symptoms Of Pulmonary Embolism
Question: I am a 57 year old S/P pericardial graft for herniation from a pericardial window. The surgery was 5 years ago for the graft, the window was over 30 years ago. I also have MS. I was dx with diastolic failure one year ago, being treated with lasix, spironalactone , to prol and flecanaid. I started with chest tightness ( like having a really tight bra on) ,and shortness of breath. Heart XXXXXXX ct of chest, cxr, 2 d echo, labs all ok with the exception of an elevated sed rate. I'm scheduled for a vq scan and a MRI of the heart next week. Checking for mobility with graft and small pe. I desat when ambulating. Drop from 100% to 92%. Could this be the graft causing the tightness and sob, it feels exactly like it did before the surgery for the graft. I was on anticoagulants for three years following the graft. Could the lake of O2 be from the dhf . I have intermittent edema and ascites. Is there reason for concern and should this be a serious problem for me. Thanks
Brief Answer:
You have a multi - task problem to resolve.
Detailed Answer:
Hello! Thank you for your question on HCM! Regarding your concern I would explain that shortness oof breathing and O2 desaturation coupled with edema and ascites raise strong suspicion on elevated systemic venous pressure, and thus on cardio-pulmonary functioning status:
(1) It may be an important diastolic cardiac dysfunction (cardiac ultrasound can confirm that); in that case diuretics regimen should be arranged properly.
(2) I don't know the reason for performing pericardial window, its existence implies 2 possible consequences: a) the reason that forced pericardial window need, may have compromised the lung functioning properly (pulmonary function test and pulmonary scan can rule it out); b) Yes, pericardial window may not function properly leading to abnormal fluid drainage or any adjacent structure interference (MRI may rule it out).
(3) Pulmonary embolism may be a reason for your complains ( V/Q scan and pulmonary angio CT scan can rule it out).
(4) Don't forget to check for MS exacerbations as it may impair respiratory drive and lead to respiratory distress in an already compromised cardio-pulmonary patient.
In the end, to cut it clear and short for you I would say that you have a multi - task problem to resolve. First to rule out pulmonary embolism as the most serious diagnosis (in that case you should be treated immediately in the hospital); and other pericardial window related consequences. Don't forget again MS.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings from Dr. Iliri.
You have a multi - task problem to resolve.
Detailed Answer:
Hello! Thank you for your question on HCM! Regarding your concern I would explain that shortness oof breathing and O2 desaturation coupled with edema and ascites raise strong suspicion on elevated systemic venous pressure, and thus on cardio-pulmonary functioning status:
(1) It may be an important diastolic cardiac dysfunction (cardiac ultrasound can confirm that); in that case diuretics regimen should be arranged properly.
(2) I don't know the reason for performing pericardial window, its existence implies 2 possible consequences: a) the reason that forced pericardial window need, may have compromised the lung functioning properly (pulmonary function test and pulmonary scan can rule it out); b) Yes, pericardial window may not function properly leading to abnormal fluid drainage or any adjacent structure interference (MRI may rule it out).
(3) Pulmonary embolism may be a reason for your complains ( V/Q scan and pulmonary angio CT scan can rule it out).
(4) Don't forget to check for MS exacerbations as it may impair respiratory drive and lead to respiratory distress in an already compromised cardio-pulmonary patient.
In the end, to cut it clear and short for you I would say that you have a multi - task problem to resolve. First to rule out pulmonary embolism as the most serious diagnosis (in that case you should be treated immediately in the hospital); and other pericardial window related consequences. Don't forget again MS.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings from Dr. Iliri.
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Thank you , you are the first physcian to understand and know that ms does play a huge role in pulmonary function. The window was for constrtive pericarditis, which lead to cardiac herniation and pericardial graft. Is it possible that the graft which was the size of a grapefruit has adhered itself causing the diastolic failure leading to the sob and chest discomfort. I notice that it is worse leaning forward and bending down. I was an active person until this started. And the sed rate being elevated would mean that theres inflammation,which would explain the chest pain. I have a history of superior vena cava syndrome following the cardiac surgery, from a mediport catheter, 80% occlusion with a left PE and a subclavian PE, which happened 6 months after the surgery. . So as you can see i have a complicated complex diagnosis. And lucky to have survived. I will see that i get to a doctor asap to figure out whats causing these symptoms.
Brief Answer:
Your diagnosis relies almost on imagine studies.
Detailed Answer:
Hello again!
Seems that you have achieved to manage a complicated serious disease like constrictive pericarditis, and all the subsequent complications derived during the course of treatment. Congratulations! As I said you before you should proceed in multidimensional reasoning in order to reach to the exact diagnosis.
Constrictive pericarditis as you may know is a consequence of several pathologies (rheumatoid arthritis; TBC, chest radiation, some drugs,etc). For sure that it may be already defined its etiology. Probably a persistent cause like rheumatoid arthritis (I don't know if is that the reason of your pericarditis), may exacerbate time after time and thus affect again the pericardial status, aggravating the symptoms of diastolic dysfunction. A raised erythrocyte sedimentation rate is in favor of such an inflammation. Don't forget that a newly inflammation appearance in the body may aggravate multiple sclerosis from the other side. So you have to be careful, and to promptly react in resolving this issue.
Pericardial graft should be investigated as it may be the source of a new possible constriction.
At the end, I would add that your diagnosis is relied almost to imagine studies (MRI, pulmonary and pericardial CT scan; V/Q pulmonary scan, cardiac ultrasound, etc). And of course an appropriate summarizing reasoning conclusion brings you to the final treatment strategy.
Hope that it comes soon. Please, let me know about those conclusions when you finish all the exams.
Wish you a good health! Greetings! Dr. Iliri.
Your diagnosis relies almost on imagine studies.
Detailed Answer:
Hello again!
Seems that you have achieved to manage a complicated serious disease like constrictive pericarditis, and all the subsequent complications derived during the course of treatment. Congratulations! As I said you before you should proceed in multidimensional reasoning in order to reach to the exact diagnosis.
Constrictive pericarditis as you may know is a consequence of several pathologies (rheumatoid arthritis; TBC, chest radiation, some drugs,etc). For sure that it may be already defined its etiology. Probably a persistent cause like rheumatoid arthritis (I don't know if is that the reason of your pericarditis), may exacerbate time after time and thus affect again the pericardial status, aggravating the symptoms of diastolic dysfunction. A raised erythrocyte sedimentation rate is in favor of such an inflammation. Don't forget that a newly inflammation appearance in the body may aggravate multiple sclerosis from the other side. So you have to be careful, and to promptly react in resolving this issue.
Pericardial graft should be investigated as it may be the source of a new possible constriction.
At the end, I would add that your diagnosis is relied almost to imagine studies (MRI, pulmonary and pericardial CT scan; V/Q pulmonary scan, cardiac ultrasound, etc). And of course an appropriate summarizing reasoning conclusion brings you to the final treatment strategy.
Hope that it comes soon. Please, let me know about those conclusions when you finish all the exams.
Wish you a good health! Greetings! Dr. Iliri.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
I will let you know my tests results as soon as they become available and thank you
Brief Answer:
You are welcome!
Detailed Answer:
You are welcome!
You are welcome!
Detailed Answer:
You are welcome!
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Going to be admitted to get diuresed. I will be seeing a chf specialist and hopefullybhe can get to the bottom of tjis so i can get some relief. I will notify u of any changes.
Brief Answer:
Notify me about treatment effects.
Detailed Answer:
I wish to you a fast relief from the complains. My best wishes! Dr. Iliri
Notify me about treatment effects.
Detailed Answer:
I wish to you a fast relief from the complains. My best wishes! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Prasad
I was hospitalized from wednesday nite to friday
nite. They gave me an push if lasix and in 45 min i was feeling better. I diuresed 2 liters in less than 8 hours. And 3 liters in a 24 hour period. My dr was astounded at the amount of fluid i had on board. My jugular was distended and after 3 doses of lasix it was back to normal. I felt better but still had the pressure of someone sitting on my chest and sob. I had a PFT which was completely normal. After seeing 10 physciians specializing in cardiac abd pulmondary a diagnoses was not obtained regarldless of my symptems, and the fluid i had and eliminated. So not meeting criteria to stay for admission i was discharged with instructions to take turosinide, daily weight and metalazole if i showed fluid buildup until my cardiac mri on tuesday. They tried to get it bumped up with no results, as they donthem only twoce a week. One of the drs that had worked on me when i had the svc clot 5 years ago even remembered me and was the one to do the mri, tried her best to get it moved bur could not. So here i am at home pretty bed boynd until tuesday when i go back from the mri which they are still not sure thats its the graft on the pericardium thats making my heart stiff. Thats what im told and its pericarditis as well. My lungs are clear and every test was normal but i had tgis huge amount of fluid on board causing the sob and chest pain. So im so confused as to what is causing the amount of edema without pulmonary congestion. It appeared to be isolated to my abdomen and chest area. I am still short of breath and have chest pain and taking the turosemide. Ive already taken one metalazole after not urinating in 3 hours. Im on percocet for pain which ive taken once with some relief but not complete. So i will continue to rest til tuesday and see what they find, if it is infact the graft they will call in the cardiothoracic surgeon who put the graft on and see what his recommendatins are. I wanted to let you know how things where going snd i will email you when i receive the results. Thank you
nite. They gave me an push if lasix and in 45 min i was feeling better. I diuresed 2 liters in less than 8 hours. And 3 liters in a 24 hour period. My dr was astounded at the amount of fluid i had on board. My jugular was distended and after 3 doses of lasix it was back to normal. I felt better but still had the pressure of someone sitting on my chest and sob. I had a PFT which was completely normal. After seeing 10 physciians specializing in cardiac abd pulmondary a diagnoses was not obtained regarldless of my symptems, and the fluid i had and eliminated. So not meeting criteria to stay for admission i was discharged with instructions to take turosinide, daily weight and metalazole if i showed fluid buildup until my cardiac mri on tuesday. They tried to get it bumped up with no results, as they donthem only twoce a week. One of the drs that had worked on me when i had the svc clot 5 years ago even remembered me and was the one to do the mri, tried her best to get it moved bur could not. So here i am at home pretty bed boynd until tuesday when i go back from the mri which they are still not sure thats its the graft on the pericardium thats making my heart stiff. Thats what im told and its pericarditis as well. My lungs are clear and every test was normal but i had tgis huge amount of fluid on board causing the sob and chest pain. So im so confused as to what is causing the amount of edema without pulmonary congestion. It appeared to be isolated to my abdomen and chest area. I am still short of breath and have chest pain and taking the turosemide. Ive already taken one metalazole after not urinating in 3 hours. Im on percocet for pain which ive taken once with some relief but not complete. So i will continue to rest til tuesday and see what they find, if it is infact the graft they will call in the cardiothoracic surgeon who put the graft on and see what his recommendatins are. I wanted to let you know how things where going snd i will email you when i receive the results. Thank you
Brief Answer:
Hope MRI comes to a helpful conclusion.
Detailed Answer:
Hello! I read all your prescription and I am sorry to know that still there isn't a final conclusion about your complains, and the causes of sytemic venous congestion. I hope that MRI will help to define which is the importance of pericardial constriction contribution to congestion (facing the reality that cardiac ultrasound didn't help in drawing the right conclusion).
Nevertheless you are forced to continue on diuretics in order to relief fluid retension and shortness of breath.
I wish and hope that such a rebus will come to an end soon.
Best Regards! Dr. Iliri
Hope MRI comes to a helpful conclusion.
Detailed Answer:
Hello! I read all your prescription and I am sorry to know that still there isn't a final conclusion about your complains, and the causes of sytemic venous congestion. I hope that MRI will help to define which is the importance of pericardial constriction contribution to congestion (facing the reality that cardiac ultrasound didn't help in drawing the right conclusion).
Nevertheless you are forced to continue on diuretics in order to relief fluid retension and shortness of breath.
I wish and hope that such a rebus will come to an end soon.
Best Regards! Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Raju A.T
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