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Suggest Treatment For Poor Pumping Of Heart
Question: >I THINK DR XXXXXXX SARKAR DID AN EXCELLENT JOB>> Thank you for repeating your answer >> In the hospital report my wife went in the hospital Aug 19th with the heart pumping at 10% After being in the hospital a Another Ecko was taken on Aug 22 to assess left ventricular function (( EF =-10-15%pleural effusion is noted ))>>I just put in what is in the report<< After that they started an IV Drip of Dobutamine for most of her stay..To get her heart pumping better to move forward with the stent procedure. When they upgrade her pacemake with the ICD implantation (Comb)..I'm going to ask a what if question >.. If my wife's heart at anytime later start to pump at a lower rate of the 25% 10-15 or so can they put a extra wire to that area to help it get back to at least 25% >I know there is a device that can do this I just do not know the name of it..
This is a very important ???
Thank you Again
XXXX
This is a very important ???
Thank you Again
XXXX
Brief Answer:
CRT-ICD combination needs to be replaced
Detailed Answer:
Hi XXXXXXX nice to see you again. From your current query, I can see that your wife has got the best possible treatment for her heart failure. I think she has already got the combination of Cardiac Resynchronization Therapy + Implantable cardioverter defibrillator. It's right now the best possible modality of treatment for your wife. But, things can worsen only due to technical fault, like battery damage etc. or due to some infection. In the former case, the battery needs to be replaced or if there is device malfunction, which is not so common, it needs to be replaced right away. In case of any infection, that needs to be treated aggressively.
But, I don't think there is a better equipment in current practice to replace the same. What your wife is currently having is a combination of biventricular pacemaker and cardioverter defibrillator and they do very well what is needed- that is, synchronizing the heart beat and preventing abnormal increase or decrease in rate. Till the myocardium is viable, it will do the job very efficiently if it is running well.
But, if the entire ventricular musculature becomes non-viable, there is no device that can do heart's function. In that case, heart transplant will remain as the only viable option left for your wife. But, don't worry. I think your wife would do well if proper compliance to ongoing treatment is assured because I think you are having the best possible management for your wife.
If you are talking about non-responders to CRT-
I think the following are the options-
Device reprogramming
Transseptal endocardial LV pacing
Medical therapy to stimulate cardiac activity and prevent arrhythmia.
I hope, you are satisfied with the answer. And please don't worry. Your wife has fought this much and you have given the best possible support and she is at good hands. If things go on like this, she will survive with a better life.
If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
CRT-ICD combination needs to be replaced
Detailed Answer:
Hi XXXXXXX nice to see you again. From your current query, I can see that your wife has got the best possible treatment for her heart failure. I think she has already got the combination of Cardiac Resynchronization Therapy + Implantable cardioverter defibrillator. It's right now the best possible modality of treatment for your wife. But, things can worsen only due to technical fault, like battery damage etc. or due to some infection. In the former case, the battery needs to be replaced or if there is device malfunction, which is not so common, it needs to be replaced right away. In case of any infection, that needs to be treated aggressively.
But, I don't think there is a better equipment in current practice to replace the same. What your wife is currently having is a combination of biventricular pacemaker and cardioverter defibrillator and they do very well what is needed- that is, synchronizing the heart beat and preventing abnormal increase or decrease in rate. Till the myocardium is viable, it will do the job very efficiently if it is running well.
But, if the entire ventricular musculature becomes non-viable, there is no device that can do heart's function. In that case, heart transplant will remain as the only viable option left for your wife. But, don't worry. I think your wife would do well if proper compliance to ongoing treatment is assured because I think you are having the best possible management for your wife.
If you are talking about non-responders to CRT-
I think the following are the options-
Device reprogramming
Transseptal endocardial LV pacing
Medical therapy to stimulate cardiac activity and prevent arrhythmia.
I hope, you are satisfied with the answer. And please don't worry. Your wife has fought this much and you have given the best possible support and she is at good hands. If things go on like this, she will survive with a better life.
If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks for the update >>I will keep you informed >>She is going for a ECKO again on Monday Dec 1 XXXX
Brief Answer:
Thanks for the reply
Detailed Answer:
Thanks for your reply. You let me know whatever problem or query comes up to you. I shall try to answer them sincerely. And, it's wonderful talking with you.
If you find my answer helpful, please close the thread and rate my answer. For any query, please write back. And wish your wife all the best for her test result.
Regards,
Dr. Kaushik Sarkar
Thanks for the reply
Detailed Answer:
Thanks for your reply. You let me know whatever problem or query comes up to you. I shall try to answer them sincerely. And, it's wonderful talking with you.
If you find my answer helpful, please close the thread and rate my answer. For any query, please write back. And wish your wife all the best for her test result.
Regards,
Dr. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Brief Answer:
Lanoxin and Digoxin are same
Detailed Answer:
Hi XXXXXXX you are absolutely right. Lanoxin and digoxin are same medication. This increases pumping activity of heart and also improves baroreceptor function in heart failure. Thus it improves the hemodynamic status in heart failure. I am not going into technical details. In simple terms, it improves pumping and reduces ill-effects of heart failure. Your doctors were also correct in saying that.
If you find my answer helpful, please close the thread and rate my answer. For any query, please write back.
Regards,
DR. Kaushik Sarkar
Lanoxin and Digoxin are same
Detailed Answer:
Hi XXXXXXX you are absolutely right. Lanoxin and digoxin are same medication. This increases pumping activity of heart and also improves baroreceptor function in heart failure. Thus it improves the hemodynamic status in heart failure. I am not going into technical details. In simple terms, it improves pumping and reduces ill-effects of heart failure. Your doctors were also correct in saying that.
If you find my answer helpful, please close the thread and rate my answer. For any query, please write back.
Regards,
DR. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Shanthi.E
I will email you tomorrow after Muga test
Brief Answer:
Thanks
Detailed Answer:
Thanks for the information. I will check it out and reply back.
Regards
Thanks
Detailed Answer:
Thanks for the information. I will check it out and reply back.
Regards
Above answer was peer-reviewed by :
Dr. Shanthi.E
XXXXXXX Gotlieb, Saltzman, Edep and Brodsky, MD lLP
Progress Note
Patient Name:
PatientID:
Sex:
Birthdate:XXXX
5029
Female
January 13, 1931
Create Date: December 5,2014
Chief Compla int
• Follow-up visit
History Of Present Illness
The patient is a 83 year old Caucasian/White female, whose was initially referred by XXXXXXX Strobis MD i who has a history
of coronary artery disease, hlo pacemaker, hyperlipidemia, hypertension, and ischemic heart disease. She was last seen
on 12/oi/2014 and returns today for a follow-up visit.
STATUSOF CHRONIC CONDmONS:
Overall the patient has been doing fairly well. The hypertension has been well controlled on the patient's current
medications. The patient's mixed hyperlipidemia levels have been well controlled on the patient's current medication
regimen. The patient has a history of stable two vessel coronary artery disease. She underwent stenting of the RCAwith a
bare metal stent in 1999. The ischemic heart disease has been slowly progressive. The left ventricular ejection fraction is
moderately reduced. Recent MUGA had shown that her EF was now 35%. She was admitted to BRRH in 8/2014 with CHF.
Repeat EF was now 10% by echo. Cardiac catheterization showed critical disease of the LAD and RCA, which were both
successfully stented with DES. Her medication was maximized and a UfeVest was placed. Plan was to re-evaluate the EF
.90 days sip stent and possibly implant a BiV AlCD. She had an SVT which responded to beta blockade. Her recent echo
and MUGA now conflrm an improved EF of 37%.
Medications:
She is currently on medications listed in the PSFH.
CURRENTSYMPTOMS:
She has been experiendng fatigue.
The patient denies chest pain, dyspnea, and palpitations.
COMPUANCE ISSUES:
The patient states she has been compliant with recommended diet, level of exercise and medications. She has not had any
significant changes in weight since the last visit. The patient has been sedentary. She has never used tobacco.
RECENTSTUDIES:
The patient has undergone the following recent studies: echocardiogram. The echocardiogram revealed a reduced left
ventricular ejection fraction. The ejection fraction was 35-40 %. MUGA showed an EF 37% .
•We all pleased with her progress & Thank God also>>
There will do An Echo in 90 days again>>
If any other changes come up I will let you know
Please comment on this report >>>>
Thanks againXXXX
Progress Note
Patient Name:
PatientID:
Sex:
Birthdate:XXXX
5029
Female
January 13, 1931
Create Date: December 5,2014
Chief Compla int
• Follow-up visit
History Of Present Illness
The patient is a 83 year old Caucasian/White female, whose was initially referred by XXXXXXX Strobis MD i who has a history
of coronary artery disease, hlo pacemaker, hyperlipidemia, hypertension, and ischemic heart disease. She was last seen
on 12/oi/2014 and returns today for a follow-up visit.
STATUSOF CHRONIC CONDmONS:
Overall the patient has been doing fairly well. The hypertension has been well controlled on the patient's current
medications. The patient's mixed hyperlipidemia levels have been well controlled on the patient's current medication
regimen. The patient has a history of stable two vessel coronary artery disease. She underwent stenting of the RCAwith a
bare metal stent in 1999. The ischemic heart disease has been slowly progressive. The left ventricular ejection fraction is
moderately reduced. Recent MUGA had shown that her EF was now 35%. She was admitted to BRRH in 8/2014 with CHF.
Repeat EF was now 10% by echo. Cardiac catheterization showed critical disease of the LAD and RCA, which were both
successfully stented with DES. Her medication was maximized and a UfeVest was placed. Plan was to re-evaluate the EF
.90 days sip stent and possibly implant a BiV AlCD. She had an SVT which responded to beta blockade. Her recent echo
and MUGA now conflrm an improved EF of 37%.
Medications:
She is currently on medications listed in the PSFH.
CURRENTSYMPTOMS:
She has been experiendng fatigue.
The patient denies chest pain, dyspnea, and palpitations.
COMPUANCE ISSUES:
The patient states she has been compliant with recommended diet, level of exercise and medications. She has not had any
significant changes in weight since the last visit. The patient has been sedentary. She has never used tobacco.
RECENTSTUDIES:
The patient has undergone the following recent studies: echocardiogram. The echocardiogram revealed a reduced left
ventricular ejection fraction. The ejection fraction was 35-40 %. MUGA showed an EF 37% .
•We all pleased with her progress & Thank God also>>
There will do An Echo in 90 days again>>
If any other changes come up I will let you know
Please comment on this report >>>>
Thanks againXXXX
Brief Answer:
Cardiac function is acceptable
Detailed Answer:
Hi XXXXXXX thanks for posting the report.
As I can see here a summary of the treatment provided were noted in the former section. The main report says that the present EF is 37%. This means that post-operatively your wife has been doing well. More importantly, she is asymptomatic now except for the fatigue issue, which is pretty common after so much interventions and compromised cardiac function. Making her happy is very important at this stage because depression sets in among almost all the debilitated cardiac patient and that exacerbates lethargy, fatigue etc.
However, the compliance of the the you two to the treatment and the response of your wife to the treatment has been fantastic till date and your doctors have also appreciated that.
No significant change in weight is also a good sign, because that indicates no further accumulation of fluid.
She initially has double vessel disease and stents were placed. Thereafter, beta blockers were used to control arrythmia and patient was managed with medications and BIV ICD implantation was planned. Till date patient has improved significantly with stenting and medications and a repeat Echocardiography has been planned after 90 days to check the ventricular function again.
Simply speaking, the patient has responded very well to the treatment and currently regular follow up is ongoing. Please adhere to the treatment and management plan and I hope your wife would do do well.
If you find this answer helpful, please close the thread and rate my answer. For any future query, you can write back directly to me and I shall be happy to help.
Regards,
Dr. Kaushik Sarkar
Cardiac function is acceptable
Detailed Answer:
Hi XXXXXXX thanks for posting the report.
As I can see here a summary of the treatment provided were noted in the former section. The main report says that the present EF is 37%. This means that post-operatively your wife has been doing well. More importantly, she is asymptomatic now except for the fatigue issue, which is pretty common after so much interventions and compromised cardiac function. Making her happy is very important at this stage because depression sets in among almost all the debilitated cardiac patient and that exacerbates lethargy, fatigue etc.
However, the compliance of the the you two to the treatment and the response of your wife to the treatment has been fantastic till date and your doctors have also appreciated that.
No significant change in weight is also a good sign, because that indicates no further accumulation of fluid.
She initially has double vessel disease and stents were placed. Thereafter, beta blockers were used to control arrythmia and patient was managed with medications and BIV ICD implantation was planned. Till date patient has improved significantly with stenting and medications and a repeat Echocardiography has been planned after 90 days to check the ventricular function again.
Simply speaking, the patient has responded very well to the treatment and currently regular follow up is ongoing. Please adhere to the treatment and management plan and I hope your wife would do do well.
If you find this answer helpful, please close the thread and rate my answer. For any future query, you can write back directly to me and I shall be happy to help.
Regards,
Dr. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Shanthi.E
Brief Answer:
Anemia increases fatiguability
Detailed Answer:
Hi, thanks for posting again.
Normally Hb 11.6 doesn't cause any significant symptom, although this means that the patient has anemia. But, with compromised cardiac function such small decrease in Hb level and the resulting hyperdynamic state can cause increased fatiguability. Therefore, Hb should be restored to normal level at the earliest. Even if you restore Hb, you have to take care of the mental health of the patient. As I have said earlier, depression needs to be prevented with proper social and emotional support.
If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr Kaushik Sarkar
Anemia increases fatiguability
Detailed Answer:
Hi, thanks for posting again.
Normally Hb 11.6 doesn't cause any significant symptom, although this means that the patient has anemia. But, with compromised cardiac function such small decrease in Hb level and the resulting hyperdynamic state can cause increased fatiguability. Therefore, Hb should be restored to normal level at the earliest. Even if you restore Hb, you have to take care of the mental health of the patient. As I have said earlier, depression needs to be prevented with proper social and emotional support.
If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks again for you answer>>
Her mental health Seem to be ok >>
O I just gave your website to a friend >>
Ok lets get back to my wifes blood work>>
I was thinking of giving her some vitamins like Folic Acid & Iron Ferrous sulfate VERY Little at a time ????
I have been giving her a Vitamin B Complex for years>>
Thanks again XXXX
Her mental health Seem to be ok >>
O I just gave your website to a friend >>
Ok lets get back to my wifes blood work>>
I was thinking of giving her some vitamins like Folic Acid & Iron Ferrous sulfate VERY Little at a time ????
I have been giving her a Vitamin B Complex for years>>
Thanks again XXXX
Brief Answer:
You need to consult the treating doctor
Detailed Answer:
Hi, thanks for posting again.
It is good to hear that her mental health is ok now. And thanks for referring the site to your friend.
Now, coming to your question, my understanding is "a little" of iron and folic acid tablets are not treatment of anemia. If treatment for anemia is initiated, firstly the type of anemia needs to be identified. If it is found that the anemia is due to iron deficiency, IFA tablets may be used for correction of hemoglobin level at doses as per recommended protocol.
If your doctors have not yet checked for the complete anemia profile (MCV, MCH, MCHC, serum ferritin, TIBC), you need to talk to them regarding the requirement of same.
Following proper diagnosis of the type of anemia, appropriate treatment can be initiated. Till then, continue with the vitamin supplement as prescribed by your doctor.
If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
You need to consult the treating doctor
Detailed Answer:
Hi, thanks for posting again.
It is good to hear that her mental health is ok now. And thanks for referring the site to your friend.
Now, coming to your question, my understanding is "a little" of iron and folic acid tablets are not treatment of anemia. If treatment for anemia is initiated, firstly the type of anemia needs to be identified. If it is found that the anemia is due to iron deficiency, IFA tablets may be used for correction of hemoglobin level at doses as per recommended protocol.
If your doctors have not yet checked for the complete anemia profile (MCV, MCH, MCHC, serum ferritin, TIBC), you need to talk to them regarding the requirement of same.
Following proper diagnosis of the type of anemia, appropriate treatment can be initiated. Till then, continue with the vitamin supplement as prescribed by your doctor.
If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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