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What Can I Do To Help Myself To Stop Things Progressing Moderate LV Systolic Dysfunction?
Question: Can you please tell me what the following mean?
1. Ischaemic heart disease with previous PCI to LAD with residual mid circumflex disease there was visually moderate to severe with a negative FFR
2. Moderate LV systolic dysfunction secondary to ischaemic cardiomyopathy
3. Mildly impaired right ventricular systolic dysfunction
I am worried about the above as I have no symptoms. Occasionally I get short of breath when walking but fine when I stop and I have leg swelling which is being controlled on Furosemide.
What can I do to help myself to stop things progressing?
Can I still have a while to live I worry I am coming to end of life. What stage do you think I am at.
1. Ischaemic heart disease with previous PCI to LAD with residual mid circumflex disease there was visually moderate to severe with a negative FFR
2. Moderate LV systolic dysfunction secondary to ischaemic cardiomyopathy
3. Mildly impaired right ventricular systolic dysfunction
I am worried about the above as I have no symptoms. Occasionally I get short of breath when walking but fine when I stop and I have leg swelling which is being controlled on Furosemide.
What can I do to help myself to stop things progressing?
Can I still have a while to live I worry I am coming to end of life. What stage do you think I am at.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
I passed carefully through your question and would explain that these findings are suggestive of chronic ischemic changes in the heart and possible heart failure.
I would like to know if you experience shortness of breath during the night? What is the distance that you can walk without feeling shortness of breath?
I would also like to know your current medication and doses. You may need to optimise your therapy ( increase furasemid dose, add an ACEI, etc.).
What are your mean blood pressure values?
I would like to directly review your cardiac ultrasound report, if you could upload it for a second opinion.
I would also recommend checking NT pro BNP plasma levels for possible heart failure.
Hope you will find this information helpful!
I remain at your disposal for any further questions whenever you need!
Kind regards!
Dr.Ilir Sharka, Cardiologist
I would recommend as follows:
Detailed Answer:
Hello!
I passed carefully through your question and would explain that these findings are suggestive of chronic ischemic changes in the heart and possible heart failure.
I would like to know if you experience shortness of breath during the night? What is the distance that you can walk without feeling shortness of breath?
I would also like to know your current medication and doses. You may need to optimise your therapy ( increase furasemid dose, add an ACEI, etc.).
What are your mean blood pressure values?
I would like to directly review your cardiac ultrasound report, if you could upload it for a second opinion.
I would also recommend checking NT pro BNP plasma levels for possible heart failure.
Hope you will find this information helpful!
I remain at your disposal for any further questions whenever you need!
Kind regards!
Dr.Ilir Sharka, Cardiologist
Above answer was peer-reviewed by :
Dr. Dr. Yogesh D
Medical Conditions:
1. Asthma
2. Diabetes type II
3. Ischaemic heart disease with previous PCI to LAD with residual mid-circumflex disease, visual moderate to severe with a negative FFR
4. Atrial fibrillation
5. Moderate LV systolic dysfunction secondary to ischaemic cardiomyopathy
6. Mildly impaired right ventricular systolic dysfunction
7. No significant valvular disease
8. High BMI
9. History of iron deficiency anaemia (all is well at the moment)
10. Diverticular disease
11. Spondylitic discitis
MEDIDATION:
1. Salbutamol inhaler as and when required
2. Amitriptyline 30mg at night (for anxiety)
3. Bisacodyl 5mg twice daily
4. Docusate 100mg twice daily
5. Atorvastatin 40mg at night
6. Candesartan 4mg daily
7. Furosemide 60/40mg alternate days
8. NovoMix 30 as directed
9. Pantoprazole 30mg twice daily
10. Duloxetine 30mg twice daily
11. Relvar inhaler
12. Apixaban SR 1g twice daily
13. GTN spray as and when required
RESULTS
Sorry I have no results available
SCENARIO
Hi, My Dad is 73 years old. He has heart and kidney failure along with many years of Diabetes Type II. The problem is 8 days ago Dad became really breathless and had build up of fluid in his legs and body. Dad was admitted to hospital and is still in. They are trying to get the fluid off my Dad, it has worked around his body but he still has fluid in his legs. He can now walk small distances with no breathlessness and is comfortable at rest. The only symptom Dad has was fluid retention and breathlessness but the breathlessness has now resolved and he looks so much better. I am really worried about the prognosis. I know in time he will eventually deteriorate but we are not at the end of the road yet are we? The Heart Care Team have got Renal Team involved as Dads kidney function keeps going very low. Dad is only in Heart Care so he can be closely monitored. They say it is not necessary at the moment but they have given him information on possible dialysis if things were to deteriorate. Dad also has had to restrict his fluids, will this be for life or once the fluid is off can he drink more? I have asked regarding staging of kidney disease and they say roughly 3B. His GFR keeps going low (did go to 15%, but has now gone back up to approximately 21%) but they that doesn't just give a true picture for the kidney disease it is other bloods also. I am sorry I have no reports. Dad has had an ultrasound scan of kidneys which shows they are entirely normal, so surely this is good news. Doctor is concerned from a heart failure point of view and says things are stable. Can you please help is there still hope that Dad will be with for a while longer yet? Also Dads diabetes has now gone out of control he is having hypos at night, I think this is due to eating less. So his Insulin is now cut down. He looks really well than he has done for months so the Doctor says this is good news.
My own GP saw Dads kidney function dropping so he stopped the Furosemide for 2 weeks and this is how Dad has ended up in the situation above. Consultant says GP should never have stopped the Furosemide.
I love my Dad and want to keep him as long as possible hence asking advice on what I can do. Thank you very much
1. Asthma
2. Diabetes type II
3. Ischaemic heart disease with previous PCI to LAD with residual mid-circumflex disease, visual moderate to severe with a negative FFR
4. Atrial fibrillation
5. Moderate LV systolic dysfunction secondary to ischaemic cardiomyopathy
6. Mildly impaired right ventricular systolic dysfunction
7. No significant valvular disease
8. High BMI
9. History of iron deficiency anaemia (all is well at the moment)
10. Diverticular disease
11. Spondylitic discitis
MEDIDATION:
1. Salbutamol inhaler as and when required
2. Amitriptyline 30mg at night (for anxiety)
3. Bisacodyl 5mg twice daily
4. Docusate 100mg twice daily
5. Atorvastatin 40mg at night
6. Candesartan 4mg daily
7. Furosemide 60/40mg alternate days
8. NovoMix 30 as directed
9. Pantoprazole 30mg twice daily
10. Duloxetine 30mg twice daily
11. Relvar inhaler
12. Apixaban SR 1g twice daily
13. GTN spray as and when required
RESULTS
Sorry I have no results available
SCENARIO
Hi, My Dad is 73 years old. He has heart and kidney failure along with many years of Diabetes Type II. The problem is 8 days ago Dad became really breathless and had build up of fluid in his legs and body. Dad was admitted to hospital and is still in. They are trying to get the fluid off my Dad, it has worked around his body but he still has fluid in his legs. He can now walk small distances with no breathlessness and is comfortable at rest. The only symptom Dad has was fluid retention and breathlessness but the breathlessness has now resolved and he looks so much better. I am really worried about the prognosis. I know in time he will eventually deteriorate but we are not at the end of the road yet are we? The Heart Care Team have got Renal Team involved as Dads kidney function keeps going very low. Dad is only in Heart Care so he can be closely monitored. They say it is not necessary at the moment but they have given him information on possible dialysis if things were to deteriorate. Dad also has had to restrict his fluids, will this be for life or once the fluid is off can he drink more? I have asked regarding staging of kidney disease and they say roughly 3B. His GFR keeps going low (did go to 15%, but has now gone back up to approximately 21%) but they that doesn't just give a true picture for the kidney disease it is other bloods also. I am sorry I have no reports. Dad has had an ultrasound scan of kidneys which shows they are entirely normal, so surely this is good news. Doctor is concerned from a heart failure point of view and says things are stable. Can you please help is there still hope that Dad will be with for a while longer yet? Also Dads diabetes has now gone out of control he is having hypos at night, I think this is due to eating less. So his Insulin is now cut down. He looks really well than he has done for months so the Doctor says this is good news.
My own GP saw Dads kidney function dropping so he stopped the Furosemide for 2 weeks and this is how Dad has ended up in the situation above. Consultant says GP should never have stopped the Furosemide.
I love my Dad and want to keep him as long as possible hence asking advice on what I can do. Thank you very much
Sorry I forgot to add Dad has no shortness of breath at night and can lie down with 2 pillows (this is normal for him). He can now walk approximately 100 yards with no symptoms and no symptoms at all at rest. Dads blood pressure is 127/68
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again, dear Alison!
It seems that your dad has recently suffered from acutely decompensated heart failure apparently due to inappropriate therapy administration (diuretics withdrawal).
Other issues may have influenced as well (not adequately controlled diabetes, potential cardiac ischemia, not properly controlled heart rate, etc.)
Coming to this point, it is necessary to properly manage his body fluid balance (fluids intake/ elimination); actually this may be achieved by fluid restriction, induction of increased diuresis, and if this strategy isn't sufficient ultra-filtration/dialysis may be utilized.
It would be helpful to investigate potential implication of diabetes in renal dysfunction (diabetic nephropathy);
An actual review of potential ongoing cardiac ischemia would clarify his LCx artery condition and guide further decision making.
The recent eGFR requires to be closely followed in order to properly decide ongoing diuretics daily dose and heart failure therapy. Addition of SGLT2 inhibitors could be considered.
Considering your dad's clinical condition, I would like to inform that there is enough space for therapy optimization, necessity of frequent and close cardiology followups.
Serial NTpro-BNP testing would be helpful in guiding therapeutic strategies.
You should discuss with his attending physician on the above mentioned issues.
Hope this will be helpful!
Wishing your dad good health!
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again, dear Alison!
It seems that your dad has recently suffered from acutely decompensated heart failure apparently due to inappropriate therapy administration (diuretics withdrawal).
Other issues may have influenced as well (not adequately controlled diabetes, potential cardiac ischemia, not properly controlled heart rate, etc.)
Coming to this point, it is necessary to properly manage his body fluid balance (fluids intake/ elimination); actually this may be achieved by fluid restriction, induction of increased diuresis, and if this strategy isn't sufficient ultra-filtration/dialysis may be utilized.
It would be helpful to investigate potential implication of diabetes in renal dysfunction (diabetic nephropathy);
An actual review of potential ongoing cardiac ischemia would clarify his LCx artery condition and guide further decision making.
The recent eGFR requires to be closely followed in order to properly decide ongoing diuretics daily dose and heart failure therapy. Addition of SGLT2 inhibitors could be considered.
Considering your dad's clinical condition, I would like to inform that there is enough space for therapy optimization, necessity of frequent and close cardiology followups.
Serial NTpro-BNP testing would be helpful in guiding therapeutic strategies.
You should discuss with his attending physician on the above mentioned issues.
Hope this will be helpful!
Wishing your dad good health!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Diuretics were stopped due to worsening renal function. They put dad on and is on intravenous diuretics but he doesn't seem to be losing as much weight as they want. What happens next? I am worried about dialysis as fluid restriction is even less I think and he drinks so much this will be so hard on him. Drinking I don't mean alcohol. Can I have dad a good few years yet please
Can dad have a small treat like once a month to a small portion of fish and chips
Dads breathing is much better now and he is passing urine on the IV tablets.
Are things looking up.
The only thing he is mentioning today is he feels really cold.
Are things looking up.
The only thing he is mentioning today is he feels really cold.
They are not happy with dad today something about creatinine not sure. Can this be sorted out
They have increased dads diuretics as he not losing enough fluid. What happens if he doesn't respond please? Also this affects his kidney function but they say the levels have slightly increased but something about creatinine level I don't know
Brief Answer:
I would explain:
Detailed Answer:
Dear XXXXXXX
Let me explain that when dealing with patients suffering from acutely decompensated heart failure it is important to closely follow renal function.
It is difficult to give an exact opinion without direct review of renal function, cardiac performance and other lab tests.
But, when considering the clinical conditions of such a scenario, we have have to think bout several organ dysfunctions (liver, renal pulmonary). as they are the major prognostic markers.
Regarding renal dysfunction, we have to take appropriate measures in every degree of its presentation. It is necessary to further fractionate the daily diuretics dose, correct electrolytes and other homeostatic imbalances, correct blood albumin levels, etc. These measures would help to overcome diuretic resistance.
Of course, a negative fluid balance is an important issue in this physiological interplay.
SGTL2 inhibitors would be helpful and neprilysin inhibitor could be considered according to the current renal function.
Hemofiltration is another therapeutic measure that would control fluid balance anf further boost renal function.
Coming to this point, I do believe that there exist solution for your dad's current clinical status.
You need to discuss with is attending cardiologist on the above mentioned issues.
Kind regards,
Dr. Iliri
I would explain:
Detailed Answer:
Dear XXXXXXX
Let me explain that when dealing with patients suffering from acutely decompensated heart failure it is important to closely follow renal function.
It is difficult to give an exact opinion without direct review of renal function, cardiac performance and other lab tests.
But, when considering the clinical conditions of such a scenario, we have have to think bout several organ dysfunctions (liver, renal pulmonary). as they are the major prognostic markers.
Regarding renal dysfunction, we have to take appropriate measures in every degree of its presentation. It is necessary to further fractionate the daily diuretics dose, correct electrolytes and other homeostatic imbalances, correct blood albumin levels, etc. These measures would help to overcome diuretic resistance.
Of course, a negative fluid balance is an important issue in this physiological interplay.
SGTL2 inhibitors would be helpful and neprilysin inhibitor could be considered according to the current renal function.
Hemofiltration is another therapeutic measure that would control fluid balance anf further boost renal function.
Coming to this point, I do believe that there exist solution for your dad's current clinical status.
You need to discuss with is attending cardiologist on the above mentioned issues.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much I am just so scared of losing my Dad. I am sure he is in the best of hands and I need to trust they are doing all they can
Brief Answer:
You are welcome!
Detailed Answer:
I am glad to have been helpful to you!
Please try to be strong! I hope for the best!
Wishing good health,
Dr. Iliri
You are welcome!
Detailed Answer:
I am glad to have been helpful to you!
Please try to be strong! I hope for the best!
Wishing good health,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My Dads GFR is 15 but this new infusion they are giving him is making him wee more than his input. Is this a good sign and can GFR improve. I really hope he doesn't need dialysis. I am panicking
Brief Answer:
Renal function is an important prognostic marker:
Detailed Answer:
Hello again, dear Alison!
You are right about the actual renal trends. More urine output and a negative fluid balance (intake/output<1) are important predictors of clinical improvements toward a compensated heart failure status.
Following these trends, it may be concluded that eGFR has good chances to increase without the need for renal replacement therapy (dialysis).
All the above are good prognostic markers; in addition with the actual circulatory mechanical support strategies, patients with heart failure live longer and in better clinical conditions.
Wishing your father good health!
Kind regards,
Dr. Iliri
Renal function is an important prognostic marker:
Detailed Answer:
Hello again, dear Alison!
You are right about the actual renal trends. More urine output and a negative fluid balance (intake/output<1) are important predictors of clinical improvements toward a compensated heart failure status.
Following these trends, it may be concluded that eGFR has good chances to increase without the need for renal replacement therapy (dialysis).
All the above are good prognostic markers; in addition with the actual circulatory mechanical support strategies, patients with heart failure live longer and in better clinical conditions.
Wishing your father good health!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you I am so scared of my dad dying
Brief Answer:
My opinion:
Detailed Answer:
Dear Alison!
Your dad has good chances of overcoming this clinical situation.
You shouldn't lose hope!
Wishing you all the best!
Dr. Iliri
My opinion:
Detailed Answer:
Dear Alison!
Your dad has good chances of overcoming this clinical situation.
You shouldn't lose hope!
Wishing you all the best!
Dr. Iliri
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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