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What Causes Tiredness And Depression In A Cardiac Patient Despite Having Normal BP Values?
Question: My father had had 2 heart attacks and has congestive heart failure. He had robotics surgery and a Stent put in the first time. The second time was 2 years latet. He had just been taken off of Plavix and he got 2 clots that caused his second heart attack. This time he had 3 stents put into an artery. He came home on low dose oxygen but no longer needs it. His levels are in the 90's and his blood pressure is good. The problem is that he is very very tired and can not keep his eyes open. He is short of breath even though his oxygen is good. He does not appear to be retaining water. He has no swelling and his weight is good. My father is 71 and was very active. He played tennis 3 days a week. He was repairing his roof when the 2nd attack occured. They said he has mild to moderate damage and the performance is about 45 percent which they said is not bad. His medications include warfarin 4mg ,amiodarone 200mg, metoprolol 25 mg, lisinopril 5mg, Plavix 75 mg, lasix 40 mg, potassium 10. He is feeling extremely tire and depressed. He says he feels like he is dying but his stats check out normal. What should we do?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding your concern, I would like to explain that your father has suffered 2 critical cardiac disorders (life-threatening conditions), and has fortunately survived, but with an important subsequent complication, which is heart failure.
A mild to moderate decrease of overall cardiac performance (left ventricular EF 45%) imposes an important exertion capacity reduction for a physically active individual such as your father is.
So, I would explain that a great proportion of his actual complains (extreme tiredness, and dyspnea) are thoroughly explained by his low cardiac output condition (because of his decreased LV pumping function and elevated LV end-diastolic pressure), despite his normal average BP values.
Other additional factors may have influenced as well, such as depression, which seems to be not rare in MI patients during the first year after heart attack occurrence (about 60% of patients).
A careful cardiac ultrasound could address the decreased value of cardiac output and cardiac index, increased LV end diastolic pressures (hence pulmonary capillary wedge pressure which may explain his shortness of breath), and consequently increased pulmonary artery systolic pressure (PASP).
A cardio-pulmonary exercise test would be helpful to determine your father's peak oxygen consumption, and hence his exercise capacity.
According to his clinical symptomatology, above echo parameters and exercise test, it would be possible to properly optimize his ongoing therapy.
From the other side, it is quite important for a heart attack patient to follow adequate physical rehabilitation program. There are several protocols, and almost all of them have shown beneficial effects regarding an optimal physical conditioning and improving exercise capacity.
Psychological issues should be addressed as well, as they may exacerbate the clinical symptomatology of HF, and may predict worse clinical outcome.
So, to conclude, I would recommend to discuss with his attending physician about the above mentioned issues, and to find the right modalities for optimizing his actual therapy, relieving possible anxiety and depressive issues, and yielding potential beneficial from a rehabilitation program.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding your concern, I would like to explain that your father has suffered 2 critical cardiac disorders (life-threatening conditions), and has fortunately survived, but with an important subsequent complication, which is heart failure.
A mild to moderate decrease of overall cardiac performance (left ventricular EF 45%) imposes an important exertion capacity reduction for a physically active individual such as your father is.
So, I would explain that a great proportion of his actual complains (extreme tiredness, and dyspnea) are thoroughly explained by his low cardiac output condition (because of his decreased LV pumping function and elevated LV end-diastolic pressure), despite his normal average BP values.
Other additional factors may have influenced as well, such as depression, which seems to be not rare in MI patients during the first year after heart attack occurrence (about 60% of patients).
A careful cardiac ultrasound could address the decreased value of cardiac output and cardiac index, increased LV end diastolic pressures (hence pulmonary capillary wedge pressure which may explain his shortness of breath), and consequently increased pulmonary artery systolic pressure (PASP).
A cardio-pulmonary exercise test would be helpful to determine your father's peak oxygen consumption, and hence his exercise capacity.
According to his clinical symptomatology, above echo parameters and exercise test, it would be possible to properly optimize his ongoing therapy.
From the other side, it is quite important for a heart attack patient to follow adequate physical rehabilitation program. There are several protocols, and almost all of them have shown beneficial effects regarding an optimal physical conditioning and improving exercise capacity.
Psychological issues should be addressed as well, as they may exacerbate the clinical symptomatology of HF, and may predict worse clinical outcome.
So, to conclude, I would recommend to discuss with his attending physician about the above mentioned issues, and to find the right modalities for optimizing his actual therapy, relieving possible anxiety and depressive issues, and yielding potential beneficial from a rehabilitation program.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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