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Would Fluid Retention Manifest As Reduced Urination In A Person With OCD?
Question: I am having a very specific and perhaps PTSD and OCD related cardiac fear. I had PVC-induced cardiomyopathy last fall which was reversed by an ablation. I am terrified of a recurrence. In the hospital, my fluids were restricted and now I'm so scared of retaining water that it's all I can think about. Is it impossible for me to be retaining water with normal heart, kidney, and liver function? Would fluid retention manifest as lowered urine output? I don't have edema or weight gain but one of my doctors said I would always be in danger of CHF and I am just so scared all the time.
Brief Answer:
No risk of possible fluid retention is actually present.
Detailed Answer:
Hello, dear XXXX!
I am glad to discuss with you again about your concerns!
I reviewed again your previous uploaded medical reports, as well as your actual ones.
Regarding your concern about possible fluid retention, I would explain that facing your actually normal clinical conditions, cardiac ultrasounds, laboratory tests (including natriuretic peptides), cardiac stress test, SPECT results, chest X ray study, all your lab biochemical profile (liver, kidney function tests, etc), it is impossible that you experience such a medical consequence.
As your overall cardiac performance is perfectly normal; you have no edema; no recently weight gain; every fluctuation in daily urine output is not a manifestation of possible abnormal fluid retention. So relax! Don't worry about that issue!
As you had a successful cardiac ablation, an excellent reverse of your arrhythmia-induced cardiomyopathy, and your clinical status is actually totally under control, there is no risk for such a complication.
You can have a normal daily balanced diet (including fluids); the same as every normal individuals without your previous clinical conditions. I assure you of that.
There are other more specific sophisticated methods (besides clinical evidence of edema, or weight measurements) to study possible fluid retention, such as cardiac ultrasound (evaluation of venous collapsibility index, etc.), or BIVA (Bio-electrical Impedance Vector Analysis), if available on your medical center of attendance.
Hope to have been helpful to you!
Feel free to ask me whenever you need!
Greetings! Dr. Iliri
No risk of possible fluid retention is actually present.
Detailed Answer:
Hello, dear XXXX!
I am glad to discuss with you again about your concerns!
I reviewed again your previous uploaded medical reports, as well as your actual ones.
Regarding your concern about possible fluid retention, I would explain that facing your actually normal clinical conditions, cardiac ultrasounds, laboratory tests (including natriuretic peptides), cardiac stress test, SPECT results, chest X ray study, all your lab biochemical profile (liver, kidney function tests, etc), it is impossible that you experience such a medical consequence.
As your overall cardiac performance is perfectly normal; you have no edema; no recently weight gain; every fluctuation in daily urine output is not a manifestation of possible abnormal fluid retention. So relax! Don't worry about that issue!
As you had a successful cardiac ablation, an excellent reverse of your arrhythmia-induced cardiomyopathy, and your clinical status is actually totally under control, there is no risk for such a complication.
You can have a normal daily balanced diet (including fluids); the same as every normal individuals without your previous clinical conditions. I assure you of that.
There are other more specific sophisticated methods (besides clinical evidence of edema, or weight measurements) to study possible fluid retention, such as cardiac ultrasound (evaluation of venous collapsibility index, etc.), or BIVA (Bio-electrical Impedance Vector Analysis), if available on your medical center of attendance.
Hope to have been helpful to you!
Feel free to ask me whenever you need!
Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much, Dr. Iliri. I am both happy and a bit embarassed to be speaking to you again. When I feel so anxious, I feel so sure there must be a practical, medical reason for it. I am seeking psychological and psychiatric care but my progress seems to be slow.
The fear of water retention started when water was snatched from my hand in the hospital when I was sick and it has been hard for me to forget. And a former doctor of mine said I would never be cured and would always need to watch out for signs of heart failure.
So I know it must be maddening for you that I ask again but would the 60 EF in 4-chamber view on latest echo suggest that nothing has changed since echoes which simply read 60 in previous weeks without the additional slightly lower EFs?
My concern is that at 55-60- the slightest change could take me into a low EF zone. Is this not how it works? Or would a disease process have to be in place for that to happen and it wouldn't matter if my EF was 56 or 66?
How quickly can these heart parameters change? I fear even the day after an echo that my heart could be weakening because I was taken off lisinopril 5 mg four months ago and about two months ago my carvedilol was lowered to 6.25 twice a day from 9.375. My heart size and function returned to normal just 3 weeks after ablation and I was never on high doses of meds. Is that good evidence that cardiomyopathy was caused solely by PVCs?
Thank you so very much, Dr. Iliri. I have always been so healthy and normal and not nervous about my health but then getting so sick with hardly any symptoms has made it so difficult to relax. Also my doctors have seen almost no other cases like mine so it seems they aren't always sure what to tell me. Some say I need to be followed closely, yet others say I don't need any more follow-ups at all as I have completely recovered. Your advice and patience and kindness and knowledge are very much appreciated.
The fear of water retention started when water was snatched from my hand in the hospital when I was sick and it has been hard for me to forget. And a former doctor of mine said I would never be cured and would always need to watch out for signs of heart failure.
So I know it must be maddening for you that I ask again but would the 60 EF in 4-chamber view on latest echo suggest that nothing has changed since echoes which simply read 60 in previous weeks without the additional slightly lower EFs?
My concern is that at 55-60- the slightest change could take me into a low EF zone. Is this not how it works? Or would a disease process have to be in place for that to happen and it wouldn't matter if my EF was 56 or 66?
How quickly can these heart parameters change? I fear even the day after an echo that my heart could be weakening because I was taken off lisinopril 5 mg four months ago and about two months ago my carvedilol was lowered to 6.25 twice a day from 9.375. My heart size and function returned to normal just 3 weeks after ablation and I was never on high doses of meds. Is that good evidence that cardiomyopathy was caused solely by PVCs?
Thank you so very much, Dr. Iliri. I have always been so healthy and normal and not nervous about my health but then getting so sick with hardly any symptoms has made it so difficult to relax. Also my doctors have seen almost no other cases like mine so it seems they aren't always sure what to tell me. Some say I need to be followed closely, yet others say I don't need any more follow-ups at all as I have completely recovered. Your advice and patience and kindness and knowledge are very much appreciated.
Brief Answer:
You are going on the right way! Nothing to worry about!
Detailed Answer:
Hi again, dear XXXX!
I am happy to be helpful to you! So don't be embarrassed when speaking to me about your concerns again and again.
It is normal to feel anxiety after such a specific cardiac disorder.
Yes! Cardiac arrhythmias (frequent PVCs, etc.) may cause important dyssynchronous ventricular contractions and arrhythmia-induced cardiomyopathy.
But, meantime, it is so wonderful to hear that your successful cardiac ablation and subsequent therapy have yielded such impressive results.
I would say you are a pretty lucky girl! So relax! Be happy!
As I have explained you before, those small EF value fluctuations are related to inherent deviations of cardiac ultrasound tests and interobserver variability.
Your cardiac performance indexes, have been steadily shown normal. No any progressive pathological changes is happening to your heart.
I believe you are completely recovered by those serious consequences.You are not suffering from any heart failure consequences.
Your LV EF is completely and unceasingly normal, no clinical symptomatology of fluid retention, no disturbing arrhythmia, a stable hemodynamics.
SO, nothing to worry about!
The only advice I would like to give, is to constantly look after your health.
Periodic medical follow-ups are necessary for early detection and prompt treatment of any eventual cardiac and other organs issues, as it is a routine regimen for every other normal individuals.
Do not hesitate to be in close contact with me for XXXXXXX possible uncertainties.
Best wishes,
Dr. Iliri
You are going on the right way! Nothing to worry about!
Detailed Answer:
Hi again, dear XXXX!
I am happy to be helpful to you! So don't be embarrassed when speaking to me about your concerns again and again.
It is normal to feel anxiety after such a specific cardiac disorder.
Yes! Cardiac arrhythmias (frequent PVCs, etc.) may cause important dyssynchronous ventricular contractions and arrhythmia-induced cardiomyopathy.
But, meantime, it is so wonderful to hear that your successful cardiac ablation and subsequent therapy have yielded such impressive results.
I would say you are a pretty lucky girl! So relax! Be happy!
As I have explained you before, those small EF value fluctuations are related to inherent deviations of cardiac ultrasound tests and interobserver variability.
Your cardiac performance indexes, have been steadily shown normal. No any progressive pathological changes is happening to your heart.
I believe you are completely recovered by those serious consequences.You are not suffering from any heart failure consequences.
Your LV EF is completely and unceasingly normal, no clinical symptomatology of fluid retention, no disturbing arrhythmia, a stable hemodynamics.
SO, nothing to worry about!
The only advice I would like to give, is to constantly look after your health.
Periodic medical follow-ups are necessary for early detection and prompt treatment of any eventual cardiac and other organs issues, as it is a routine regimen for every other normal individuals.
Do not hesitate to be in close contact with me for XXXXXXX possible uncertainties.
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Iliri, you are so knowledgeable and comforting. I do feel lucky to have recovered and I don't really understand why I cannot relax more and enjoy my health. I had other trauma when I got sick like my mother becoming gravely ill and going through a divorce. My EP believes it was stress that made my PVCs get so bad (65,000 a day).
A couple more questions for you, Dr. Sharka, if you don't mind.
1. Stress may have caused my PVCs to get so bad. Could my anxiety and stress cause a recurrence even without PVCs? I do feel a few PVCs now and again but only a few and last holter showed 50.
2. I have been nervous about exercise. I know exercise is so good for health and heart so I am going to rejoin the gym and make sure to get plenty. But does exercise directly affect EF? Am I harming myself by not having done vigorous exercise for last two to three months?
3. Is it normal for carvedilol to have less effect on heart rate as you get used to it? When I started my heart rate never got above 50. Now it's still under 60 at rest but can be 70s with mild activity like cooking. Normal? I'm worried my heart rate will be too high once I am off the carvedilol.
4. My dr told me to ignore the multiple EF readings on last echo and just focus on the 60 in 4-chamber view. Perhaps he is humoring me but it does comfort me to feel EF is 60-63 instead of closer to 55. I simply can't help but think that 55-60 is so close to being low. I know I am too focused on the numbers but having had so few symptoms at EF 25-30, I can't help it.
Thank you so much, Dr. Sharka. You are helping me so much. Your words and knowledge are very reassuring.
A couple more questions for you, Dr. Sharka, if you don't mind.
1. Stress may have caused my PVCs to get so bad. Could my anxiety and stress cause a recurrence even without PVCs? I do feel a few PVCs now and again but only a few and last holter showed 50.
2. I have been nervous about exercise. I know exercise is so good for health and heart so I am going to rejoin the gym and make sure to get plenty. But does exercise directly affect EF? Am I harming myself by not having done vigorous exercise for last two to three months?
3. Is it normal for carvedilol to have less effect on heart rate as you get used to it? When I started my heart rate never got above 50. Now it's still under 60 at rest but can be 70s with mild activity like cooking. Normal? I'm worried my heart rate will be too high once I am off the carvedilol.
4. My dr told me to ignore the multiple EF readings on last echo and just focus on the 60 in 4-chamber view. Perhaps he is humoring me but it does comfort me to feel EF is 60-63 instead of closer to 55. I simply can't help but think that 55-60 is so close to being low. I know I am too focused on the numbers but having had so few symptoms at EF 25-30, I can't help it.
Thank you so much, Dr. Sharka. You are helping me so much. Your words and knowledge are very reassuring.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hi, dear XXXX!
It’s a pleasure to be of some help for you!
Regarding your last questions, I would explain as follows:
1. Your increased level of stress and anxiety may have aggravated your arrhythmia condition, but I don’t believe that anxiety is able to develop arrhythmia from nothing (without a favorable myocardial substrate, as I have explained you before). Once you have eliminated your myocardial environment (by the successful cardiac ablation), the role of anxiety is completely vanished. So, relax my dear! The actual role of anxiety is powerless to cause you any harms.
2. I recommend you to not be so fixed over EF. It is not the only index of cardiac performance, instead it is just one of echo parameters we use routinely as a surrogate marker of systolic ventricular function. Exercise has direct beneficial effects not only on myocardial conditioning, EF, but also in systemic vascular component by improving blood vessels elasticity, blood cells function, and psychological components, as well. It will help in improving your anxiety consequences. I strongly encourage you to attend a meticulous scheduled physical exercise program.
3. Regarding Carvedilol, I would explain that as you are weaning off, it is normal to have a slight heart rate increase. Your doctor is acting the right way, weaning very gradually form Carvedilol (gradually tapering off its daily doses), as it may cause rebound effect when interrupt abruptly.
4. My dear, I don’t believe your EF is 55, or closer to 55% (as I have explained you before), nevertheless I would say that 55-60 is not so close to being low. Thinking of your EF value variability (because of ECHO measurements inaccuracy), will not be of any help in relieving your anxiety, or increasing your EF even more. So, just stop thinking that way my dear XXXX!
That’s my opinion.
Hope to have clarified some uncertaities!
Regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hi, dear XXXX!
It’s a pleasure to be of some help for you!
Regarding your last questions, I would explain as follows:
1. Your increased level of stress and anxiety may have aggravated your arrhythmia condition, but I don’t believe that anxiety is able to develop arrhythmia from nothing (without a favorable myocardial substrate, as I have explained you before). Once you have eliminated your myocardial environment (by the successful cardiac ablation), the role of anxiety is completely vanished. So, relax my dear! The actual role of anxiety is powerless to cause you any harms.
2. I recommend you to not be so fixed over EF. It is not the only index of cardiac performance, instead it is just one of echo parameters we use routinely as a surrogate marker of systolic ventricular function. Exercise has direct beneficial effects not only on myocardial conditioning, EF, but also in systemic vascular component by improving blood vessels elasticity, blood cells function, and psychological components, as well. It will help in improving your anxiety consequences. I strongly encourage you to attend a meticulous scheduled physical exercise program.
3. Regarding Carvedilol, I would explain that as you are weaning off, it is normal to have a slight heart rate increase. Your doctor is acting the right way, weaning very gradually form Carvedilol (gradually tapering off its daily doses), as it may cause rebound effect when interrupt abruptly.
4. My dear, I don’t believe your EF is 55, or closer to 55% (as I have explained you before), nevertheless I would say that 55-60 is not so close to being low. Thinking of your EF value variability (because of ECHO measurements inaccuracy), will not be of any help in relieving your anxiety, or increasing your EF even more. So, just stop thinking that way my dear XXXX!
That’s my opinion.
Hope to have clarified some uncertaities!
Regards,
Dr. Iliri
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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