Signs of low cardiac output?

Hey all,

I go for right heart catheterization on the 18th to check my cardiac output and other values.  Doc says if it is below 2 he will start me on inpatient inotropes.  I don't have signs of congestion except very mild lower extremity edema (but I am heavily diuresed).  So far my lab values aren't bad, creatine is 1.00 up from 0.7 3 months ago, and mildly low potassium.  Other than that everything is in normal limits.  I am curious if anyone has personally experienced low cardiac output without congestion and what there symptoms were like.  I know all the classic symptoms but I am curious how others have experienced it and especially what it's like at 2 or below?  Also has anyone had their cardiac output drop and diagnosed before renal impairment started showing up?


2 Comments

Signs of low cardiac output - apologies long message

by Gemita - 2021-05-06 06:21:43

As usual from you dear Asully, another challenging, interesting post.  A question though to you. 

Are you talking about permanent low cardiac output without congestion as in heart failure alone, or do you wish to open the subject up to those of us who might suffer intermittently from low cardiac output from other causes too, perhaps temporary causes, like from low blood pressure, arrhythmias?  

I attach a few links below on Cardiac Output for those (like me) who might wish to understand it a bit more.

I know what poor cardiac output feels like when I have it Asully and some of the things that might cause it.  A few causes come to mind immediately for me like dehydration, and as my doctors keep reminding me, blood volume decreases when we are dehydrated. To compensate, our heart beats faster, causing palpitations.   Also our blood retains more sodium, making it harder for it to circulate through the body, causing fluid retention.  (However I do appreciate the need to restrict fluids with heart failure - a difficult balancing act).

I also experience hypothermia episodes due intermittent autonomic dysfunction which is often a cause of poor cardiac output for me, as is my low blood pressure and of course my awful arrhythmias.  All these conditions for me can lead to reduced blood flow to the brain and other organs, causing worsening symptoms of hypotension, bradycardia (now better controlled with pacemaker), tachycardia, hypoxia (low blood oxygen), shortness of breath, fatigue.  

I can definitely experience low cardiac output without retaining fluid but of course I do not struggle with permanent low cardiac output as you do.  I am though getting some fluid retention epigastric area which is a little worrying. .

My hubby battles with low cardiac output too.  He has heart disease and a history of strokes and kidney disease.  Latter worsened due sepsis causing acute kidney injury.  Remarkably though so far hubby doesn’t have any major noticeable congestion, some slight pitting edema ankles and some fluid accumulation occasionally lungs but he has mild COPD and pulmonary hypertension.  He often gets dizzy spells, appears to breathe faster (like in hyperventilation) which affects his gas exchange.  He then develops palpitations, can become agitated, confused and difficult to manage.  But I have learned techniques of breath control to help calm him (and myself) and to get help when we both need it.  He suffers from hypoxia with some truly concerning symptoms and skin changes.  We are waiting to see another consultant for this.  

Your final question about having low cardiac output before renal impairment is first noticed, I would say in my husband’s case, yes.  His heart disease and low cardiac output symptoms seemed to be evident before his kidney function deteriorated, although of course we all know that many conditions can lead to heart disease and my husband has his fair share of these conditions, including diabetes.

Asully I hope your right heart catheterization procedure on the 18th May gives you and your doctors answers and that the procedure is as pain free and straightforward as possible.  I expect you will be awake, but nicely sedated so you will be able to see and hear what is going on.  I hope your results are good and you will not need further treatment at the moment since I see you have only recently started a diabetic med Jardiance to see whether this might help with your symptoms.

https://www.theonlinelearningcenter.com/assets/carter/46/course_01/module_04/mod_04.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575587/

https://open.oregonstate.education/aandp/chapter/19-4-cardiac-physiology/

Thanks Gemita!

by asully - 2021-05-06 14:20:31

I am open to both permanent and intermittent!  I just really am curious about personal expieriences and descriptions of how they felt and how low it was.  Everyone expieriences symptoms slightly different and I feel lived expieriences can sometimes give more information than just reading the classic (and vague) descriptions you find in medical literature.  Like how it says "weakness" or "shortness of breath" haha, I think anyone with heart problems knows this all is on a spectrum.  It always cracks me up when the nurses at the advanced heart failure clinic come in and ask me the routine questions "Are you expierienceing any shortness of breath?"  I always chuckle a little, it's kind of like a "well duh, I am at the advanced heart failure clinic am I not" of course I don't say that but that's what I am thinking.  I am sure others can relate.  I feel like it should be "How bad is your shortness of breath?  When are you expierienceing it? Has it become worse?"
 

I have a hard time believing my cardiac output could below 2, on my last cath before my mitral valve replacement last November it was 3.6.  I feel more symptomatic now, but I do have days where I can make a small trip to the grocery store or walk (albeit slowly) to the mailbox and back which is about a mile.  Other days I can't lift a pillow due to lack of strength without shaking and expierienceing significant shortness of breath.  I probably should have added in my post I have been getting worsening peripheral cyanosis.  Mostly in the toes and present about 90 percent of the time, physical exertion makes it worse and on bad days it is present under my fingernails as well.  Good news is I have not noticed any signs of central cyanosis.  I think my symptoms may be due to things like you said, medication side effects such as low blood pressure (I was 84/64 at my Monday appointment), and dizziness or electrolyte imbalances.  I suppose it's all a chicken and egg question, are my symptoms actually worse and my heart function declining or is it just all the heavy new meds causing side effects.  Either way I feel like dog dookie.  I just can't imagine that I am sick enough yet to need to be inpatient on inotropes,  I assumed I had another year or two before I got that bad.  I have also lost an additional 6lbs on top of the 12-15 I lost the 2 months prior, it appears to be all muscle wasting.  I am 5'9 135lbs now when fully diuresed.  But I can't tell if it is deconditioning or actually from the HF.....it sounds like my symptoms are very similar to both yours and your husbands when y'all expierience low output.  I guess since I know I'm "low" I am trying to figure out some scale in my head that indicates as low as 2 symptom wise.  The information about your husbands renal function not declining at first is helpful!  My doctor told me that "usually" they already see decline in renal function when they find low CO, but I asked him if they ever find low CO before the renal decline occurs he did say yes and agreed it was common in younger patients like myself because our bodies can hold up longer.  Personally I would rather them catch it before my other organ systems start to take damage!!!

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