Heart failure or not??

2 weeks ago I was put in the hospital for an infected gallbladder that had to be removed. Before being able to do the surgery I had to be cleared by a cardiologist.Just to let you know what I am being treated for before I went into the hospital. I have a pacemaker for complete heart block, take medicine for afib and Wolff's Parkinson White Syndrone until ablation procedure scheduled for May that my EP said will leave me 100% dependent. They done an echo on me to discharge me for the surgery and the cardio said that my Mitral and tricuspid valves were leaking and my ejection fraction was 40%. He said I should be fine with the surgery. Everything went okay but when I got home I was so swollen that you couldn't tell I had knees and I was having a hard time breathing. After 2 days I decided to call MY cardiologist and have him take a look at the echo results from the hospital where I had the surgery (keep in mind that the cardio and the hospital where I had the surgery is not where I go for my pacemaker checkups and etc.). They called me back that afternoon and put me on a diuretic med and a potassium med. which took the swelling down after several days. They told me that I wasn't in congestive heart failure. I had to take a blood test a week later (wednesday) to check up on some things. My question is: can someone tell me if it is some 'kind' of heart failure that caused the swelling or is it just because of the valves leaking? Should I be worried about all of this...leaky valves and low ejection fraction? My cardio is going to call me Monday but I am having a hard time hanging on so long for answers:( Sorry for the long winded post, I am just concerned. My husband told me that I worry too much and that he thinks everything is okay.

Pacie

4 Comments

Heaert Failure

by SMITTY - 2009-03-13 09:03:11

Hello Pacie,

I'll give you my opinion on your questions. I'll not say my opinions are answers to your questions as they are just based on my experience with similar problems.

As for the fluid retention there can be many reasons for that. Some of the many common causes of fluid retention include:

Dietary deficiency - such as insufficient protein or vitamin B1 (thiamine) in the diet.

Medications - certain drugs, including high blood pressure medication (antihypertensives), corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) are known to cause fluid retention.

Chronic venous insufficiency - weakened valves in the veins of the legs fail to efficiently return blood to the heart. The pooling of blood can result in varicose veins.

Medical conditions
Fluid retention may be a symptom of underlying conditions, including:

Heart failure - if the heart does not pump effectively, the body compensates in various ways. It starts to retain fluid and increase the volume of blood. This results in congestion of the veins, enlargement of the liver, and the accumulation of fluid in body cavities like the abdominal cavity (ascites) and in subcutaneous tissues, causing swelling (oedema) of the legs.

Chronic lung diseases - such as severe emphysema, which put excessive pressure on the heart’s right ventricle, leading to its failure.

Liver disease - such as severe cirrhosis that triggers liver failure.

Malignant lymphoedema - cancerous tumours that block structures of the lymphatic system, such as the lymph nodes.

Thyroid disease - such as hypothyroidism.

Arthritis - joints affected by some types of arthritis tend to swell with fluid.

As for the ejection fraction, 40% is low (normal is considered to be in the 55% to 65% percent range) but I don't thionk it is in the critical range. For example my last test showed mine to be about 35%, but to be honest I don't feel any worse than when it was reported to be 45%. Over the years I have learned that apparently my EF depends a lot on the method by which it is determined and the person performing that procedure. My suggestion is not put to much emphasis on that 40% EF unless your doctor makes an issue of it.

As for the leaky valves, a lot depends on what caused them to leak and how much they are leaking. My wife, who will 80 in a few months, has had a leaky valve since she was 9 years old. Her's is due to rheumatic fervor she had prior to the leaky valve diagnosis. She says it has never been a problem toher and has rejected all suggestion that she have it repaired.

Finally, I say don't be worried, but just be aware of your problems. Depend on your doctor to tell you when it is time to be concerned.

I wish you the best,

Smitty

Thank you

by pacie - 2009-03-14 11:03:11

Thank you for the response, Smitty. It means a lot. They said the valve problem was mild to moderate. Does that mean that I will have to be on a diuretic for a long while? I have been on them for a little over 2 weeks now and all of my fluid is gone (I'm pretty sure) on the visible areas anyway and my breathing is better. Do you think the valves is what is causing my swelling or my EF? I'm not sure if my leaky valves were caused by rheumatic fever or not, but I do remember 'keeping' strep throat with an extremely high fever when I was growing up. We were too poor to go to the doctor so my mom doctored it at home the best she could.

Health Problems

by SMITTY - 2009-03-14 12:03:19

Hi Pacie,

Let say first, please understand I'm not qualified to give answers or solutions to your problems. All I can do is guess or speculate.

Now, for starters I wouldn't hang all the blame for needing a diuretic on your valve problem. I've been taking a diuretic continuously since the mid-60s and my initial need was caused by a low thyroid. Then one thing led to another (probably for years it was the low thyroid and my love of salt on my food) and then my heart problem became a reality in 1982. Among other things I have drastically reduced my salt intake, but the need for the diuretic has continued. In your case rely on your doctor to tell you why and how long you will need to take a diuretic. My having to take a diuretic daily is the least troublesome of any of my medications..

I can't say whether the leaky valve is, or is not, causing your low ejection fraction. As I said my EF is low, and so far as I know I have no valve problem,

The symptoms you listed for an illness you had in your younger years are some of those that go with rheumatic fever, but deliver me from saying that you had rheumatic fever or that illness was in any way connected to your problems today.

I do think your problems could be interrelated and no single one can be singled out as the root cause of all your health problems. I know there is a world of information on health problems available on the Internet. However, since our body is so complex it could be a mistake for any of us to try self diagnosis based on this information. We all need to rely on our doctor to tell us what we need in the way of medical care.

Good luck,

Smitty

Thanks again...

by pacie - 2009-03-15 11:03:31

Thanks again, Smitty. See, you made me feel better. All I wanted was someone to talk to me about all of this. My husband is in deep denial that anything is wrong with me and therefore will not talk to me about it. Thanks for being a friend:)

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