Diagnosis for CHF....

[Lalita7601]

My MIL has been having all the classic symptoms of CHF and yet no Cardiologist that has treated her (we've had 3 in the past 2 years) has diagnosed her with CHF. She has massive swelling in the legs and feet, has pulmonary edema, unable to sleep on her back, shortness of breath on even the smallestof movement, Echocardiograms have shown leaky valves and pulmonary tension and yet every doctor she sees gives her suggestions for symptomatic relief only(pressure stockings to relieve the water retention in legs, sleeping upright with feet elevated, a diuretic : 40mg Lassix). My questions are: (1) what more symptoms does a patient have to exhibit before they are diagnosed as having CHF (2) if she were to be diagnosed with CHF, would the treatment be any different from what they are already suggesting ? (diuretic, sleeping upright etc. ?). (3) Would the Cardiologist, for instance, take her off her Beta-Blocker (Atenelol) and put her on some other medication (Internet says ACE inhibitors are better for CHF) ?

Her symptoms seem to be getting worse day by day yet the doctors dont seem to call it CHF and treat it aggressively. I really dont know what to do.

[Dr J Singh]

Hi,
As per the symptoms described by you, the chances of her suffering from CHF are quite high. The standard treatment of CHF is to off-load the heart. This can be done in 2 ways. One, by decreasing the fluid overload which we call the preload and that’s done by the use of Lasix. Lasix ensures that the extra fluid in the circulation is passed in urine so that the work load of the heart is less. The other method is by reducing the after load which is done by medications which cause dilation of the arteries and thus the heart has to work against less narrowed vessels (which is common in CHF) and thus improving the efficiency of the heart. In this, the ace-inhibitors play an important role. There’s a third class of drugs which help by improving the contractility of the heart and that is digoxin. You should consult another cardiologist and maybe another echo will help in settling the matters. I sincerely hope that helps. Take care.

[Encephalomalcia]

Ask her doctor if she has heart failure.  It may not be congestive heart failure, but it certainly sounds like heart failure.  Congestive is when it affects the lungs and cough a lot.  Sometimes there is clear or white mucus coughed up and sometimes there is only a dry cough.  Water retention in the abdomen is left side heart failure symptoms and water retention in the ankles, legs is right side heart failure symptoms.  Doctors usually treat with beta blockers or ace inhibitors. Ace inhibitors have shown to increase lifespan in studies.  Lisinopril is a good ace inhibitor and is low in price.  Beta blockers help with symptoms, but have not shown in studies to increase in lifespan.  Some doctors treat with both ace inhibitors and beta blockers.  Lasix is good for getting off the water, but IV Lasix is best when the pills at home will not help.  If she is filling up with water, she may need IV Lasix to get the water off now and then follow up with her daily pills at home.  Atenolol is a beta blocker that peaks and drops in levels.  Atenolol does not stay at a constant level throughout the day, and this can create problems.  Does she weigh herself daily?  A pound a day is a warning sign that she is retaining water. How much she drinks needs to be watched and ice cream included as liquid. Does she take a potassium pill to replace the potassium that the Lasix takes from the body?  Ask her doctor what stage of heart failure is she in now?  Different medications are used for the different stages of heart failure.  Monitor her blood pressure and heart rate daily.   Atenolol can not be stopped suddenly, so be careful that she is taking the Atenolol as prescribed.  I have not heard from anyone that Atenolol causes any water weight gain.  I took it myself when I was pregnant for a rapid heart beat.