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Thread: Heart Failure

  1. #1
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    Unhappy Heart Failure

    Any mags (or MD, DO, RN, PA mags) have any experience with heart failure? My dad (63) recently spent a week in the hospital. Started as AFIB, but he was diagnosed with heart failure. EF is 25. No blockages and the cardiologists he's seen aren't sure what caused the rapid decline of his heart.

    Seems like the long term prognosis is pretty bleak. He's not allowed to work out anymore and he is on a boat load of medication. He's particularly bummed because blood thinners mean no more skiing.

    Both his brothers have heart issues and both have been really healthy throughout their lives. One was a triathlete and nationally ranked marathon runner, the other was a college football player and weight lifter later in life. My dad has not been super active the past 10 years or so. All 3 now have major heart issues in their 60s.

    His parents both had heart issues as well- my grandpa died at 63 of some kind of heart issue and my grandma (now in her late 80s) had a heart attack in her 60s depsite being in good physical shape (5'4'', 110 lbs).

    I'm particularly worried he isn't getting the care he needs in small town Indiana. I flew out to visit while he was in the hospital and was pretty discouraged by the cardiologist that was treating him. No game plan other than take meds and hope for the best. He didn't mention anything about diet or weight loss.

    He's currently trying to get into some better cardiology teams for a second/third opinion and I've encouraged him all in on a low/no suger, low carb, low sodium diet with lots of produce. He's lost 32 lbs in the past 3 weeks since he first went into the hospital- he's down to 218 from 250. He's 5'10, so I told him to shoot for 180 lbs or lower.

    Life expectancy stats look grim. I'm pretty worried.

  2. #2
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    No meaningful experience but sorry to hear.

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    My dad has been dealing with AFIB issues. Docs don't really know what's going on. His situation doesn't fit usual patterns. Might have surgery soon. He downplays it all. Seems like he's aging quicker recently. It sucks.

  4. #4
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    Heart Failure

    My dad lived w CHF for years. He had to go in for diuresis once a year or so for the last three years for so of his life. He changed up his diet and started exercising regularly so perhaps the doc has other concerns as CHF shouldn't prevent working out. Bigger hospitals generally have a CHF specialty service that can help you manage meds and overall health. It's also good to always have a baseline on weight. Every morning have him log his weight so you will know if there is a sudden increase - that's telltale sign meds need to be adjusted. It's a manageable problem for many people. Get a second
    Cardiologist opinion if possible. My dad lived w it so hopefully yours can too. Reducing salt intake is no easy task. All packaged foods are loaded with it. The numbers add up fast so if you can help him manage his diet that would surely help

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    Quote Originally Posted by mcski View Post
    My dad lived w CHF for years. He had to go in for diuresis once a year or so for the last three years for so of his life. He changed up his diet and started exercising regularly so perhaps the doc has other concerns as CHF shouldn't prevent working out. Bigger hospitals generally have a CHF specialty service that can help you manage meds and overall health. It's also good to always have a baseline on weight. Every morning have him log his weight so you will know if there is a sudden increase - that's telltale sign meds need to be adjusted. It's a manageable problem for many people. Get a second
    Cardiologist opinion if possible. My dad lived w it so hopefully yours can too
    How long did he live?

  6. #6
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    Quote Originally Posted by Kevo View Post
    How long did he live?
    He lived until 89. There were a couple of times were his CHF ramped up and I thought he was done for sure (couldn't stand, labored breathing), but hospital diuretics took the fluid off and his sprang right back up. The CHF team
    Encouraged his exercise. He was also diabetic and lost a leg in his late 70s. He took diuretics for a number of years before he had what I think of as his CHF period where we watched it closely for
    About 10yrs. It's pretty manageable but usually there are comorbidity issues to manage as well and there is always the balance between the CHF meds and not damaging the kidneys.

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    Geez 89's a pretty good run with all that going on.

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    Blood thinners don't necessarily mean no skiing. I take thinners and ski. My prescribing doc "wishes" I didn't but my vasc surgeon says go. I don't huck or fall so it depends on expectations. Tell your dad. It's early in the process for him and many variables.
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    Read some of Dr. Dean Ornish books. I like his approach. Has to be better than living with a cabinet of expensive drugs and scared all the time.

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    Quote Originally Posted by iceman View Post
    Geez 89's a pretty good run with all that going on.
    In retrospect he was a tough mf'er. His laundry list of various surgeries (bipass, multiple vascular bypasses and amputations) was impressive. After all that , I became a huge fan of Medicare. Never paid a cent besides the premiums + supplement.

    Ultimately, the kidneys got him not the CHF. Probably would have survived another year or so but the last admitting doc he had didn't have a good handle on his baseline weight and overdid it with the diuretics and kidneys finally threw the towel.

  11. #11
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    A fib is a common cause of CHF. Sounds like he's diagnosed with Low Output HF? Is he a candidate for ablation? There are studies showing after ablation EF may increase in some A fibbers. https://www.nejm.org/doi/full/10.1056/NEJMoa041018

    Blood thinners are normal with Afib to prevent clots. What cardiac meds is he on? Rate control vs antiarrhythmic or both? The cardiac meds can have pretty serious side effects.

    Any other heart issues they've diagnosed, Chamber enlargement? Bifascicular block? Axis deviation?

    Hopefully the doc has a long term plan of getting him out of Afib one way or another. If not, seek another opinion for sure.

    I'm not an MD, but I do have a Cath lab rotation tomorrow. Vibes to your dad, hopefully he can turn it around. Bad genetics are a bitch, if you haven't already you might have your heart checked on to be safe with that history.

  12. #12
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    Sorry you are having to deal with this.

    My father had rheumatic fever as a child which damaged his heart. He struggled with limitations due to it for his entire (short) life stil he managed to hike/climb most of the Olympics and Cascades. He had a def. gusto for life not allowing his heart issues to dictate too much of what he could and could not do.

    Re: medical care - advocate, push, insist, question and don't take "no" for an answer.

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    Quote Originally Posted by Benny Profane View Post
    Read some of Dr. Dean Ornish books. I like his approach. Has to be better than living with a cabinet of expensive drugs and scared all the time.
    word.

  14. #14
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    Sounds like you have so.e really shotty genes. Get yourself lined up with a good cardiologist a d start doing whatever you can not to follow all your relatives.

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    Quote Originally Posted by wooley12 View Post
    Blood thinners don't necessarily mean no skiing. I take thinners and ski. My prescribing doc "wishes" I didn't but my vasc surgeon says go. I don't huck or fall so it depends on expectations. Tell your dad. It's early in the process for him and many variables.
    I had a DVT when I was 18 so I was on warfirn for a few years, and if I get another clot Ill be on them for life. However, fuck that if they think I wont ski. I cant play tennis or baseball (because of a rip rubbing against one of my veins in my shoulder), and thats fine but I will not stop doing the things I love.

  16. #16
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    A couple of things. Normal ejection fraction is about 60%, so 25%, while serious, is not as bad as it sounds.

    The main dietary recommendation is salt restriction. Since he doesn't apparently have an artery blockages a heart-healthy diet is not a high priority at this time but it certainly won't hurt. Carb restriction isn't going to affect the CHF. Weight loss is certainly beneficial.

    It would be nice to get him out of afib. A fib doesn't cause CHF but in someone with CHF it can make it worse. When the atrium pumps blood into the ventricle the ventricle is stimulated to contract harder. In afib the atrium isn't contracting so the ventricle loses that extra kick--about 20% is my recollection of how much afib reduces heart function. People sometimes can be converted to a normal rhythm with drugs or electric shock to the heart. This is usually done after they've been on anticoagulation for a while; if a patient is converted while there is still clot in the atrium the clot can be knocked loose when the atrium starts to contract. People have also had pacemakers put in to control both the atrium and ventricle--I don't know if this is still the practice; I stopped putting in pacemakers a long time ago.

    A second opinion at a referral institution is certainly an excellent idea. The survival of people with CHF has improved considerably over the years, mainly due to medication. I would make sure he is under the care of a board certified cardiologist. If the second opinion seems in line with the first then you can be reassured that he is in good hands. One thing that helps in cases like this is case management--often a nurse practitioner or PA that monitors his condition more closely than a physician ordinarily will. If his anticoagulant is warfarin, which has to be monitored, this is best done by a warfarin clinic pharmacist rather than by the physician. This kind of case management may be hard to come by in a small town but may be available remotely--the NP/PA and the pharmacist don't have to be able to see him in person so maybe if he is seen in a university cardiology clinic they can set him up with case management that works with his local cardiologist.

    As far as skiing goes on anticoagulants, certainly not skiing is the responsible medical recommendation. I probably wouldn't follow it for myself, but that's just me. Definitely a helmet, perhaps a MIPS helmet or one rated for speed events, although I'm not aware of any evidence that one kind of a helmet is more effective in reducing head injury than another. The big risk of bleeding with anticoagulation is bleeding in the brain.

    Like anyone with a serious medical condition (and everyone else) he should have a durable power of attorney for health care to designate who makes medical decisions for him if he is unable, and he should discuss with family and his doctors his wishes re life sustaining treatment if he is unable to make decisions. (Like I said --this isn't just for sick people. My family knows no dialysis or tube feedings for me.)

    Good luck.

  17. #17
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    Good luck dude. I don't have any medical advice to offer at all unfortunately but I have an idea of what you're dealing with. Unfortunately I also have no advice for dealing with it yet.





    Edit: removed stuff, this is Kevo's thread
    Last edited by abraham; 05-22-2018 at 01:26 PM. Reason: Personal shit

  18. #18
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    To echo old goat, get a second opinion. At this point the why doesn't really matter, the how to manage it now is key. Medications are very effective in managing symptoms and life improvement as well as lifestyle changes - diet modifications are huge and one of the largest causes for readmission to the hospital in HF patients. Quitting smoking and alcohol (if he does either) should be part of the plan.

    I know you said no blockages but wondering if he had rhumatic fever as a child? Any history of Lyme Disease or have they tested for it? And I know you said no blockages but did the echo the heart for structural valve issues like mitral regurgitation - a valve replacement would improve output if so.

    Last thing, get yourself to a cardiologist! With that history better safe than sorry. Best of luck to your dad!
    Quote Originally Posted by Kevo View Post
    Any mags (or MD, DO, RN, PA mags) have any experience with heart failure? My dad (63) recently spent a week in the hospital. Started as AFIB, but he was diagnosed with heart failure. EF is 25. No blockages and the cardiologists he's seen aren't sure what caused the rapid decline of his heart.

    Seems like the long term prognosis is pretty bleak. He's not allowed to work out anymore and he is on a boat load of medication. He's particularly bummed because blood thinners mean no more skiing.

    Both his brothers have heart issues and both have been really healthy throughout their lives. One was a triathlete and nationally ranked marathon runner, the other was a college football player and weight lifter later in life. My dad has not been super active the past 10 years or so. All 3 now have major heart issues in their 60s.

    His parents both had heart issues as well- my grandpa died at 63 of some kind of heart issue and my grandma (now in her late 80s) had a heart attack in her 60s depsite being in good physical shape (5'4'', 110 lbs).

    I'm particularly worried he isn't getting the care he needs in small town Indiana. I flew out to visit while he was in the hospital and was pretty discouraged by the cardiologist that was treating him. No game plan other than take meds and hope for the best. He didn't mention anything about diet or weight loss.

    He's currently trying to get into some better cardiology teams for a second/third opinion and I've encouraged him all in on a low/no suger, low carb, low sodium diet with lots of produce. He's lost 32 lbs in the past 3 weeks since he first went into the hospital- he's down to 218 from 250. He's 5'10, so I told him to shoot for 180 lbs or lower.

    Life expectancy stats look grim. I'm pretty worried.
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  19. #19
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    Kevo, sorry about your dad. Agree with the above and getting yourself a cardiologist and having things assessed. Also, where in Indiana is your dad? And did the cardiologist talk about what type of heart failure? It's a big catch all term that can mean very different things with different trajectories.

  20. #20
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    There’s plenty of good cardiologists in the Indianapolis area for second opinions.


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  21. #21
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    I've got nothing but ++vibes++ to offer.

    Hang in there Kevo and abraham.
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  22. #22
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    My dad had a really bad heart. The guy had his first heart attack in his early 50's and two more along the way. He lived to be about 82. His cardiologist was amazed to see him still alive each year, because half of his heart didn't really even work. His wasn't the best life, but he loved being here. He always told me that eating a cup of blueberries every day was what kept him around, so I eat them a bunch too.
    I miss him. See your dad as often as you can.
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  23. #23
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    One possibility for CHF with no arterial blockages or bad valves would be a viral infection of the heart; not common, not rare.

  24. #24
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    Thanks all for the replies Kinda hard to keep track of everything right now. Still traveling 75% for work and was working about 60 hours a week when I got word about my dad, so managing family and work and personal life is difficult. Lots of competing priorities. In the past 3 weeks I've gone from Denver to NYC, Indiana, San Fran, back to NYC and now in LA today. I'm working to set things up to take a bit of a step back from work so I can spend more time with my parents.

    The viral infection valve issue seems to be the best guess as of now. My dad sounds tired when I talk to him, which is a bummer. He's still on the weight loss train though, which is good.

    I guess I should get checked out at some point.

    Re: skiing. My dad is an intermediate skier, but it is his favorite thing. He has been skiing one week a year for a long time. I do worry about him though. He's lost a lot of strength, flexibility and balance the past couple years. I think he'd need to be working out a lot to be safe getting back into skiing. When he gets tired, he goes straight instead of making turns. There were times this year where I was worried he was out of control and close to taking a big fall.

    He is in Fort Wayne btw, in case anyone knows any local cardiologists.

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  25. #25
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    Not sure how old he is, but people in general and definitely older folks need someone that can advocate for them and help navigate and keep track of the various doctor recommendations. I have a nurse practitionee friend that does that as his business, not sure if Ft Wayne has anyone providing that service but worthy checking into. Also push to have a home health nurse manage his case for a while after his hospital discharge. They can help arrange PT and all kinds of things in addition to keeping in eye on his CHF and blood thinners. Most hospitals work w an agency or two that provide this and it is covered by Medicare

    Being tired goes hand in hand w CHF so no surprise there. Following up w another cardiologist asap is probably a good idea.

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