Sudden Rapid Heart Failure

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Submitted by Dr T on September 2, 2013 – 2:36am

Question: 
My husband a 71 years old, wt 83 kg, height 180cm, very active with outdoor activies, including riding his bike 12 miles in less than 30 minutes per day, was diagnosed with A Fib May 2013, during a routine pre-op visit. surgery has been put on hold (herina).  He has always had a regualr irregular heartbeat., normo tensive, negative for Diabetes. June 24 he had a echocariogram. Conclusions- minimally dilated left ventricle, EF 45-50%, mild global hypokinesis, mild lt ventricular hypertrophy, biatrial enlargement, lt atrium 5 cm, moderate mitral valve regurgitation, mild to moderate tricuspid regurgitation. July 12, 2013 a nuclear and exercise stress test, defect of interventricular septum which is predominately fixed. Second maller defect involves lt ventricular apex and distal lateral wall of lt ventricle. EF was 33%. July 31, 2013 has a left heart cath, coronary angiography, lt ventricluogram. Angiographically normal lt main coronary artery, lt anterior descending and nondominat lt circumflex coronary arter. Normal large, dominat right coronary artery. Mildy dialted and globally hypokinetic left ventricle with EF of appromiately 20%. Normal lt ventricular end diastolic filling pressures. He is now on Coumadin, Coreg, Lisonpril and scheduled to see an electrophysiologist. No history of major illness, stopped eating red meat in 1970, stopped smoking 15 years ago, social drinker. I am a nurse and very worried about the seemingly fast decline in his EF over such a short time frame. He is now experiencing swelling of the lower legs, loss of energy and staminia, loss of mental acuity. He does in my opinion have sleep apena, although not tested for. What is your suggestion for next steps in treatment? I feel like no one is listening. this is a 71 yr old who still takes on side jobs in construction, takes his boat out fishing several times a week. He no longer is riding the bike, until we find out our next steps. However, he does go out and walk 2-3 miles per day. I don’t want him written off due to a numerical age.
 

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