Right ventricular dilation with impaired function

Heart health and blood vessels
1

Hi guys, have been trying to make sense of a letter my father has received following an echo scan. Basically he’s found over the last 18months to have massively lost the ability to walk any distance, breathlessness, dizziness and swollen feet/ankles. Following this echo he has been given an appointment to see a cardiologist. The letter states

Right ventricular dilation with impaired functionestimated severe pulmonary hypertension with associated severe tricuspid regurgitation Pleural effusion

Is anyone able to provide a simplified explaination of what that means?, what are the implications and likely options available to him,  it’s taken so long for any diagnosis or any sort

Many thanks

2

Hi

I have the same problem since 2011. for me the left ventricular became bigger than normal size. Your father seems that the rioght one became smaller but the effect is the same. I am Ok now but taking some pills every day. For me cannot be solved completely and I have to take pills and check it regularly but I have my normal life.

 

3

I have RVH with moderate tricuspid regurgitation, and PH, why I don't fully understand, but I know there is more than one condition that can be associated

with such findings.  I also had a pleural effusion, and it was never investigated,

by that I mean I never had a pulmonary tap done to determine the etiology behind

the finding.  They can be indicative of a transudate ( which would be associated

with heart failure) or an exudate, which is associated with different conditions not

associated with cardiac function.  If he didn't undergo a tap ( which is a relatively

easy procedure to do) then his doctor must assume he has a transudate, given

his other symptoms, like breathlessness, swollen feet/ankles, etc.,,  I take a diuretic when indicated ( too much sodium in the diet), however, I've yet to be

started on any med for the PH.  I don't know what they're waiting for, I guess I'm

not bad enough yet.  I wish you luck with your father, he's got an uphill battle ahead of him, as PH is not curable, but it is manageable.

4

Firstly - has your father seen a cardiologist, it would seem to me to be a case of being managed by a cardiologist.

​My husband has left sided heart failure, but a little different with right sided.

​Right ventricular dilation, stretched out ventricle, our heart only remain efficient when it is small, bit like a bulging car tyre, not a good idea, so we change the tyre, not so simple with the heart.

​Right ventricle pumps blood into our lungs, where we exchange oxygen for carbon dioxide.

One of the valves that stops the blood falling back into the heart by the effects of gravity tricuspid, is not closing properly, and allowing the blood the fall back, so no matter how hard his heart pumps, it cannot stop this.

​Pleural effusion, - our lungs as I said previously exchange oxygen for carbon dioxide, this is water trapped in the bottom of the lungs, so he just doesn't have the lung tissue to exchange the gases, breathless, therefore build up of carbon dioxide in blood stream, dizzy.

​From my experience with my husband, limited intake of fluids, 1 half litres a day, that's only about 6 cups of fluid in total, we were very strict, but with experience and on very hot days, he can increase his fluid intake, its a balancing act, fluid overload, I give him his frusemide tablets which make his kidneys work overtime to clear out excess fluid, but he does not need them all the time.

​Husband does not get swollen ankles, this is a symptom of heart failure I afraid for most people, but a small number of people do not get the swollen ankles, so I have to be very aware, of his symptoms of fluid imbalance, cough, squeaky lungs that even I can hear, by putting ear to back.

​Being overweight disaster area, you must be on the light end of normal with heart failure, husband at the moment needs to go on a strict diet to get his weight down again.

​Exercise, he does 3-4km's each and every day, early in the morning, then potters around the house, hangs out washing, does dishes, plays in the backyard with his lawnmowers, he fixes all the local neighbours mowers as a hobby, and looks after about 6 beehives., weekly.

​Nearly seven years ago now he was discharged from hospital, with the instructions from the Dr's keep busy, and keep active, letter to GP which we never saw for months  said to GP, expected death date less than 30 days, well they were wrong there weren't they.

​He is on blood pressure tablets that keep his blood pressure down, tablets that slow his heartbeat, as a dialated or damaged muscle needs rest, not possible to put heart up on a footstool, but you can slow it down.

​We have listened very carefully to the cardiologist, tried to write down questions as they occur to us, and ask them at the next appointment, hit the library and read about heart issues, many of them don't apply to huband, but knowledge is power, and with this knowledge I have been able to use the correct medical words in the heart hospital, and unless the nurses and Dr's ask my directly are you a nurse, I don't bother to inform them otherwise. I believe it has made a difference in his care. 

I have read Dr to Dr papers on the internet, many of no real interest, but all of them have educated me, about heart issues, and even asked my GP for his cardiology books which he has shared with me.

I have been able to ask why that tablet, when it causes issues with liver function, when his liver function is all ready in trouble during a recent virus.   I was really angry the Dr's overlooked they were doing more damage.

​I identified a electrical issue with his heart, and for 15 months nobody would believe what I was saying, about intermittent issues, pain in left arm, fading in and out, hard to describe, just not with me, until his heart dropped to 30BPM at home, drove him to heart hospital, and even when we arrived at ER even then they questioned what was going on, withdrew some of his tablets that can cause slow heartbeat, YEAHHHH right, and his heart dropped to 23BPM during the night, I went in early to meet the senior cardiologist and gave him a piece of my mind about his juniors, an their skills, to my shock the senior agreed with me, pacemaker installed late the same day.

​Yes there is a lot they can do, medication etc, but you are part of the team as the patient as well.

Best wishes from a fellow heart failure patient to you and your family.

 

5

Hi Lyn, and thank you so much for responding. He is booked in to see a cardiologist on the 11th jan. It’s frustrating because when the chest pains and symptoms first started some 2yrs ago he was immediately referred to cardiology, where they conducted several tests, and repeated with no real diagnosis and pushed him in the direction of a respiratory consultant, from there to ent, then to renal (there are some kidney issues where they were being careful on giving meds for the fluid retention as to not effect the kidneys any further as they aren’t working near as good as they would like).  From there to neurology, with no real diagnosis, it’s was his gp that was convinced of heart issues based on his symptoms and pushed for this echo to be done.

Weightwise he’s around 11 stone, so very slight and certainly not overweight, with no real change in his weight, it’s remained around that for some time.

Exercise,  now heres where he struggles, these days he needs to stop v regularly, he could walk 20metres then need to catch his breath ( he describes this strange feeling coming over him feeling unsteady), then he feels completely fine and is able to walk again. This process is repeated throughout the day. We have seen over the last 2yrs that the distance he is able to walk has reduced dramatically.

Can I ask when you first became aware of issues with your husband, was there much of an improvement upon seeing a cardiologist ? I.e Taking medication, diet changes etc, to his quality of life. 

The big thing he wonders is would there be a reasonable improvement in things following what intervention is available, he so wants to able to just do simple things as to walk without the need to stop so often to rest. I just hope they are able to do something to improve things for him, that would give him a much needed lift.

He’s been on high blood pressure meds for a while which they stopped, maybe that’s something they will look at the introducing.

I will certainly look to read a lot more into this as you advise and quite right knowledge is indeed power.

A list of questions for the cardiologist..., I have so many, so will be armed with a list to try and prose as much information I can.

Thank you so much for taking the time to respond, it really is appreciated, more than you realise and I sorry you have to go through the things you talk about with your husband.

Kind regards

Lisa 

6

Hi scotgal, and thank you for responding. I’m sorry to hear of your struggles with rvh.

Can I ask how mobile you are and if the medication intervention has made much difference to this? 

It’s certainly been an uphill battle so far, but I’m determined to do all I can to help him in whatever way necessary, be it support, information whatever. As lyn1951 mentioned knowledge is power and I think getting a full understanding of his situation (which I appreciated we won’t get until we see the cardiologist on the 11th jan) then they will best place us to help him.

Thank you for taking the time to respond and hope things improve for u

7

Will try to answer your questions as per your points - 

​Weight - with left sided heart failure you need to weigh yourself each day, when you first get up, in his undies just after weeing, he weighs himself, and writes it in a booklet we keep, if there is more than 2 kilo change, back to the hospital with him, with his booklet, they have photcopied a number of times as it proves what I have been saying, with him getting worse, over time you can see the patterns of weight increase, I assume it is the same with your dad, ask cardio if this is what he should be doing.

​Exercise, it not the speed or even the distance, its the fact that he does something each and every day, if he can, we were told he must be able to walk slowly enough so he can keep up a normal conversation, and if he can't talk, slow down, but keep moving, again if he can.

​Yes big improvement after seeing the cardiologist, in the hospital, he spent 8 days, in hospital until they stablised him, gave him tablets prendopril, that dropped his blood pressure, astrovastin, that's a tablet for cholesterol, and bisoporol, which he is still on for heart muscle, as I understand it keeps the muscle fibres straight rather than forming into scar tissue, aslo frusemide for fluid overload, when we came home, he was still really sick, Dr's telling me their was no more they could do for him, we started walking from the bedroom to the lounge room, sat down puffing, I looked at him, and thought you are going to be trouble just sitting around, let alone sitting around killing you, so started with him walking to the front door, about 12 - 15 steps, and returning, had to put chair at the front door for a start, he got so breathless, encouraged him to do this exercise up to 4 - 5 times a day, no lunch until I see you walk to the chair at the door and back, no afternoon tea until you walk again, he hated me for it, got called names, Nazi wife, Nazi diet, he was really angry with me. Then after about a week, put the door chair out at the front boundary by the letter box, and again made him walk to the letterbox, take a break, and walk back again, for another week, slowly slowly slowly, a week later moved the chair to the neighbours letterbox, over about 18 months from not able to walk across room in the hospital to walking 5 -6 km's or 3 miles a day, Dr's amazed.  For the Dr's info his EJ or ejection fraction was at 23% when he started this walking and came back into the high 40's.

​Over the next 5 years he slowly started to get arm pain, shoulder pain, see previous post, and his ejection fraction dropped to 34%, at that point we were told he was eligible for a pacemaker and defib, he collapsed at home 10 days before the appt to see the surgeon about having this procedure done.

​Once they put in pacemaker and defib, he has had all the energy in the world, as they managed to get both sides of his heart to beat together, previously not happening, as he had LBBB, that progressed to RBBB, (left branch bundle block and right branch bundle block), also stop and start weeing, suggested it was prostate problem but turned out to be lack of blood supply, (as per Dr Lyn, me), Dr's suggest otherwise, but it doesn't make sense to me, that before pacemaker he had trouble weeing, and immediately after he reports weeing like a horse.

​Also can you get access to rehab unit, here in Australia we were lucky enough to get access, they were wonderful, with diets, exercise, counselling physical as well and mentally, and it did help understanding what was going on physically as well as mentally, I would have hated to have been on our own without that help, and also meeting other patients with varying conditions, we discovered there were lots of other patients, also with heart conditions, can understand just how lonely it feels on your own.

 

8

Hi Lyn,

Thank you for all the information you have shared, I will make sure we look at everything you have spoken about, and it’s certainly good to know there is a chance that meds and other things are available which may help him. A massive thanks and hope things are improving with your husband.

Kind regards