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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Sunday, November 22, 2009
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Sunday, November 22, 2009
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Heart Failure |
Mitochondrial Myopathy and Heart Failure01/07/2009 |
I have a neuromuscular disease ( mitochondrial myopathy) that has affected my proximal muscles,respiratory muscles and it can cause a cardiomyopathy. I had an echo in 1999 that wnl- ef > 55%. Last year I had an echo that showed mild lt atrial enlargement, mild lt ventricular systolic function, minimal aortic and mitral valve regurgitation and ef 45%. I just had the echo repeated last week but do not have the results yet. I have a positive ANA (1:640-speckled),mild HTN and Hashimoto`s thyroiditis and a decreased dlco (68%) on my pft`s also. My cardiologist says he will not be concerned about the echo unless the ef goes below 30%. In your opinion, is it safe to wait for the ef to fall below 30% before initiating some type of beta blocker etc? I have tachycardia up to 180 with climbing 2-3 flights of stairs and can go to 130 just walking across the parking lot ( verified by event monitor) with pvc`s and dyspneic . My cardiologist doesn`t seem to think this is significant. Any insight would be aprreciated.
It is always difficult to give specific recommendations without having a complete patient history and physical, but a few comments can be made:
There are no specific treatments for mitochondrial myopathy. A decreased left ventricular ejection fraction is defined as less than 40%. However, a person can have chronic heart failure with a normal or only slightly reduced ejection fraction.
In your case, if you have symptoms of heart failure, such as shortness on breath with effort, fatigue and/or rapid resting heart rate, it would be reasonable to start a beta blocker, an ACE inhibitor and possibly other medication for heart failure. However, other conditions that can mimic heart failure have to be ruled out first. These include (among others): lung disease, blood clots in the lung, pulmonary hypertension, severe anemia, valvular heart disease, pericardial heart disease, and kidney disease with proteinuria.
If the diagnosis of heart failure is confirmed and these other conditions are ruled out, one can consider treatment with a beta blocker and ACE inhibitor. It is important to start at a low dose and to slowly increase the doses, at about two-week intervals.
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Max C. Reif, MD Director, Hypertension Section Division of Nephrology & Hypertension Department of Internal Medicine College of Medicine University of Cincinnati |
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