Diastolic dysfunction

Everything else
1

So I had an echocardiogram done along with a carotid ultrasound a few weeks ago, the tech who performed these said my heart was strong and that he could drive a 18-wheeler through my arteries. Great news, especially after my best effort to have a heart attack at age 54 three years ago. My cardiologist had scheduled an appointment post-tests, which I went to this Monday along with my wife.

Apparently the tech who performed the echocardiogram focused too much on the ejection fraction. The cardiologist said the results show I’m in early congestive heart failure. More specifically it’s diastolic dysfunction. Basically the heart walls have thickened which keeps it from relaxing and letting more blood into its chambers for the sistolic portion of the beat. Which makes the sistolic, or pump, work harder since it’s moving less blood per beat, thus greater strain. This is in part why my ejection fraction #s looked good to the tech. He basically told me the damage is permanent, my lifespan will not be normal at this point, the congestive heart failure will only worsen with time, but if I lose weight I should have some time left. If I don’t, he said based on his experience (he’s in his late 50s) he expects me to die between ages 60-65. He said the hopeful signs are that my blood pressure is good, as is my cholesterol, major arteries appear to be clear, and I’m not as yet diabetic, though he expects that to be coming by 60 if I don’t lose at least 100 lbs.

I am going to get a second opinion on the test results, but I suspect it’s rather hard for an experienced doctor to misread a standard test like an echo. He’s urged daily exercise and a dramatic reduction in sodium intake. We walked last night after dinner and tonight, since it was colder and rainy, I did 10 flights from the basement up to the 2nd floor in my house.

I’m not going to mention this on FB/social media. I just told my older sister, urging her to not repeat it to our 84yo mother. I highly doubt she outlives me and her health isn’t the best, so putting this on her, when it’s not something I can change in terms of reversing the damage done, just doesn’t strike me as the right thing to do. But I wanted to talk about it somewhere, felt like I needed to. I’ve told my best friend and my sister, but not my brother, we’re both not sure he can be trusted to keep it quiet, he’s liable to tell a cousin who’ll tell their parent who’ll call their sibling (my mom).

2

Sounds like a tough break man. Hang in there. Internet hug from Qt3.

I’m sure you can do a good job with the weight and exercise part. We’ll be rooting for you. Post how you’re getting on.

Alistair

3

Really sorry to hear. As someone who is having heart issues myself (stress test to find out more soon), I can relate.

On the positive side, there are some actions you can take that will help. Concentrate on what you can do.

4

I’m curious why he is urging the dramatic reduction in salt intake, since your blood pressure is fine. Regardless, if you have 100+ pounds to lose, that seems like an obvious priority.

Are you willing to do low carb? Did you ask the doctor about that?

5

Tough news John, I feel for you, man. Consider this an internet hug back. Sounds like you’ve started some lifestyle changes. Keep it up!

If you can go low carb it can really work for weight loss. Talk to your doctor first of course.

6

Your doctor saying you’ll be dead in 3-8 years seems unnecessarily dire. A second opinion would be prudent. I take EMS runs all the time on CHFers that seem like they are hanging around forever. This isn’t a great diagnosis, but it doesn’t have to be a death sentence.

7

Hard to believe in today’s world of medicine that giving you a death sentence was the best they could do. Get another opinion or two. And try to stay positive.

8

Holy shitballs, man. I’m sorry to read that.
Still, a guess is a guess. I hope you get to laugh at it in about in 10 years, best of luck.

9

Fluid retention around the lungs and heart are always an issue in CHF, so limiting salt is always a food thing to do.

John, I’m very sorry to hear this, but there’s another way to look at this. You’re still young, relatively healthy outside of the CHF, which means you’re an excellent candidate for a heart transplant or Ventricular Assist Device - of which they’re constantly improving upon. When I was going through pre-transplant for my lungs, I always shared the waiting room with many individuals with VAD’s and they always looked and sounded really good being in end-stage CHF. You have options, so keep that in mind and let your doctors know sooner rather than later if you’re interested in not letting CHF just run its course.

Lots of hugs!

10

Makes sense, though I’m thinking that in the near term, focusing on weight loss would be wise. If he can do that while limiting sodium, great!

11

Damn, that is tough, but at least you got some warning and there are some things you can do to try to mitigate. Hang in there, and good luck.

12

John. Sorry you’re dealing with such shitty news. I second what others have said. Definitely get a second opinion and focus on the things you can do. And as always, feel free to vent.

13

I should add that the lifespan #s the doctor was throwing out, I believe, was in part to scare me into a sense of urgency for losing weight (I’m open and frank with him, stating food is my one true addiction in life), I think he’s likely seen worse-case situations with some patients dying early with similiar conditions, which lets him feel like he can ethically make such statements to me, and mostly because he’s aware of my paternal family history. My grandfather died before I was born at age 53 from a heart attack, and my father from congestive heart failure at age 69. When I went into the ER three years ago with chest pain, they were more concerned over this history than anything else.

The doctor and I did speak about the difficulties of sodium reduction in America, with all our processed and fast foods. He said to stay away from the latter, which I actually tend to do. In recent years I can’t eat at McD’s or Wendy’s/Burger King -style places without feeling really queasy and borderline nauseous afterwards.

I should mention I did lost 60 lbs in the first half of 2019 after my first heart scare, but got super-stressed when I accepted the Army job over in Italy, and then Covid came along and blew that all up and we quarantined and I eventually gained it all back and then a bit more, putting me close to 350 lbs now. The doctor actually wants me to lose 150, but I know that’s not very realistic, and even when younger and healthier, hitting the gym six mornings every week very religiously, I could not get below 200. I’m built like a small NFL player, largest chest and shoulders, wide frame, big arms. When I was around 200 lbs with a 34" waist, x-large shirts often didn’t fit me because of the shoulders and arms.

So I flat-out told him I’ll be thrilled if I can get down to around 225 in a few years, closing in on age 60. That’s my goal right now. I don’t want to crash 60 lbs in 5.5 months like I did a few years ago, that was too quick, too extreme a lifestyle/habit set of changes that I obviously didn’t sustain. He wants to see me again in March and wanted me to lose 20 lbs by then, which won’t be too hard since at my size the first 30 lbs or so drop super-easy.

I will say I woke up this morning with my back sore from running those flights of steps last night. Today’s weather is better though, so I’ll walk after dinner tonight and then I’m off work Fri-Sun so I’ll do some light weights this weekend on top of getting out and walking (the weather is supposed to warm up).

Thanks for the replies though, guys. I really appreciate having a sounding board.

14

I must say I understand where you are at with the weight. I topped out at 297 a few years ago, which scared me. I did NOT want to admit I could be over 300 lbs. Plus high blood pressure, high blood sugar, etc.

Over the roughly 5 years since then, through better eating habits (I still don’t really exercise though I do walk more than a mile per day) my weight, I am thrilled to say, is down to 237. Not perfect, but tons better than before. My ultimate goal is 200, but I’m doing it slowly to make sure it stays off. My pants line is down from 46 to 40, and even the 40s I have to really cinch up with a belt.

I wish you the best of luck. Take it off and keep it off. Believe in yourself and it really is possible, without fads and without ruining your quality of life.

15

Sorry to hear that man. I think the biggest thing you can do is adjust diet. If I were you, stop all restaurant food, right now. That will contain how much salt and oil you take in.

reduce carbs, and what carbs you do eat make it whole grain. If I were you, drop sugar, completely, for sweet treats / drinks, and only berries/fruit or maple syrup to help , for example, oatmeal, but really if you go low carb than you shouldn’t need sweeteners for anything. Stop (alcohol) drinking, if you can, or make a glass a weekend treat.

Ditch all rapeseed oil, or any kind of ‘vegetable’ oil (processed at high heat, carcinogen, crinkles your arteries, hence, stay away form fast food). Use cold pressed olive oil which is fine. Butter for frying, or lard.

Good news, have as much meat and eggs and veggies and dairy and beans / hummus (made with olive oil) and nuts as you want. But the more you eat at home, the better you’ll be.

And then exercise, sure. It can be as easy as 20 min of indoor HIIT a day (youtube is your friend) and you’ll see results. But diet is #1… good luck!

16

For me getting the mental part of eating adjustments under control is always the biggest hurdle. I’ve found that working towards some daily intermittent fasting(the kind where you have a set eating window each day) goal is incredibly helpful for me to build that self control and help get those cravings under control.

For example, right now my goal is to eat between 2pm and 7pm but I started with a wider window than that and have worked my way down. For me, this is far more sustainable as there is always an end in sight where I get to eat the thing I want, but there is still periods of having to overcome the cravings on the way to get there. Eventually your body adjusts and you generally won’t feel hungry during non-food times.

I’ve since modified this so that I’m low carb until dinner time, and then at dinner I can mix in some carbs and have something sweet after. Sugar has always been my weakness and this strategy again goes back to trying to find something sustainable for me where I can get little hits of sugar but not be hugely at risk of out of control binging.

Trying to figure out what will work for you as a long-term sustainable thing is really the most important thing. Thankfully you aren’t trying to crash the weight down again, so I’d wholly recommend that you experiment a month at a time with some different strategies and see what works and what you may be able to sustain.

17

I have heard modern studies corroborating with your practice, Abrandt, that resisting any snacking after supper (and fasting until brekkietime) has a huge positive impact on your metabolism/weight control. On top of all the other things I mentioned of course. My wife has been an avid researcher of all the studies of the last decade-- overturning the last generations’ ‘lowfat’ diet bullshit-- and putting them in action for us, and we’ve both seen incredible gains in our overall physical disposition.

18

Yeah, as nearly as I can tell, the “Mediterranean” diet is spot-on for healthy and sustainable weight loss. And it really isn’t a diet at all, it is just healthy eating. When I took a nutrional course after being diagnosed with diabetes, they never called what they were recommending by that name, but it is definitely what they were describing.

“Eat food, not too much, mostly plants.”

19

Sure, but I think the mostly-plant thing is being revised. Meat, eggs and dairy isn’t bad, if you can avoid it being deep fried or mixed in sugar (ie, not all yogurts are equal by a longshot… ironically lowfat will have tons of sugar, fullfat often none). Funny thing about the Mediterranean diet, as we choose to understand it, isn’t only what people traditionally ate from where it supposedly harkens from (it’s a funny story why that is, based in economic cultural exchange, marketing etc). They ate plenty* of lamb, beef, fish, butter, milk, cream, whathaveyou. So do the French, etc.

It’s the combination of excessive and nutrition and fiber poor carbs, vegetable oil, and sugar that’s killing the Western world, not [the good kind of] fat.

That said, if you can live on veggies only (esp. if you include nuts), good for you, but that’s really hard.

*plenty meaning, by today’s standards, only moderate amounts :)

20

If your dad lived to be 69 with CHF than I would expect you can beat that if you get the weight off. Medical care is better now.

I need to see a new cardiologist too. I moved away from my current one. He’s also one of those high achiever types who doesn’t understand normal humans. “I don’t see what’s so hard about not smoking? Just don’t smoke!” That’s a conversation he and I had. I don’t smoke, but smokers came up for some reason.