I'd like to hear from any MD or someone who had severe heart attack & then CHF?

Question

I want to hear what happened to me was typical or not. 09/05 I was struck by car- in the ICU I had severe MI - large infarct in EVERY wall of heart. Surgery to mend broken tibia was deferred till 4 mos later. & I wore fixator 3 months then bone mended & Dr. removed it. I walked well with no impairment or limp. All these mos. I ate & drank, walked& talked, urinated copiously. I didn't feel feeble.Then in Nov.06 I suddenly swelled w/water edema all over-my r.leg burst the skin, creating a constant drip of cold water from inside my tissues. Now I gasp for each breath, if I talk, exert, climb stairs, anything.My legs are stiff & painful from water pressure INSIDE tissues. I can't bend or flex legs to wear pants or go up or down stairs. I am now an invalid,can't go in or out, take transit, anywhere. & when edema began,my urination declined. I have 50% ejection fraction. My liver/kidney/lipids are normal. So tell me, after severe MI - do symptoms of CHF appear 1 yr later? Is this typical?

Barry M -My body had NO reaction to Lasix, torsemide, Zaroxylyn, HCTZ, They produce NO urination at all. Yet if I drink some coffee, I will have increase diuresis- but not with the Rx drugs. some of us are refractory to diuretic chemicals.

Answer 1

There are to many variables involved to ever have a "typical" situation, such as your level of health precipitating the incident compared to someone who developed CHF from cardiovascular disease progressing over years. If your MI was brought on by the car accident, you could have had a variety of compensatory mechanisms that allowed your heart to function effectively for some time (a year, more, less) until these measures were no longer effective and the muscle began to fail.
MI causes tissue death within the heart. There are 2 types of tissue: muscle, which contracts, and nervous, which conducts electrical impulses. After an MI, the tissues are replaced by scar tissue, which cannot contract or conduct electrical impulses. The heart is not able to pump as effectively then, so the body begins to compensate. The remaining muscle fibers may stretch further, which allows them to pump more blood when they do contract. Eventually the fibers become overstretched, and cannot contract effectively, decreasing cardiac output (ejection fraction).
The remaining muscle may become thicker (called hypertrophy) in the left ventricle due to the strain of pumping, causing less room in the ventricle for blood. The thickened muscle also does not contract as well as the normal tissue.
The nervous system may try to compensate by causing the heart to beat faster and consticting peripheral (your extremities) blood flow to increase the amount of blood entering your heart. This is usually a last resort, since the remaining muscle tissue needs to work much harder and eventually fails.
The kidneys regulate blood pressure by causing you to urinate or retain urine. When blood flow to the kidneys slows (due to CHF), they think that the body is low on fluid, so they retain more water. This increases the amount of blood, increasing the blood pressure, increasing blood flow to the kidneys, but also increases the amount of work on the stressed heart. The veins are not muscular like the arteries, and the blood begins to pool in the lower veins of the body since the heart is not producing enough force to bring it back. The fluid leaks from the vessels into the tissues, causing edema.
There are many medications that can help. Diuretics are often used to increase the excretion of water from the kidneys to reduce edema and blood volume. ACE inhibitors are used and usually beneficial in all stages of CHF. Your ejection fraction is high for CHF (normal is 55-75%), 40-50% indicates damage to the heart, and below 30% is very low and compromised function. You have a good prognosis for getting the symptoms under control and maintaining function if you begin to educate yourself and follow a good therapeutic regimen.
I hope some of this information has been helpful, and I'm very sorry for the trauma that you have experienced.

Answer 2

Sorry, I can't help you with the heart issue, but I can tell you the edema can be treated with drugs like Lasix. Your physician should have you on heavy doses of some kind of diuretic to relieve the edema. If he doesn't, get a new doctor. The edema is putting undue pressure on your heart, lungs, and other major organs as well as your problems with your extremities. Since your kidneys are in good shape, you should have no problem tolerating Lasix. You may be in the bathroom a lot getting rid of that excess fluid, but it will allow you to become ambulatory again and as we all know, activity is a good thing. Sorry about all of the problems and hopefully someone else will be able to help you with your heart questions.

Answer 3

CHF symptoms can appear at any time after such a severe MI. Shortness of breath and edema as severe as you describe is a medical emergency. Get yourself to the ER ASAP and get diuresed!