Can heart failure cause lower limb microvasculature resulting in more fragile skin?

Hi doctor,

My wife has cardiomegaly, HFpEF 50 to 55%. Moderate PAH (44 mmHg) by the echo. NT-proBNP of 1130 pgs/ ml. She had COVID-19, and was in ICU; massive systemic glucocorticoids or other catabolic steroids saved her, but during her ten days in the hospital, NT-proBNP was 5,000 pgs/ml; fasting glucose 330 mg/dl. She had Parkinson's for seven years, cognitive impairment (dementia) for five years, and is in a nursing home. They exercise no more than 120 minutes total/week in five sessions. She uses a wheelchair otherwise but for transfers to bed or toilet. Only TV as an activity. Legs are almost always dependent. She can not tolerate compression socks. She has OSA resulting in excessive daytime sleepiness and EDS; she is not tolerant of CPAP. She is currently taking Apixaban 5 mgs q12, Donepizel 10 mg mornings, Diltiazem er 360 mg q24, 25 mg Metoprolol, Carbidopa/Levadopa 25/100 2 tabs tid, Levothyroxin 150 mcg, Azilect 1 mg morning lactose. Just started keyless about 500 mg tid. Is it probable some damage has been done to lower limb microvasculature resulting in more fragile skin? Would that cause more damage when scratched, especially if the skin is dry? Would HF, as described, contribute to this condition? If so, how and what can be done to retard progression? Would more walking help. Would physical therapy help? Please respond only if you are highly experienced and credentialed in either area. Thank you very much.

Hello doctor,

Thank you for the reply. What I want to know about is the photo I thought was attached. It is the possibility of leg and foot ulcers that concerns me. Does edema damage the microvasculature of the skin? How does being in a wheelchair all day except for 15 minutes of exercise each day for four days/week contribute to the leg foot sores you see? I will get an echo, but they did not send ECG. Thank you very much.

Hi doctor,

Thank you for the reply. I have other things now but want to keep in touch with you. Unfortunately, the NH will not give enough exercise even though many specialties advise it. I would like to follow up with you later or tomorrow, but I must get offline soon. Regards.

Hi doctor,

Thank you for the reply. I will upload the echo. Regards.

Hi doctor,

Thank you for the reply. I do not have ECGs. I will request. I showed your answer to my primary. My cardiologist says primary knows cardiology well. He agreed to your response. Please keep all personal information confidential. She was very tired today. Up 12 hours but often very fatigued. She wakes up when her friend visits. I think I mentioned ICU for covid-19 with NT-proBNP 5000 pgs/ml. Evidently, more damage had been done by SARS or massive IV. Systemic steroid, which probably saved her life. She was in ICU for five days. Thank you for reviewing. Not sure the cardiologist has ECG. No recent ones. Perhaps NP would order. Regards.

Hi doctor,

Thank you for the reply. Few in our country get profit from Nhs get quality care. The in-house multidisciplinary teams and primary care sign to support the policies of the NH. Since businesses control them, basic but not extensive preventative care is given. Without intervention in OSA and atrial fibrillation, will the left atrium continue to enlarge? How long before physiological processes remodel the left ventricular, so heart failure causes hospitalization and a shortened time to death. Even where VADs are reliable, our medicare government system will not pay for a ventricular assist device for anyone whose comorbidities are irreversible and lethal. Yes, no dysfunction heart compensates for now, but we do see the beginnings of, I believe, pressure when ventricle or left side in diastolic mode, I think. Thyroid seems to have been corrected with 150 mcg Levothyroxine. Can thyroid nonetheless contribute to HF? Interesting point about afib; yes, I guess that stress can damage heart cells. I will try to upload a pre-covid echo. The echo you see was taken 18 months after discharge from covid hospitalization. In what ways could covid have damaged her heart? Does it seem that heart damage is progressing if the next NTproBNP is higher? What is your experience? Would you estimate a time range to the heart becomes decompensated? At what rate would you estimate her LVEF would decrease annually? Yes, proBNP 5,000 pg/ml. Could that reflect more permanent damage to myocytes or atrial enlargement? She sleeps poorly; how will this damage the heart? Thank you very much for taking the time to read and understand.

Hi doctor,

Thank you for the reply. When I first spoke with the electrophysiologist, I thought he said anatomic and physiologic remodeling would occur. I must agree with you about MVR as I recently had intervention surgery to reduce the regurgitant. The diltiazem keeps my wife's HR below 90 except when she is upset. PCP noted the difference but did not connect its cause. What medicines improve myocarditis? The proBNP has been going up slowly but went from about 900 to 1100 pg/ml in five months. Blood was drawn this morning, and hopefully, the lab will test for NT- proBNP, and BNP as they have been. Thanks again.

Hi,

Thank you for the reply. Perhaps I should stop trying to understand as this is complicated. Still, when you address tachycardia, I take, in context, ventricular tachycardia but a node that stimulates contraction to find its way to, or develop in, LA causing atrial tachycardia, which could result in LA enlargement? I do not think an electrophysiologist wants to ablaze my wife's heart.