Dr. Carlos L. Alviar
Critical care physician
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 41-year-old male with a height of 5'11" and weight of 214 pounds. Multiple sclerosis and bipolar disorder are co-morbid conditions. I was recently admitted for a heart catheterization to check for any potential blockage after an abnormal ECG, chest and chin pain, months of breathlessness, and a very strong family history of cardiovascular disease. Fortunately, no blockages were found. However, my cardiologist informed me that I had diastolic heart failure. To be clear, he did not say diastolic dysfunction, and he said heart failure. My high blood pressure has always been controlled. My reports say, moderate tortuosity of epicardial vessels consistent with hypertension, hyperdynamic left ventricular ejection fraction of 75 to 80 % and moderate to severely elevated left ventricle end-diastolic pressure 24 mm Hg. My cardiologist never gave me a prognosis. He told me to eat a low sodium diet and to get checked for sleep apnea (which I will do), but he never gave me a prognosis. I have dealt with health problems for a very long time. It is essential for me to know what a diastolic heart failure diagnosis means for my lifespan. I am married and have five children, and it would be nice to know what I am looking at. Kindly advice.
Hello,
Welcome to icliniq.com.
I am sorry to hear that you did not receive any detailed explanation of your condition. Diastolic dysfunction is the inability of the heart to relax, which can be diagnosed with echocardiogram or with evidence of high pressures inside your heart chambers, as evidenced by the increase LVEDP (Left ventricular end-diastolic pressure) in your cardiac cath (it was 24 mmHg, and normal is considered less than 15 or 18 mmHg). The term diastolic heart failure is used when we have evidence of diastolic dysfunction as above in addition to symptoms of heart failure (the shortness of breath you described). There is some belief that diastolic heart failure is more benign than systolic heart failure, but in reality, that is not the case. They have similar prognosis when compared in general. However, patients with advanced systolic heart failure have a worse prognosis than those with diastolic heart failure. The complicating aspect is that there are no many proven therapies that work for diastolic heart failure, other than low sodium diet, diuretics, exercise, proper eating, and lifestyle modification. To provide a more precise diagnosis, it would be essential to understand how is your exercise tolerance, however that can be challenging with your multiple sclerosis. I hope this information helps. I do not want you to feel discouraged but instead focus on lifestyle modification. Eating well, stress reduction (mindfulness or mediation can help) and practice physical activity.
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Patient's Query
Thank you doctor,
Can you give me an estimated life expectancy?
Hello,
Welcome back to icliniq.com.
Unfortunately, no test or series can tell your life expectancy. There are risk predictors for other conditions such as coronary artery disease that can be put into an algorithm and show you the risk of certain events, such as having a heart attack in 10 years, or in the case of atrial fibrillation the risk of having a strike over one year period. However, for diastolic dysfunction or diastolic heart failure is not that simple. Moreover, we would have to take in consideration your exercise capacity. If you would like to get a more objective assessment, you can see a heart failure specialist see if they can do a cardiopulmonary stress test so that they can provide a better estimate. However, that test might not be covered by your insurance.
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Critical care physician
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