Sunday, September 13, 2009

State of the heart

A couple of years back, I was diagnosed with Left Ventricular Dysfunction. A 2D Echo Cardiogram showed that my Ejection Fraction (EF) was fairly low. My valves were leaky. I was put on medication. After about a year I repeated the 2D echo. It was normal. The EF was normal, the leaks had stopped. Benefits of daily dialysis, I concluded.

I've been taking a drug called Digoxin for the heart. Every time I tell another doctor that I am taking Digoxin, they ask Why? There is something about this drug that is not good. I never get any convincing answers. During my visit to the neph a few weeks back, he told me to do a 2D echo and stop Digoxin if it is normal.

So, I went and got a 2D echo done. The Left Ventricle was dilated. The EF was normal however. To top it all I was feeling a little breathless for the past few days. I went to the cardiologist yesterday. He saw all the reports and examined me. He said the 2D echo was not a perfect test and a lot depended on the person performing the test. Nevertheless it could be used as an indicator but never as the final word. He went on to say that the fluctuations in heart condition were normal in someone with Chronic Kidney Disease (CKD). CKD affects every cell in the body. These conditions sometimes express themselves at the macro level but they are always present at the micro level.

Basically, he said, this was something I would have to live with.

I told him I was swimming every day and asked if that was safe? His answer confused me. He said brisk walking is safe. But he was not comfortable with a treadmill. Swimming. Treadmill. They don't even sound alike! I let it rest.

3 comments:

Dr. Roger Smith MBBS, DM. said...

Hi I found this blog through the big list of blogs at www.billpeckham.com. Which has a list of CKD blogs.

I have started a site about kidney disease and was wondering if i could link to you from my site.

Kamal D Shah said...

Sure Dr. Smith.

Dr. Roger Smith MBBS, DM. said...

BTW the reason that doctors dont like digoxin is that it causes the heart to work more in order to reduce your symptoms. Unlike other medications that decrease the work of the heart.

Heart failure is a situation where the heart cannot meet the peripheral demand by it self.

when you give digoxin you force the HEART to work harder. Plus digoxin is excreted by the kidney so if you have kidney failure it can be a nightmare to monitor the digxoin levels to prevent toxicity.

all in all the modern management of heart failure as moved away from digoxin to newer drugs. But it still has its niches as a short term reducer of symptoms.