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Is Heart Or Kidney Failure Possible In An Asymptomatic Patient?
Question: Dear dr,
I would like to know if it would be possible to go into heart/kidney failure with very few noticeable symptoms?
I had pvc-induced cardiomyopathy diagnosed in October 2014. Other than the PVCs, which my doctor kept telling me were completely benign, I had no symptoms even though EF was estimated as low as 25-30, and I was in CHF. I had successful ablation in December 2014 and by January 2015, heart size and function were back to normal.
I am totally terrified of a reccurence although PVCs are now virtually gone (20-50 a day on follow up
Holter). My former doctor was very focused on fluid retention and so I have become intensely obsessed with weight, drinking, and urine output. My weight is generally very stable but sometimes can fluctute 3-4 lbs over a few days. Is that a dangerous sign if heart function and kidneys and liver are normal? I'm so scared that I end up in the ER often, and everything always tests normal.
I guess my question is how do I make sure I still healthy without being tested every week? Every day I fear that my EF is going down or my creatinine is going up and I'm going into heart/kidney failure but won't know until I collapse. How could I have been so sick and not known? I'm so scared it could happen again so easily without my knowing.
Is it normal for urine output to vary widely even when taking in same amount of fluid and exercise and not sweating excessively?
Is it impossible for me to be retaining fluid with normal heart and kidney function? I'm so focused on fluid I cannot live my life normally at all. I know I urinate more than 500 ml daily, and it was 2.6 liters when measured but sometimes it's definitely much less. Can kidneys fail quickly without warning?
Is there no way to test kidneys definitively in the hospital to make sure I am processing fluids properly? Fluid challenge? With my normal tests, I've been told there are no tests necessary beyond what I've already had.
I am being treated for anxiety but am finding it very difficult to live. Any advice would be tremendously helpful.
Many thanks.
I would like to know if it would be possible to go into heart/kidney failure with very few noticeable symptoms?
I had pvc-induced cardiomyopathy diagnosed in October 2014. Other than the PVCs, which my doctor kept telling me were completely benign, I had no symptoms even though EF was estimated as low as 25-30, and I was in CHF. I had successful ablation in December 2014 and by January 2015, heart size and function were back to normal.
I am totally terrified of a reccurence although PVCs are now virtually gone (20-50 a day on follow up
Holter). My former doctor was very focused on fluid retention and so I have become intensely obsessed with weight, drinking, and urine output. My weight is generally very stable but sometimes can fluctute 3-4 lbs over a few days. Is that a dangerous sign if heart function and kidneys and liver are normal? I'm so scared that I end up in the ER often, and everything always tests normal.
I guess my question is how do I make sure I still healthy without being tested every week? Every day I fear that my EF is going down or my creatinine is going up and I'm going into heart/kidney failure but won't know until I collapse. How could I have been so sick and not known? I'm so scared it could happen again so easily without my knowing.
Is it normal for urine output to vary widely even when taking in same amount of fluid and exercise and not sweating excessively?
Is it impossible for me to be retaining fluid with normal heart and kidney function? I'm so focused on fluid I cannot live my life normally at all. I know I urinate more than 500 ml daily, and it was 2.6 liters when measured but sometimes it's definitely much less. Can kidneys fail quickly without warning?
Is there no way to test kidneys definitively in the hospital to make sure I am processing fluids properly? Fluid challenge? With my normal tests, I've been told there are no tests necessary beyond what I've already had.
I am being treated for anxiety but am finding it very difficult to live. Any advice would be tremendously helpful.
Many thanks.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello, dear XXXX!
We have discussed several times previously on some topics of concern, like the risk of HF re-occurrence, fluid retention, risk of a new impairment of left ventricular EF, etc.
I am sorry to hear that your anxiety is actually on such high levels, and your fears perturb your mind time after time.
I have reviewed your previous medical history, and would say that you have been provided with a lot of information regarding those issues.
Nevertheless, I would like to add some explanations as follows:
Our body weight is subject of a continuous fluctuation, as we daily take different amounts of food and fluids, as well as eliminate by different ways wasting substances.
Daily body weight is a simple method to evaluate fluid balance in hospital settings, when dealing with severe heart failure management.
But, it is a bad guidance if used in ambulatory settings, where no possible way could evaluate strictly our intake/output balance.
If no important clinical symptomatology is obvious (dyspnea, frequent palpitations, polydipsia, etc), body weight couldn’t be used as a single reliable marker of fluid retention.
So, nothing dangerous could be deducted by a small fluctuation (3-4 lbs), facing a normal heart, kidney and renal function.
As far as you haven’t any extra-systolic arrhythmia re-appearance, you don’t need to perform such frequent cardiologic follow ups. At least one cardiac checkup yearly is quite sufficient.
Remember, what happened to you is called tachy-cardiomyopathy (arrhythmia induced cardiomyopathy); and it was not so unknown, as a significant clinically symptomatic arrhythmia was a strong harbinger of what happened.
Fortunately, all that bad dream is over now. So, just relax! Nothing could arise form nothing! There are always warning signs.
The same philosophy hold true in regards of kidney function.
Urine output could not be predicted only by the amount of fluids intake/elimination through several ways. It is grossly influenced by plasma osmolality homeostasis; and this is so complicated that you could never predict by yourself your daily amount of urine.
So, don’t be so addicted by the idea of strict urine output control.
At the end, I agree with your doctors that you don’t need extra tests to confirm your perfectly normal kidney function.
You are on perfectly good health conditions. So, just enjoy your conditions and leave your fears go away.
Hope to have been helpful to you!
In case you have further uncertainties, do not hesitate to ask me!
Wish you a good health! Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello, dear XXXX!
We have discussed several times previously on some topics of concern, like the risk of HF re-occurrence, fluid retention, risk of a new impairment of left ventricular EF, etc.
I am sorry to hear that your anxiety is actually on such high levels, and your fears perturb your mind time after time.
I have reviewed your previous medical history, and would say that you have been provided with a lot of information regarding those issues.
Nevertheless, I would like to add some explanations as follows:
Our body weight is subject of a continuous fluctuation, as we daily take different amounts of food and fluids, as well as eliminate by different ways wasting substances.
Daily body weight is a simple method to evaluate fluid balance in hospital settings, when dealing with severe heart failure management.
But, it is a bad guidance if used in ambulatory settings, where no possible way could evaluate strictly our intake/output balance.
If no important clinical symptomatology is obvious (dyspnea, frequent palpitations, polydipsia, etc), body weight couldn’t be used as a single reliable marker of fluid retention.
So, nothing dangerous could be deducted by a small fluctuation (3-4 lbs), facing a normal heart, kidney and renal function.
As far as you haven’t any extra-systolic arrhythmia re-appearance, you don’t need to perform such frequent cardiologic follow ups. At least one cardiac checkup yearly is quite sufficient.
Remember, what happened to you is called tachy-cardiomyopathy (arrhythmia induced cardiomyopathy); and it was not so unknown, as a significant clinically symptomatic arrhythmia was a strong harbinger of what happened.
Fortunately, all that bad dream is over now. So, just relax! Nothing could arise form nothing! There are always warning signs.
The same philosophy hold true in regards of kidney function.
Urine output could not be predicted only by the amount of fluids intake/elimination through several ways. It is grossly influenced by plasma osmolality homeostasis; and this is so complicated that you could never predict by yourself your daily amount of urine.
So, don’t be so addicted by the idea of strict urine output control.
At the end, I agree with your doctors that you don’t need extra tests to confirm your perfectly normal kidney function.
You are on perfectly good health conditions. So, just enjoy your conditions and leave your fears go away.
Hope to have been helpful to you!
In case you have further uncertainties, do not hesitate to ask me!
Wish you a good health! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much for your detailed explanation. It helps very much. I want so much to relax and feel healthy but it is so difficult. As I have explained to you, one doctor told me I was not going to see my baby grow up and I would always be in serious danger of CHF, even if I got better. His voice is always in my head, scaring me, telling me that I am going to die soon.
Is lowered urine output a somewhat advanced symptom in heart/renal failure? It would not be a first symptom? Again, I so appreciate your explicit explanation about why I cannot predict output. And again I hear my old doctor's voice telling me that if I gain half a pound or am not urinating every two hours, then I must be in CHF.
Do I need to worry about occasional PVCs? I sometimes feel one or two and am so scared that they are coming back. My EP says under 20,000 per day won't hurt me and I had 63,000 per day, but I have read that far fewer, even 1000 a day can lead to LV dysfunction. My ablation was 8 months ago. Is it true that if I were to have had a recurrence it would have happened in the first 6 months after ablation?
Is ProBNP of 71 truly a normal value? I continue to be alarmed that that seems somewhat elevated. BNP has never been higher than 19. Is there any significance for ProBNP being 71 instead of, say 20? Is is normal for it to be higher than BNP? Is this not "high normal" and mean something?
Thank you so much, Dr. Iliri. You have been so wonderful, patient, and kind throughout these many many sessions of questions. I cannot thank you enough.
I just drank herbal iced tea, and am terrified of not needing to urinate as it wasn't an amount I had measured. I don't remember how it felt to drink and eat and urinate normally, without terror.
Many thanks.
Thank you so much for your detailed explanation. It helps very much. I want so much to relax and feel healthy but it is so difficult. As I have explained to you, one doctor told me I was not going to see my baby grow up and I would always be in serious danger of CHF, even if I got better. His voice is always in my head, scaring me, telling me that I am going to die soon.
Is lowered urine output a somewhat advanced symptom in heart/renal failure? It would not be a first symptom? Again, I so appreciate your explicit explanation about why I cannot predict output. And again I hear my old doctor's voice telling me that if I gain half a pound or am not urinating every two hours, then I must be in CHF.
Do I need to worry about occasional PVCs? I sometimes feel one or two and am so scared that they are coming back. My EP says under 20,000 per day won't hurt me and I had 63,000 per day, but I have read that far fewer, even 1000 a day can lead to LV dysfunction. My ablation was 8 months ago. Is it true that if I were to have had a recurrence it would have happened in the first 6 months after ablation?
Is ProBNP of 71 truly a normal value? I continue to be alarmed that that seems somewhat elevated. BNP has never been higher than 19. Is there any significance for ProBNP being 71 instead of, say 20? Is is normal for it to be higher than BNP? Is this not "high normal" and mean something?
Thank you so much, Dr. Iliri. You have been so wonderful, patient, and kind throughout these many many sessions of questions. I cannot thank you enough.
I just drank herbal iced tea, and am terrified of not needing to urinate as it wasn't an amount I had measured. I don't remember how it felt to drink and eat and urinate normally, without terror.
Many thanks.
Brief Answer:
Just follow a healthy model of thinking about.
Detailed Answer:
Hi again, dear XXXX!
As you are so addicted to urine output control, I would explain that you are quite right!
When urine output is affected by heart/renal failure, it means that the clinical conditions are severely aggravated, and many other signs and symptoms are surely preceding it.
Your old doctor probably would regret for those hasty opinions (leading to a very increased anxiety and unjustified fears), facing your perfectly normal actual clinical conditions; especially your current cardiac function.
Regarding the efficacy of your previous cardiac ablation, it shouldn’t be considered questionable, as it has been confirmed by provocative tests during electrophysiological study, subsequent cardiac follow ups, and tremendously improved clinical conditions. We don’t need to wait a certain period of time to assure those scientific conclusions.
Addressing your interest on NT-proBNP value of 71 pg/ml, I would like to add that in accordance with your age the reference values for females are 10-140 pg/ml. So no evidence for “high normal”range.
BNP is a separated test with different reference values (
The important issue is they are completely normal.
XXXXXXX the only way of feeling better is to not care at all about urine output or those completely trivial PVCs. I assure you that even your old advising doctor does the same thing.
So just follow a healthy model of thinking about these issues.
Best regards,
Dr. Iliri
Just follow a healthy model of thinking about.
Detailed Answer:
Hi again, dear XXXX!
As you are so addicted to urine output control, I would explain that you are quite right!
When urine output is affected by heart/renal failure, it means that the clinical conditions are severely aggravated, and many other signs and symptoms are surely preceding it.
Your old doctor probably would regret for those hasty opinions (leading to a very increased anxiety and unjustified fears), facing your perfectly normal actual clinical conditions; especially your current cardiac function.
Regarding the efficacy of your previous cardiac ablation, it shouldn’t be considered questionable, as it has been confirmed by provocative tests during electrophysiological study, subsequent cardiac follow ups, and tremendously improved clinical conditions. We don’t need to wait a certain period of time to assure those scientific conclusions.
Addressing your interest on NT-proBNP value of 71 pg/ml, I would like to add that in accordance with your age the reference values for females are 10-140 pg/ml. So no evidence for “high normal”range.
BNP is a separated test with different reference values (
The important issue is they are completely normal.
XXXXXXX the only way of feeling better is to not care at all about urine output or those completely trivial PVCs. I assure you that even your old advising doctor does the same thing.
So just follow a healthy model of thinking about these issues.
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Iliri-
I had a scary episode in the night. I had run up stairs, felt fine, no SOB and then felt a PVC. I took my pulse, felt normal then several seconds of forceful, faster beats. Like this: beat beat BEATBEATBEATBEATBEAT beat beat beat. Could nsvt feel like this? Brief SVT? Going to my cardio later but it was very short duration so he probably won't be able to catch it. I have felt it do that once before, back in XXXXXXX and not again until last night. Very scared. Thank you.
I had a scary episode in the night. I had run up stairs, felt fine, no SOB and then felt a PVC. I took my pulse, felt normal then several seconds of forceful, faster beats. Like this: beat beat BEATBEATBEATBEATBEAT beat beat beat. Could nsvt feel like this? Brief SVT? Going to my cardio later but it was very short duration so he probably won't be able to catch it. I have felt it do that once before, back in XXXXXXX and not again until last night. Very scared. Thank you.
Brief Answer:
No medical evidence reveals any health disorders.
Detailed Answer:
Hi XXXX!
I don't believe it was a NSVT or SVT, as during exertion palpitations are common and are considered physiologically normal. They (palpitations) may be mistakenly interpreted as arrhythmic events.
I would like to assure that whichever it may be, appearing so rarely, there are no chances to induce any ventricular dysfunction. So, relax!
If those palpitations appear again, more frequently and become disturbing, then an evaluation by wearing a Loop Recorder would be the right way to study them.
Dear XXXXXXX if you keep being scared from every beat of your heart, you will soon finish to a mental exhaustion.
Seems that you are searching by any means (fearing form your insufficient urine output, to your LVEF, then some rare ectopic beats, and hypothetical SVT) to find something getting wrong with your normal heart.
The most important issue on this entire story is that, when judging about a certain health disorder, we should rely on accurate lab medical tests conclusion, and not on some anecdotal phrases somewhat non-ethical unintentionally escaped by any old doctor.
As no medical evidence reveals any health disorders, you should calm down and try to relax.
Please could you send me your photo, in order to have a better understanding how anxiety is affecting you.
Greetings,
Dr. Iliri
No medical evidence reveals any health disorders.
Detailed Answer:
Hi XXXX!
I don't believe it was a NSVT or SVT, as during exertion palpitations are common and are considered physiologically normal. They (palpitations) may be mistakenly interpreted as arrhythmic events.
I would like to assure that whichever it may be, appearing so rarely, there are no chances to induce any ventricular dysfunction. So, relax!
If those palpitations appear again, more frequently and become disturbing, then an evaluation by wearing a Loop Recorder would be the right way to study them.
Dear XXXXXXX if you keep being scared from every beat of your heart, you will soon finish to a mental exhaustion.
Seems that you are searching by any means (fearing form your insufficient urine output, to your LVEF, then some rare ectopic beats, and hypothetical SVT) to find something getting wrong with your normal heart.
The most important issue on this entire story is that, when judging about a certain health disorder, we should rely on accurate lab medical tests conclusion, and not on some anecdotal phrases somewhat non-ethical unintentionally escaped by any old doctor.
As no medical evidence reveals any health disorders, you should calm down and try to relax.
Please could you send me your photo, in order to have a better understanding how anxiety is affecting you.
Greetings,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear dr iliri,
That is me with my son and with my niece (she is wearing glasses). I think I look happy and normal and most people could not guess the anxiety I experience daily and know what I have been through. I have also lost my mother to sudden onset dementia, although she is still living and am going through marital separation. A very tough time in my life. My EP believes it was stress which made my PVCs get so bad although my regular cardio thinks maybe a virus caused the PVCs to get bad. I guess I will never know.
You are right about everything and I think I would be 99% better if I could stop thinking about fluids. You're also right that I should not give power to an unethical doctor. But somehow I've become fixated and unfortunately I've noticed how variable and strange our bodies can be.
I saw my cardio today who did 2-minute EKG and saw nothing wrong. He says all the same things you do- that I am cured and only suffer from anxiety. He thinks it was normal exertion or possibly PACs but thinks it was totally inconsequential.
I wish I could erase the memories of being told that drinking water would weaken my heart and kill me, that gaining half a pound would mean I was in heart failure.
Thank you very much, Dr Iliri. You are helping me and will surely hear from me again until I am no longer afraid of water.
Many thanks
.
That is me with my son and with my niece (she is wearing glasses). I think I look happy and normal and most people could not guess the anxiety I experience daily and know what I have been through. I have also lost my mother to sudden onset dementia, although she is still living and am going through marital separation. A very tough time in my life. My EP believes it was stress which made my PVCs get so bad although my regular cardio thinks maybe a virus caused the PVCs to get bad. I guess I will never know.
You are right about everything and I think I would be 99% better if I could stop thinking about fluids. You're also right that I should not give power to an unethical doctor. But somehow I've become fixated and unfortunately I've noticed how variable and strange our bodies can be.
I saw my cardio today who did 2-minute EKG and saw nothing wrong. He says all the same things you do- that I am cured and only suffer from anxiety. He thinks it was normal exertion or possibly PACs but thinks it was totally inconsequential.
I wish I could erase the memories of being told that drinking water would weaken my heart and kill me, that gaining half a pound would mean I was in heart failure.
Thank you very much, Dr Iliri. You are helping me and will surely hear from me again until I am no longer afraid of water.
Many thanks
.
Brief Answer:
I hope to hear you are going to feel better soon.
Detailed Answer:
Dear XXXX!
I wish you will successfully pass through all this difficult period of your life; and everything will be fine again!
All your troubles will then be like a bad dream memory.
I wish your health issue fears will vanish with the time.
By the way, I didn’t find your photo.
Best wishes,
Dr. Iliri
I hope to hear you are going to feel better soon.
Detailed Answer:
Dear XXXX!
I wish you will successfully pass through all this difficult period of your life; and everything will be fine again!
All your troubles will then be like a bad dream memory.
I wish your health issue fears will vanish with the time.
By the way, I didn’t find your photo.
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Is it truly impossible that one week after having normal heart function and kidney and liver function that I could be having severe issues today? So scared of drinking. I am going to therapist today.
Is there no definitive test to make sure I am processing liquids properly? Like being hospitalized and given a fluid challenge? I just can't relax or quiet my fears. At night, when drinking is done for the day, I relax a little bit.
Photos here. I am the one without glasses. Last week at the beach. Little boy is my son.
Thank you doctor.
XXXX
Is it truly impossible that one week after having normal heart function and kidney and liver function that I could be having severe issues today? So scared of drinking. I am going to therapist today.
Is there no definitive test to make sure I am processing liquids properly? Like being hospitalized and given a fluid challenge? I just can't relax or quiet my fears. At night, when drinking is done for the day, I relax a little bit.
Photos here. I am the one without glasses. Last week at the beach. Little boy is my son.
Thank you doctor.
XXXX
Brief Answer:
You look nice!
Detailed Answer:
Dear XXXX!
It's not possible to have severe health complications while on a perfectly normal body function.
As your body organs keep functioning well (your heart/kidneys/liver), there is no evidence of excess fluid retention or other signs/symptoms of congestive heart failure.
Regarding your idea of fluid restriction, besides the fact it will not help in preventing any hypothetical CHF (fluid restriction isn't considered a component in CHF preventive cardiology); the other drawback of fluid restriction is a suboptimal body hydration with its subsequent consequences (hypovolemia, urine concentration, predispositions for kidney stones and urinary infections; constipation; altered hydric and electrolytes homeostasis; implications in coagulation systems; decreased body organs vitality; decreased immunity against infections, etc. etc.).
As water is the main component of life, we can't choose being on the opposite part.
As all your medical tests have resulted normal, no doctor will consider you seriously if you ask for a hospitalization.
I assure that no other tests are needed to definitely confirm your perfect metabolism and normal blood circulation (without fluid retention).
If you can't relax, I recommend you walking outside in the fresh air; getting deep breaths, and thinking about your lovely son. So, all the fears will subside.
You look a vivid nice girl, full of energy to surpass daily difficulties, being a lovely mom the photo.
Hope to have been of some help to you!
Best wishes,
Dr. Iliri
You look nice!
Detailed Answer:
Dear XXXX!
It's not possible to have severe health complications while on a perfectly normal body function.
As your body organs keep functioning well (your heart/kidneys/liver), there is no evidence of excess fluid retention or other signs/symptoms of congestive heart failure.
Regarding your idea of fluid restriction, besides the fact it will not help in preventing any hypothetical CHF (fluid restriction isn't considered a component in CHF preventive cardiology); the other drawback of fluid restriction is a suboptimal body hydration with its subsequent consequences (hypovolemia, urine concentration, predispositions for kidney stones and urinary infections; constipation; altered hydric and electrolytes homeostasis; implications in coagulation systems; decreased body organs vitality; decreased immunity against infections, etc. etc.).
As water is the main component of life, we can't choose being on the opposite part.
As all your medical tests have resulted normal, no doctor will consider you seriously if you ask for a hospitalization.
I assure that no other tests are needed to definitely confirm your perfect metabolism and normal blood circulation (without fluid retention).
If you can't relax, I recommend you walking outside in the fresh air; getting deep breaths, and thinking about your lovely son. So, all the fears will subside.
You look a vivid nice girl, full of energy to surpass daily difficulties, being a lovely mom the photo.
Hope to have been of some help to you!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Iliri,
You see, I can smile and look normal and be told I am normal but inside I am just so anxious.
As I told you, I saw my cardio yesterday and he did an EKG and physical exam and said I was in perfect health. I felt somewhat reassured but I was remembering the day I was diagnosed by him. Even in CHF, with 65,000 PVCs, he thought after EKG and exam that I was ok. Only after echo did he find the heart weakness. With proBNP over 8000 at diagnosis is it possible I didn't have fluid in my lungs and around heart despite cough? My chest xray also showed normal heart without fluid. Only echo showed the severe trouble. It's why I am so addicted to echo and EF. It seems that even in CHF, I seemed healthy so if Something is wrong now, I am terrified it can be missed.
Perhaps my dr actually did suspect but did not want to alarm me and that's why he ordered the echo in the first place to be done immediately?
You are helping me very much, despite my asking you the same things again and again. I am out today, instead of just work and home. It does help. I hope to be able to believe that I am normal very soon.
So I guess my question is this- if someone were quite ill with renal or heart issues, do you think you would at least suspect upon physical exam so you would know to do more testing? I feel now as if I need an echo every week.
Thank you so much, dear Dr Iliri
You see, I can smile and look normal and be told I am normal but inside I am just so anxious.
As I told you, I saw my cardio yesterday and he did an EKG and physical exam and said I was in perfect health. I felt somewhat reassured but I was remembering the day I was diagnosed by him. Even in CHF, with 65,000 PVCs, he thought after EKG and exam that I was ok. Only after echo did he find the heart weakness. With proBNP over 8000 at diagnosis is it possible I didn't have fluid in my lungs and around heart despite cough? My chest xray also showed normal heart without fluid. Only echo showed the severe trouble. It's why I am so addicted to echo and EF. It seems that even in CHF, I seemed healthy so if Something is wrong now, I am terrified it can be missed.
Perhaps my dr actually did suspect but did not want to alarm me and that's why he ordered the echo in the first place to be done immediately?
You are helping me very much, despite my asking you the same things again and again. I am out today, instead of just work and home. It does help. I hope to be able to believe that I am normal very soon.
So I guess my question is this- if someone were quite ill with renal or heart issues, do you think you would at least suspect upon physical exam so you would know to do more testing? I feel now as if I need an echo every week.
Thank you so much, dear Dr Iliri
Brief Answer:
Too many frequent tests would be useless.
Detailed Answer:
Hi XXXX!
Physical exam is an important clue for arriving to a definite diagnosis. It gives the first impression and suspicions on what should be investigated further.
A comprehensive physical investigation coupled with a careful medical history review, are quite accurate for leading to the right clinical decision making) in the majority of cases.
In your case a periodically scheduled follow up (1-2 times/yearly) would be necessary to detect potentially new clinical signs/symptoms and lead to additional useful tests.
You should be familiar with the idea that too many medical tests are useless, if not driven by a certain clinical scenario.
A very frequently performed cardiac ultrasound (ECHO) would be exaggerated even in a chronic well known cardiomyopathy.
There are no clinical guidelines to support a weekly ECHO. Also from a theoretical point of view, nothing substantial is expected to relapse so quickly.
I think you are going to feel better soon, as you are a young woman, willingly to achieve success in your daily commitments, being a dedicated mother too.
You should only pay a little more attention on how several unexpected difficulties affect your psychological condition, and increase anxiety.
Regards,
Dr.Iliri
Too many frequent tests would be useless.
Detailed Answer:
Hi XXXX!
Physical exam is an important clue for arriving to a definite diagnosis. It gives the first impression and suspicions on what should be investigated further.
A comprehensive physical investigation coupled with a careful medical history review, are quite accurate for leading to the right clinical decision making) in the majority of cases.
In your case a periodically scheduled follow up (1-2 times/yearly) would be necessary to detect potentially new clinical signs/symptoms and lead to additional useful tests.
You should be familiar with the idea that too many medical tests are useless, if not driven by a certain clinical scenario.
A very frequently performed cardiac ultrasound (ECHO) would be exaggerated even in a chronic well known cardiomyopathy.
There are no clinical guidelines to support a weekly ECHO. Also from a theoretical point of view, nothing substantial is expected to relapse so quickly.
I think you are going to feel better soon, as you are a young woman, willingly to achieve success in your daily commitments, being a dedicated mother too.
You should only pay a little more attention on how several unexpected difficulties affect your psychological condition, and increase anxiety.
Regards,
Dr.Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much. I am trying very hard to control my anxiety. If only I could stop worrying about fluids, I think I would be ok. Can I truly just forget about fluid retention? I know no dr would hospitalize me but I know I need to trust my drs, including you.
Another question- is there any relation to my wrist pulse strength and heart function? Sometimes I feel like my pulse feels weak and I think it means my heart is weak.
Thank you, Dr. Iliri. My cardiologist told me I'm young, healthy, pretty, and incredibly lucky because I've been cured. I am trying so hard to believe that I am cured and there is no reason for me to relapse.
Thank you so much. I am trying very hard to control my anxiety. If only I could stop worrying about fluids, I think I would be ok. Can I truly just forget about fluid retention? I know no dr would hospitalize me but I know I need to trust my drs, including you.
Another question- is there any relation to my wrist pulse strength and heart function? Sometimes I feel like my pulse feels weak and I think it means my heart is weak.
Thank you, Dr. Iliri. My cardiologist told me I'm young, healthy, pretty, and incredibly lucky because I've been cured. I am trying so hard to believe that I am cured and there is no reason for me to relapse.
Brief Answer:
You need to forget your unreasonable fears.
Detailed Answer:
Dear XXXX!
You need to forget about the persisting idea of fluid retention. You have alternative choices other than doing so. Only such way your fears will be harmless, and your anxiety will become quite a distant friend.
Regarding your pulse strength, I would explain that many confounding factors influence on such a perception (vascular resistances [influenced by several chemical mediators and hormones, foods, environment temperature, physical activity, etc.etc]; cardiac output [influenced by systolic cardiac performance during stressful conditions like physical activity, anxiety, psychological stress, certain medications, etc.etc]).
So, you should not worry too much about pulse strength variations, as many many factors influence on such a fluctuating feeling, and no one could precisely predict (in a normal individual) cardiac stength only by pulse strength perception.
Your cardiologist is a good adviser for your clinical conditions, but your therapist (psychiatrist or psychologist) should be a close friend helping you to control anxiety and your fears.
Best wishes,
Dr. Iliri
You need to forget your unreasonable fears.
Detailed Answer:
Dear XXXX!
You need to forget about the persisting idea of fluid retention. You have alternative choices other than doing so. Only such way your fears will be harmless, and your anxiety will become quite a distant friend.
Regarding your pulse strength, I would explain that many confounding factors influence on such a perception (vascular resistances [influenced by several chemical mediators and hormones, foods, environment temperature, physical activity, etc.etc]; cardiac output [influenced by systolic cardiac performance during stressful conditions like physical activity, anxiety, psychological stress, certain medications, etc.etc]).
So, you should not worry too much about pulse strength variations, as many many factors influence on such a fluctuating feeling, and no one could precisely predict (in a normal individual) cardiac stength only by pulse strength perception.
Your cardiologist is a good adviser for your clinical conditions, but your therapist (psychiatrist or psychologist) should be a close friend helping you to control anxiety and your fears.
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much for your wise words and advice. I want anxiety to be a distant memory so badly. To indulge a bit of the melodramatic, I feel
like when I was told I would not see my child grow up that I left this world because it became surreal and so painful and then h
Thank you so much for your wise words and advice. I want anxiety to be a distant memory so badly. To indulge a bit of the melodramatic, I feel
like when I was told I would not see my child grow up that I left this world because it became surreal and so painful and then h
Brief Answer:
I recommend some small tips to help you with anxiety
Detailed Answer:
Dear XXXX,
You have nothing to be afraid. I would like to reassure that nothing bad is going to happen.
Your cardiac tests indicate that everything is fine.
I would like to recommend practicing meditation. It is really helpful to get peace inside you.
It comes now into my mind a book title : "Don’t Sweat the Small Stuff... and it’s all Small Stuff" , of the author XXXXXXX Carlson. I recommend you to read this book and other books from this author (he was a big stress therapist). It may help you change your point of view regarding some "small things".
Wish you a pleasant weekend,
Regards,
Dr. Iliri
I recommend some small tips to help you with anxiety
Detailed Answer:
Dear XXXX,
You have nothing to be afraid. I would like to reassure that nothing bad is going to happen.
Your cardiac tests indicate that everything is fine.
I would like to recommend practicing meditation. It is really helpful to get peace inside you.
It comes now into my mind a book title : "Don’t Sweat the Small Stuff... and it’s all Small Stuff" , of the author XXXXXXX Carlson. I recommend you to read this book and other books from this author (he was a big stress therapist). It may help you change your point of view regarding some "small things".
Wish you a pleasant weekend,
Regards,
Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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