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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Mom is 94. Has cong heart failure as a diagnosis.

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Dr. Bhanu Partap

Cardiologist

Practicing since :2010

Answered : 2182 Questions

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Posted on Mon, 14 Jan 2019 in Hypertension and Heart Disease
Question: Mom is 94. Has cong heart failure as a diagnosis. 5 ft...106 lbs... one kidney. One month ago, she developed wheezing and short of breath , more edema in lower legs, gained 3 lbs. Began 20 mg ... then a few days later 40 mg of lasix....Echocardiogram showed fluid in pleural space. Got thoracentesis 10 days ago. Removed 350 cc of fluid from one space... nothing in other space. Began 2 liters of oxygen... now taking only when sleeping...ox rate is 92 now without the oxy on.... 98 with it on...Since then—- no sob or wheeze... ankles fluid way down... weight is 102 ( probably because of lasix and low salt diet) Very sleepy yesterday.. sleeps all the time.....the doctor said stop the lasix and watch the salt intake and do more drinking. Drink fluid to avoid dehydration.
Is it ok to stop lasix abruptly , all at once, or should I gradually stop lasix ??
What symptoms do I look for to start back the lasix???
doctor
Answered by Dr. Bhanu Partap 24 minutes later
Brief Answer:
Need few more details

Detailed Answer:
Hello

After going through the medical details provided by you I can understand your concern for your mothers health and I would like to ask you few things before giving any opinion.

1. How much Lasix she is taking (taking oral or injections?)

2. Any other cardiac disease history

3. What was the ejection fraction percentage on echo

Kindly revert back with required information.

Kind Regards
Dr Bhanu Partap
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Bhanu Partap 3 hours later
Before 1 month ago, she wasn’t taking any lasix at all. Then after the wheezing, SOB , oxy level without oxygen on was 85 !!!, and lower leg putting edema, she began 20 mg of lasix daily, but that didn’t help for 5 days , so they increased to 40 mg, and did the thoracentesis, where they took off 350cc from pleural space on1 lung. The improvement wasn’t immediate , but within 3 days, the SOB and wheezing were gone, she felt better , and even her oxygen level without oxygen on, was up to 92. With oxygen on it is 98. Her weight had dropped from 107 to now 102..... probably due to lasix and not eating as much?? So, since I noticed moms legs were much improved, she stopped the SOB, etc and breathing easier, and oxy level was much better, I wanted to see if we should stop the 20 mg of lasix.... or continue to take 20 mg daily?? and the last 20 mg of lasix she took was 48 hours ago. One doctor said that we could take lasix again if symptoms returned, but I need to know what you think.......
She has htn and takes the previously mentioned meds for htn. She has A Fib but only occasional ( one episode every two weeks)’flare ups of erratic heart beats , which last only about 2 hours , and increased metoprolol gets heart rate into synus rythem.She has had afib for over 8 years.
She has had 3 or 4 “ tia” episodes, but not for about 2 months. I don’t know the ejection fraction. Thanks
I was worried that abruptly stopping lasix completely would be harmful .
doctor
Answered by Dr. Bhanu Partap 7 minutes later
Brief Answer:
Hello again

Detailed Answer:
I asked about ejection fraction because that was very important to know as that will decide whether the lasix should be continued or dose should be reduced or could be stopped abruptly or not. Kindly upload the echocardiogram report.

The symptoms which you have mentioned are of heart failure and lasix plays an important role in keeping these patients symptom free. Also amount intake depend on ejection fraction. If it is low then water intake has to be restricted. If echocardiogram has been done for her then upload the image of the full report and if not then talk to your doctor about getting it done.

For now you can reduce the dose of lasix to half and keep water intake to a moderate level.

Kind Regards
Dr Bhanu Partap
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Bhanu Partap 11 hours later
I uploaded the only reports I have . I’m not sure it’s what is needed. I gave mom 20 mg of lasix today and we give it every other day now
doctor
Answered by Dr. Bhanu Partap 7 hours later
Brief Answer:
Hello again

Detailed Answer:
No it’s not that report it’s just pleural fluid examination report. Yes you can use this alternate day approach also but do talk to your treating doctor about planning an echo done.

Kind Regards
Dr Bhanu Partap
Above answer was peer-reviewed by : Dr. Kampana
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