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Dr. Andrew Rynne

Family Physician

Exp 50 years

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My mother is 94. She had a diagnosis of Congestive

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6220 Questions

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Posted on Thu, 10 Jan 2019 in Hypertension and Heart Disease
Question: My mother is 94. She had a diagnosis of Congestive heart failUte for years. She watches her salt intake and she is not overweight. She has had swollen ankles some in the past . Ten days ago, she started some wheezing and short of breath. X-ray showed fluid in lung. Ankles and lower feet with edema . Began 20 mg of lasix per day . Did not seem to help much. Now on 40 mg daily. Did not clear it up but wheezing better. Yesterday we went to her cardiologist . Did ultrasound ( echo) test of heart and lung. Saw fluid between heart and lung ... in a spece . Doctor ordered an
Thoracentesis to get fluid out of the space. Said they will put a needle inbeteeen ribs to get fluid out. Scheduled in 5 days.
1. Is that appropriate for her condition? Dr said she will feel much better after oricedure.
2. Is it dangerous for her to have this test?
3 They told her to stop the blood thinner she is on until after the test. ( Eliquis). Is that appropriate
4. Generally, what caused the fluid buildup in the space and what can prevent it
5. Will she have to take the thoracentisis again?
doctor
Answered by Dr. Ilir Sharka 22 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome to Ask a Doctor service!

I passed carefully through your question and would explain that Thoracocentesis is the right procedure in case of excessive fluid accumulation in this region.

This is a quite safe procedure if performed by a specialist of the field and if the amount of fluid is considerable. It will help improve her situation (shortness of breath) very quickly.

Regarding the blood thinner (Eliquis), I agree with her doctor recommendation that it should be stopped before the procedure in order to minimize the risk for bleeding during the procedure. Low weigh heparin may be used following the procedure.

We can not determine exactly the origin of the fluid, but I suppose that it could be related to the heart failure or local inflammation. The citological examination of the fluid that will be removed from this space, will give a more detailed information on its main cause and the main treatment in order to prevent it from future accumulation.

We can not make predictions if this fluid will build up again, but I would recommend increasing the dose of Lasix further, in order to help reduce its accumulation in this space.

Hope you will find this answer helpful!

I remain at your disposal for any further questions whenever you need!

Kind regards,

Dr. Ilir Sharka, Cardiologist


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 6 hours later
Dr Sharka
One follow up.... mom has one kidney and the creatinine went from 1.4 to 2.1 after lasix for 4 days... is that a common occurrence ? Also.... when you are taking lasix, how much should she drink... her BUN was 76 a few days ago... she doesn’t drink much any
how....should I measure the amount you drink
doctor
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

Such low dose of Lasix is not the cause of renal failure.

But, you should know that the renal impairment could be related to the acute decompensation of heart failure (also called cardio-renal syndrome).

For this reason, the main thing to do is the optimization of her heart failure therapy and increase the dose of Lasix, even considering her renal impairment.

Thoracocentezis is also necessary to help improve her situation quickly.

Hope you will find this answer helpful!

Wishing good health,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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