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Diastolic dysfunction and resulting a-fib

Posted by @predictable, Jun 1, 2016

My doctor wants to add a beta blocker to control my blood pressure. Mayo research suggests that’s a mistake for someone with diastolic dysfunction (DD), which I may have (based on BP readings in recent months). I’d like to hear from anybody who has been diagnosed with DD about symptoms and treatments.

REPLY

Good question @predictable. I think @hopeful33250 @cynaburst @dawn_giacabazi @evelyn247 @matthewbosner may have some thoughts and experiences related to diastolic dysfunction, symptoms and treatments.

@colleenyoung

Good question @predictable. I think @hopeful33250 @cynaburst @dawn_giacabazi @evelyn247 @matthewbosner may have some thoughts and experiences related to diastolic dysfunction, symptoms and treatments.

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Hi @predictable: I have DD it seems to be due to multi-valve regurgitation with the aortic valve having moderate regurgitation with a DX of aortic insufficiency. (My heart valve probs began at age 11 and I’m 68 now, so I feel that I’ve done pretty well, overall.) At this point I’m just taking an Ace Inhibitor but as my last cardio-pulmonary stress test showed a reduced heart functioning from the previous year’s test, my meds may change. I had one cardiologist explain DD this way: if you have DD when your heart is at rest it will remain stiff, not relax entirely. My only symptom seems to be exercise-induced fatigue. It seems that no amount of physical training can help that type of fatigue. If I exercise, I know that I’ll be very fatigued. I still keep exercising, though, because I know that the long-run benefits outweigh the fatigue. I’m looking forward to hearing what you and others have to say about DD as well.

First, I am not a doctor or nurse. However very familiar with hypertension & DD. May I ask what your BP readings have been? Sometimes DD is very mild and the risk does not out weigh the benefit for treatment of the BP. Have they confirmed the DD is the cause of elevated BP? My BP was 300/200’s when I was admitted to St Mary’s Hosp Mayo Clinic. I have DD & hyperaldosteronism. DD is minimal problem. Regular tachycardia which we treat with another hypertension medication along with three others. I would however recommend PGx test for medication management before starting new meds. It will eliminate guessing game on which medications you respond to best

@dawn_giacabazi

First, I am not a doctor or nurse. However very familiar with hypertension & DD. May I ask what your BP readings have been? Sometimes DD is very mild and the risk does not out weigh the benefit for treatment of the BP. Have they confirmed the DD is the cause of elevated BP? My BP was 300/200’s when I was admitted to St Mary’s Hosp Mayo Clinic. I have DD & hyperaldosteronism. DD is minimal problem. Regular tachycardia which we treat with another hypertension medication along with three others. I would however recommend PGx test for medication management before starting new meds. It will eliminate guessing game on which medications you respond to best

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Thanks, @dawn_giacabazi. Under moderately aggressive medication for hypertension, BP in recent months averages 148/98. Diastolic has crept up steadily since a-fib diagnosis two years ago and now repeatedly appears a little above to a little below 100. DD is not yet confirmed (I’ll know more Monday after seeing a cardiologist); it’s a new possibility for me that may explain what caused my a-fib. What is “PGx test?”

@dawn_giacabazi

First, I am not a doctor or nurse. However very familiar with hypertension & DD. May I ask what your BP readings have been? Sometimes DD is very mild and the risk does not out weigh the benefit for treatment of the BP. Have they confirmed the DD is the cause of elevated BP? My BP was 300/200’s when I was admitted to St Mary’s Hosp Mayo Clinic. I have DD & hyperaldosteronism. DD is minimal problem. Regular tachycardia which we treat with another hypertension medication along with three others. I would however recommend PGx test for medication management before starting new meds. It will eliminate guessing game on which medications you respond to best

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PGx Testing:

http://mayoresearch.mayo.edu/center-for-individualized-medicine/drug-gene-testing.asp

@dawn_giacabazi

First, I am not a doctor or nurse. However very familiar with hypertension & DD. May I ask what your BP readings have been? Sometimes DD is very mild and the risk does not out weigh the benefit for treatment of the BP. Have they confirmed the DD is the cause of elevated BP? My BP was 300/200’s when I was admitted to St Mary’s Hosp Mayo Clinic. I have DD & hyperaldosteronism. DD is minimal problem. Regular tachycardia which we treat with another hypertension medication along with three others. I would however recommend PGx test for medication management before starting new meds. It will eliminate guessing game on which medications you respond to best

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Thanks @cynaburst. Exactly what I needed.

Martin (@predictable)

@colleenyoung

Good question @predictable. I think @hopeful33250 @cynaburst @dawn_giacabazi @evelyn247 @matthewbosner may have some thoughts and experiences related to diastolic dysfunction, symptoms and treatments.

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Thanks @dawn_giacabazi. News to me!

@predictable

Martin, Nice to see you as well as read your messages @predictable. Thanks for adding your avatar picture.

Liked by fastfay

@colleenyoung

Good question @predictable. I think @hopeful33250 @cynaburst @dawn_giacabazi @evelyn247 @matthewbosner may have some thoughts and experiences related to diastolic dysfunction, symptoms and treatments.

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I would like to add the PGx testing is now covered 100% by medicare and most private insurances. It is currently covered by medicaid in 39 states.

@colleenyoung

Martin, Nice to see you as well as read your messages @predictable. Thanks for adding your avatar picture.

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Thanks, @colleenyoung. Mayo has always been close to me. If you’re in Rochester, you’ll understand. I grew up in Decorah, 60 miles southeast. My mother died in St. Mary’s Hospital 20 years ago. My brother-in-law got his Pacemaker at Mayo. My brother died at Gunderson in LaCrosse while awaiting test results from the Mayo lab. On the positive side, family and friends always felt more secure, knowing that Mayo was an hour away. I feel the same way today way out here in Virginia. My favored hospital is Virginia Hospital Center in Arlington, a component of Mayo Clinic Care Network. So far, I haven’t had to be admitted there!

Martin

I owe everybody on this thread — especially @hopeful33250, @dawn_giacabazi, and @cynaburst — an update on my Diastolic Dysfunction after visiting with my cardiologist a few days ago. He told me A-fib is the very definition of DD, which is now a condition I probably can’t avoid, and after 2 years of it, I have learned to manage it. Since I have no tangible symptoms (other than a tendency to bleed from wounds, thanks to Coumadin therapy) he saw no reason for surgery and believes no medication would “cure” me. So management is the challenge, and he flatly stated that I need not fear trying a beta blocker in that effort. So my nephrologist prescribed carvedilol to bring my blood pressure down, starting with a minimal dose, possibly raising it over the next six weeks in hope of reaching a maximum positive (balanced) result.

Does this make sense to you? Do you have any suggestions for me based on your experience?

Thanks for the update @predictable. Given that you are about to start carvedilol (Coreg), you may want to read this thread started by @teatime http://mayocl.in/28YeSeN It includes a response by a Mayo Clinic pharmacist. @neeci and @teatime had to wean off the drug, but many use it successfully. We’ll be interested in your sharing your experience starting and finding your balanced dosage.

@predictable

I owe everybody on this thread — especially @hopeful33250, @dawn_giacabazi, and @cynaburst — an update on my Diastolic Dysfunction after visiting with my cardiologist a few days ago. He told me A-fib is the very definition of DD, which is now a condition I probably can’t avoid, and after 2 years of it, I have learned to manage it. Since I have no tangible symptoms (other than a tendency to bleed from wounds, thanks to Coumadin therapy) he saw no reason for surgery and believes no medication would “cure” me. So management is the challenge, and he flatly stated that I need not fear trying a beta blocker in that effort. So my nephrologist prescribed carvedilol to bring my blood pressure down, starting with a minimal dose, possibly raising it over the next six weeks in hope of reaching a maximum positive (balanced) result.

Does this make sense to you? Do you have any suggestions for me based on your experience?

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Martin: Thanks for the update. I wish you well as you pursue new treatments. I was not aware that DD and A-Fib were related, this will give me something to discuss with my cardiologist next month. My blood pressure tends to be low at times with a big gap between the diastolic and systolic numbers, perhaps that is related to the aortic insufficiency. I am planning on ordering that blood pressure monitor that has been discussed. I need to keep an accurate handle on what is happening. Please keep me posted on how your new med therapy is working for you.
Blessings,
Teresa

That does make sense. I also have diastolic dysfunction as a result of Hypertrophic Cardiomyopathy and I take a beta blocker and have for years. I do not have a fib, but beta blockers are a common medication for Afib as rate control is key.

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