SOB ..Entresto or diuretic Treatment? Which doc to follow?

My cardio prescribed Entresto to deal with SOB.  Standard Procedure he says.

I ordered Entresto.  Before taking it I had an annual exam by family doc who discovered fluid in the lungs and elsewhere..  Prescribed diuretic and balanced my blood.    I lost lots of weight, feel good and able to walk hills with frequent stops.   EF = 35. Reduced diuretic.  Visit family doc next week. 

Now what?  Start Entresto ( replacing lisinopril) hoping it will help keep weight down and deal with SOB?  No diuretic or Entresto; see how it goes?   

Entresto was prescribed w/o checking blood or having an xray.  The Cardio could have looked deeper and initialy prescribed the diuretic.   

Any comments?








by Gemita - 2021-01-01 14:33:23


Go with the doctor you most trust and with your own gut feeling and with the med with the least potential side effects.

Do you have confidence in your cardiologist?  Your cardiologist is trying to help treat your heart failure which is probably causing worsening breathlessness (due to fluid buildup) and he perhaps believes Entresto may help to improve your EF which is low at 35% and improve your symptoms overall.   

I see you did well on a diuretic though.  Personally I would have a word with your family doctor/cardiologist and ask whether a low dose diuretic would help treat your SOB by preventing fluid from building up again.  You could ask your cardiologist if you could have a trial with a diuretic first (ask which one would be best) to help with the shortness of breath and whether it could also be effective at helping you to restore your EF?  I would also ask your cardiologist about another echocardiogram if you haven't had one recently, to check your EF, and whether it would be possible to consider an upgrade to a CRT device, or do you already have one?  

I wouldn’t see how it goes with an EF of 35% and fluid build up.  I would stay safe and choose a low dose diuretic first and then reassess.  It may be that a combination, low dose diuretic + Entresto or other medication might work better for you.  At this stage it is trial and error, but try to keep the trial and error as safe as possible.  I hope for the very best



by EdH - 2021-01-01 14:35:29

Forget losing weight with medicine.

get rid of food with sugar additives. If you drink coffee or tea do not add sugar.

stay away from soft drinks, drink water.

no junk food snacks,  try walnuts.

change your food shopping habits by eliminating sugar added products.

read canned food labels for killer sugar content. Stay out of fast food restaurants.

follow these guides for 3 months and I guarantee you will lose at least 20 lbs and lower your A1C diabetic count as a bonus.



by AgentX86 - 2021-01-01 16:15:42

One of the less common side effects of Entresto is fluid buildup and weight gain (and kidney failure). The first sign of fluid retention is usually noticed in the ankles.  You can feel the softness of the ankles and if you press your thumb into the lower leg/ankle, the imprint should go away in a few seconds. If it lasts a lot longer, you may be retaining fluid. 

My guess is that the diuretic and Entresto are trying to compensate for each other but it's indeed a fine line to walk and one that perhaps you shouldn't attempt.  One side, you risk your kidneys and other side, the heart.  My mother walked this line for a decade or more (not with Entresto but other drugs).  You shouldn't attempt this tightrope act without close monitoring of a competent cardiologist.

Edit:  By "shouldn't attempt", I meant that you shouldn't attempt this without close supervision of your cardiologist, not that it shouldn't be done at all.


by LeeLee1976 - 2021-01-01 22:10:14

Entresto has a diuretic in it. I take 103-97 but on occasion I have to take laxix for leg swelling 

SOB ..Entresto or diuretic Treatment? Which doc to follow?

by azviking - 2021-01-01 23:25:27

Thank you all for the comments...   I am careful with sweets..but can do better. I have a good diet - and can do better.   Now that I am at the weight of my 20's I see the need to control it more so I .  Fluid in the lungs was a wake-up call.   I see my family doctor next week - my guess;  Entresto and low dose of diuretic. 

LEE LEE    97/103  is a high dose.  How long have you been on the drug?    Tolerable side effects?   ...  

 GEMITA    My cardio was not happy when I told him about reading patients talk about serious side effects they experienced - and the high $ cost.  I see my family guy next week.

HIGH COSTS  Entresto is marketed in New Zealand under the name NYMADA...ordered through Drug Mart Direct, Canada... 6-8 weeks delivery.  I order well in advance.   Same drug, different name.  My wife gets inhalers there - Identical drug, same container, different name - shipped directly from the mfg w/o shipping through in New Zealand. 



Communication between doctors

by AnnaFerris - 2021-02-03 01:06:46

Getting doctors to communicate is a huge issue.  I would insist my family doctor talk with cardio to come up with a joint plan that is consistent and works for me. That isn't always easy since some docs have big egos.    Managing heart disease is complex and those of us without the training are just guessing.  

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