Diagnoses

A little frustrated here.  My mother is 85 and has an enlarged heart.  She has a left bundle block and some leaky valves. She had shortness of breathe last year so her internist did an echo and ekg.  They saw abnormalities and started her on meds and said maybe crt.  What is normal procedure to diagnose this.   She saw a cardiologist who said he wants to figure out what caused this, probably ischemia.  Another Dr. said leaky valves.  I tried to get an mri for but she said the nurse said this is rare.   So far all they do is throw pills at her.  She is a little difficult, and doesn't always follow up with dr, or switches around to new dr.  She had original echo and a follow up ekg.  Any thoughts, everyone here seems to know their exact condition and exactly what is going on with them.  This has been going on for a year.


6 Comments

"Everyone here know[s} ..exactly what is going on with them" - that's an illusion

by crustyg - 2022-05-12 11:10:53

While it's true that some contributors here have, over a period of time, gained information about, and an understanding of, their condition(s) to a high degree, there are also plenty who still have doubts, uncertainties and are missing pieces of their own diagnostic puzzle.  And don't forget that many of us have conditions that will inevitably change, so whatever we might have thought was the entirety of our condition last year may no longer be the case.

One of the recurring themes from the wiser contributors here is that this forum is less about telling anyone 'The Answer(s)' but more about helping each other ask better questions of our medical and EP-tech advisors.  And the best people to direct these questions towards are your medical team (or your mother's team).  I know, from personal experience, how frustrating it can be to be subjected to tests and more tests while diagnoses are considered and perhaps excluded, or rendered less likely.  And being of the profession I tend to assume the worst when I look at what's being tested for.

Sometimes, there is no obviously 'correct' diagnosis (or diagnoses) and the trick here is to work on the best possible quality of life while any underlying condition makes itself clear.  'Throw pills' speaks of a fairly significant value judgement - that you don't think 'pills' do anything.  I wonder if you're really in a position to make that assessment?

You have a diagnosis?

by Gemita - 2022-05-12 11:17:33

DBO, From your previous post, you have a diagnosis for your mother:  Stage 3 heart failure.  Getting a safe treatment plan for heart failure can be a long long process because they have to get it right, especially with an 85 year old patient.  Medication is often tried first for long periods because it is less invasive, it often helps treat the condition and can give the medical team information to decide whether your mother can successfully be treated with meds alone.  While a CRT device might help, it can be an invasive procedure for an 85 year old and might set her back so they need to be sure it is going to improve her situation before they move ahead.

My sister and my husband both have heart failure.  My husband has a pacemaker, my sister does not and she is in the same boat as your mother, still waiting for a range of tests to help her heart failure team decide on the best way forward.  She is waiting for a cardiac MRI to give them more information on the cause for her very sudden reduction in ejection fraction.  She may need other invasive tests too like an angiogram to look for coronary artery disease.  She is being managed with medication alone and they have told her that a medical device may be needed in the future (like an ICD or CRT pacemaker) but that these would be invasive and that she may not be a suitable candidate.

I see they are still carrying out investigations.  There may be many investigations:  ECG, Echocardiogram, Angiogram, Cardiac MRI, Blood checks before they make a decision.  You need to be patient while supporting your mother as best you can and making sure that any worsening symptoms are brought to the attention of her doctors as quickly as possible, when immediate intervention may be needed.  

Heart failure

by AgentX86 - 2022-05-12 14:17:38

As you know, there are many causes for heart failure. Her doctors are on the hunt for the cause but it anyway take a while and may involve many tests to eliminate possible causes. It my not be a single problem that can be fixed with a magic bullet. An MRI may not be the best diagnostic tool in this case. I'm not a doctor but it would seem that one of the first steps would be exactly what her doctors have already done. Depending on the results, I would imagine that if they suspected the problem was ischemia that they'd want to image the blood flow 8n the heart muscle. It would depend upon her overall condition and exactly what they suspected, which diagnostic path, if any, to take.

An MRI probably wouldn't be high on the list. It's really not the best tool for the job. Depending on where she lives (please fill out the bio page) an MRI may be difficult (justification for the expense) or impossible (none to be had).

Diagnoses

by DBO - 2022-05-12 14:36:30

Very helpful comments, helps to get real responses, rather than just watching videos. I had a bunch of tests once.  They wanted to put a stent in me an their was really nothing wrong.

Stent

by AgentX86 - 2022-05-12 17:11:28

Been there. An ultrasound and then a CT-A showed a 70-80%, or some such, blockage in my carotid arteries. I was given a choice of stenting or a hack and slice on my neck to scoop them out.  I chose the stent. When they got in there, the blockage was no more than 20% so they did nothing. I chose wisely. Lots agnst over nothing. Neither doctors or their tests are infallible. 

85 year old mother

by TAC - 2022-05-13 12:36:47

An accurate diagnosis isn't necessary for understanding that you mother has an 85 year old heart with all the features of wear and tear after 85 years of beating uninterrumptly. I'm afraid that there are no fixes available.

You know you're wired when...

You trust technology more than your heart.

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