My father's echo test shows his heart function only 18%, we always know he has weak valve due to last attack more than 10 years ago. But for the past 2 years, his condition got worse. He is currently not able to walk due to swollen legs. He consumes diuretic pill (Lasix) but seems it's not helping. Is there any medication that need to be changed? Does he have options for other medical actions beside stem cell?
I am so sorry to hear about your father's condition. I know you are trying to get him the best medical care. My father also had heart failure. It is a very tough situation. Lasix is one option but it also depends on his diet and his salt intake. I would talk to the cardiologist and see what options there are. I wonder if your dad might also have diabetes or kidney failure and that is also affecting his condition.
Both valves in the heart close between beats to allow the ventricles (the bottom half of the heart muscle) to push out blood that has just come from the lungs and is full of oxygen.
When the valve is faulty there is no flap that completely closes, thus the heart is unable to pump it’s normal volume to the body because the “gates” of the valve don’t close and the ventricles never really empty in time for the next beat. Thus the body tissue is not getting enough blood through and that leads to the swelling, shortness of breath and all the other adverse effects of a faulty aortic valve. The 18% EF means his ventricles are pumping less efficiently (normal EF is > 50%).
Many elderly folks have aortic valve replacements and make it through, but often the anesthesia & the rigors of the procedure itself will significantly increase symptoms of dementia if he has them or often cause the beginnings of dementia if he does not.
A difficult decision for your family & I am sorry for that.
Some cardiac surgeons perform a valve replacement surgery that is less invasive but the person needs to be pretty healthy otherwise to be deemed a candidate.
Try to limit his salt, elevated his legs or use compression hose in the interim. Hope this helped you understand why diuretics alone will not work.
Getting your father to raise his legs is better than swaddling them, if possible. A footstool, a riser recliner chair, or even lying down on his bed for a couple of hours during the day will help.
Don't use the compression stockings without speaking to your dad's doctor first.
My dad had an ejection fraction of 12% which was so alarming but the doctor described to me a way that the heart goes about protecting itself. That's it's job, to keep beating, so it creates what are called collaterals out of its own tissue. These are like little vessels in the heart that allow the blood to flow more freely. They're not a cure, they only postpone, but they're really quite amazing. My dad lived for quite a long time with his 12% (about a year, maybe more) and those collaterals. And what got him in the end was his liver, not his heart.
You're doing all the right things.
1. Bumex is another diuretic. My nurse relative tells me that it expels retained fluid at a much higher rate than Lasix, which is more moderate. It would be up to the doctor to determine if this would be appropriate in your father's condition - it might not be.
I've seen it used twice. First time was after an operating team overinfused during pacemaker surgery and the second time was when a pleural effusion occurred. In both times Bumex was used to eliminate the excess fluid. And it worked, very successfully and quickly.
2. I'm not a medical person, so this is observational and anecdotal. My aunt eventually died rapidly after being diagnosed with lymphedema, which presents with fluid weeping from the body, in her case, her legs. She was in treatment, by home care medical people.
Her legs were wrapped as well, but in something more complicated which she described as like a hockey player's leg padding, restricting her movement and literally making her walking more difficult. However, she had been worried about this padding being sterilized and potentially introducing bacteria into her weeping legs. And I think her concern was valid. She died a few days later from sepsis.
The concern that I have in wrapping your father's legs is the sterility of the cotton, although the gauze might be sterile. Anything not sterile could introduce bacteria.
I'm not trying to scare or frighten you; but I would raise with a medical person the issue of wrapping the legs. There are swaddling treatments, but they need to be done very carefully.
And raising the legs is at least a first step, as well as cutting back on any food containing salt, although you indicate he's not eating much.
The “weeping” in his legs is a very hard thing to care for. The bandages often fall off frequency.
If you are going to do that make sure you wash his legs with saline solution, rinse well, apply
Agree it may be time to consider hospice. So sorry for you and your family.
Take comfort in the fact that you did all you could for him .
Thank you for updating us.
Both of you are in my prayers.