You're welcome - tough disease that as a medical field we are still learning alot more about, both in diagnosis and treatment, so I suspect we'll be looking at this through a completely different lens within a few years

Appreciate the comment, thank you. With the risk in obesity and as we learn more about diseases like amyloid this is going to be a much more common diagnosis in the coming years and hopefully more research is done both on prevention and treatment

I assume the diagnosis came from an echo and if really stage 1 you have no symptoms. If the cause of the diastolic dysfunction is high blood pressure (which can happen even if lifestyle is good), then keeping the BP better controlled is exactly what should be done. 2 points: 1, If you notice any puffiness in your feet that can happen with amlodipine so let your doctor know (if so they will likely adjust meds and it will go away), 2, I would repeat an echo in 1 yr to make sure it is not progressing or hopefully improved. And thank you for the comments :)

And thanyou for your comment - i do get concerned about my constant high resting heart rate always over 90- i get horrendous sweats... no side effects from amlodopine- been on them for 7 months.... great video- ❤

@@skyechambers1968 - sorry for the delay in responding, I missed your reply. amlodipine does not effect heart rate so it won't bring that down. We don't like resting heart rates that high so if your doctor never checked things like thyroid function, anemia, etc, I would ask about those, and if your weight is normal your probably not very out of shape but the more conditioned you are the lower the heart rate usually.

1 year late on this reply (as above, I was not monitoring messages, sorry), but there is data for them and they are good so if he is not on an sglt2 it might be appropriate for him.

Glad to, email me and we can share contact info: dr.davidnajman@gmail.com

Nobody wants to be an interesting patient but this is a unique combination of data points. Diastolic dysfunction is most often caused by increased thickness of the heart muscle, that in turn is most often caused but chronically elevated blood pressure or longstanding obesity (which usually goes along with the higher bp). So to have a low bp (which is a good thing to treat diastolic dysfunction) along with that diagnosis raises questions. Please DO NOT post anything you're not comfortable with as this is not private, but what grade diastolic dysfunction (ie, grade 1-4, or mild-severe), what is the thickness of the left ventricle (should be 2 measurements), and is your kidney function normal?

Thank you!

@David Najman

Not taking chlorthalidone will not cause diastolic heart failure, but it can cause someone to start retaining fluid. The mvp and mild MR would not be causing this either...

Please don't put any personal/private information here, but what is your ejection fraction on the echo and were there any significant abnormalities with your valves? Entresto is a very good drug for patients with low ejection fractions, and even though it has an indication for what we call heart failure with preserved ejection fraction (diastolic dysfuntion), that data is very sparse as far as if or how much benefit it provides. It is very good at lowering blood pressure, so if your blood pressure was on the low side to start, it likely will make you feel worse. If your symptoms are driven by excess fluid in your body an SGLT2, spironolactone, or other diuretic should improve your symptoms. If your body mass index is over 35 that is most likely what the underlying cause is and getting that down to a normal range will likely resolve the problem. Feel free to send non-private info or follow-up questions and hope you feel better.

Kamusta po. The easy answer is maybe. There are a few numbers that would be good to know, there should be a measure of septal and posterior wall thickness, there should also be something called tissue doppler (which is often written as e'). Those measurements would help answer the question, if your blood pressure is high, if you have diabetes, or if your body mass index is over 30 those will also effect it. Let me know if you're able to find those numbers

@@davidnajman7640 Hey Dr., LV septal wall thickness = normal LV Posterior wall = thickness mildly increased LV Diastolic Function MV peak E: 0.94 m/s MV peak A: 0.47 m/s E/A ratio 2.01 LV IVRT: 67 msec Left Ventricle - IVSd 2D 0.97 cm LVPWd 2D 1.18 cm LVIDd 2D 4.88 cm LVIDs 2D 3.07 cm LV FS 2D 37.1% Blood pressure 130-135/80 Non diabetic BMI = 23% 5' 10" Height 160lbs

@@filipinostride6647 - Sorry for the delay in responding, I didn't notice you sent more info. Easy answer, I'm not worried about you at all. We look at e' (which they didn't measure and is the more accurate measurement of diastolic function), but your E/A ratio is normal, and the IVRT on the low side essentially excludes diastolic dysfunction. So I question how they came up with putting that on the report, and the only thing not completely normal there is the thickness of the posterior wall (and I would question if that was measured correctly given all of the other normal readings). Perhaps in 2 years repeat the echo, see if there are any changes, but there really aren't any concerns I would have based on your echo.

@@davidnajman7640 Thank you so much!

@@filipinostride6647 - hope to hear from you in 2 years :) and you're welcome

Just based on what you wrote, that likely is what she has. As I tried to explain in the video the heart is a muscle and has to squeeze blood forward, but it also has to relax to actively pull blood back from the body into the heart. A 'rigid' heart is often too stiff to pull fluid back in. A few good questions to ask her cardiologist (they will understand these and should provide answers to her): 1. How bad is her diastolic function. 2. Is the pulmonary hypertension out of proportion to the extent of her left sided cardiac problems. 3. Have secondary causes such as amyloid been considered. 4. Would a right heart cath help both manage meds and find out how much is due to lungs or heart. I've seen too many patients unfortunately not adequately diagnosed or cared for, we can usually make symptoms alot better so I would get answers to these questions and those answers hopefully will make her much better.

Yes, it is possible to improve or even resolve this, but it depends on the cause. If it is due to obesity and weight comes down to a normal range this should improve, the same would be true for blood pressure or certain valve problems as well.

I apologize for the delay in responding as I was not monitoring comments. That proBNP is not bad, and assuming the systolic and diastolic function is reported from an echo it is less likely that she has heart failure. If the breathless feeling occurs more with exertion and she has more ventricular beats (you did not state if it was atrial or ventricular), a good stress test may be best for her. I am monitoring comments more closely so if this did not answer your questions adequately please let me know

@@davidnajman7640Thanks for the reply. Sorry for not clarifying, ECG shows VPC trigeminal. Her breathlessness is not related to exertion, when she feels breathlessness, she feels it even when lying in bed and when she does not have breathlessness, she do not have it even during exertion. Giving some of her history: She was detected Mild MR Mitral valve during the initial stage of her pregnancy and it increased to Moderate at the 9th month of pregnancy. After delivery, it went again to Mild and started breathlessness. The doctor asked us to do NTPROBNP and on day 1 it was 680, the doctor asked us to repeat the test the very next day, and it was 450. I have consulted a lung doctor, lungs are clear and hyperactive.

Once again apologies on delay, I'm still learning youtube (cardiology is alot easier) and just found a response with new reply category. Thank you for the updated, a bnp of 680 and 450 alone isn't really a concern, but the combination of everything that you wrote does make me a little worried and I would ask her doctor if they feel getting a cardiac MRI would be warranted (I think it would be a good idea based on what you're describing). Sorry again for the 6 month delay...

@@davidnajman7640 thankyou for the reply. Her NTProbnp is now normal without any medicine. Looks like it was elevated due to pregnancy. Latest ntprobnp is 45. But still she has breathlessness but her breathlessness is not related to exertion, when she has breathlessness it doesn’t matter if she is walking or lying down. We checked with lungs doctor also, lungs functioning is also normal.

There are 2 tests that could be helpful to figure it out, the 1st is the MRI as I wrote above, the other would be a cardiopulmonary stress test where we measure both heart and lung function. If you're able to message her doctor I would ask their thoughts of either test. I hope they find an answer and she gets back to normal and you 2 can be normal healthy parents :)