Congestive Heart Failure

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Tried to go to sleep last night. Minutes or seconds after my head hit the pillow I thought I was suffocating. Tried this four different times between 11 and 2 AM with the same results.

Went to the ER and stayed there until 8:30 this morning. Diagnosis. Congestive Heart failure (very mild 132 where 125 according to the doctor is high normal) Also diagnosed with bronchitus.


Just got my one year 3d class renewed. Only one year due to a SI.


Now, for the important question. Is CHF disqualifing?
 
Thank you. Needless to say I was pretty shook up when I heard the diagnosis. However, when I was being released from the hospital, I saw the CEO in the emergency room. We are pretty good friends so I called to him. He looked pretty sad to see me in the ER and, asked me what was wrong. When I told him congestive heart failure he didnot bat a eye lid and gave me a very blase answer. He is the most considerate and caring man I know so when he blew this off I knew it was not very serious.

Just hope the FAA feels the same way.
 
CHF is VERY serious. The CEO is not medical and really has no clue. Don't take his attitude to have ANY meaning.
Now, the numbers. I am assuming you are talking about a BNP? I would not be concerned with a BNP of 132. It needs to be > 400 to be concerning, ie: CHF.
More importantly, what did the chest xray show? Did he give you any diuretic like lasix? Any other treatment?
I would strongly recommend getting another opinion from a Internal Medicine or Cardiologist.

RR

Unregistered said:
Tried to go to sleep last night. Minutes or seconds after my head hit the pillow I thought I was suffocating. Tried this four different times between 11 and 2 AM with the same results.

Went to the ER and stayed there until 8:30 this morning. Diagnosis. Congestive Heart failure (very mild 132 where 125 according to the doctor is high normal) Also diagnosed with bronchitus.


Just got my one year 3d class renewed. Only one year due to a SI.


Now, for the important question. Is CHF disqualifing?
Click to expand...
 
Yes, CHF can be very serious, but it can also be managed. As for the FAA, I don't know. What I know comes from riding an ambulance for 10 years, and 4 years in an ER. Follow up with your family doctor, and take care of yourself. Then wait for Dr. Bruce to answer on the FAA.
 
I'm assuming there was a follow-up scheduled with a cardiologist. Let HIM tell you whether you have congestive heart failure or not. And if he says "not", get it in writing. I'm sure Dr. Bruce will be along soon with more detailed instructions, but this is certainly a case of "take care of your ticker first, worry about your ticket later".
 
Yeah, I said Family Doc, but Tim's right. Cardiologist. My intent wasn't to direct you to a particular caregiver, but to direct you to consistent follow-up care, which isn't in the ER.
 
I got called out of work one day because my Mother was in the ER. She was diagnosed with CHF, and she later died. Thirty years later at age 86! And the last ten of those years were very stressful for her due to three of my siblings moving in and out with their families due to various family emergencies. It is serious. It can be managed. Good luck to you.
Let's see what Dr. B. says.
 
The diagnosis of CHF by an ER physician based solely on a minimally elevated BNP is problematic. It depends on a lot of other findings. An echocardiogram is the best place to start. As we age the heart muscle gets stiffer and can lead to CHF from isolated diastolic dysfunction AKA CHF with preserved systolic function. If the pumping function is reduced it is usually a more serious problem. There can be other issues like heart valve problems and coronary artery disease. A cardiologist who understands pilot issues would be a good place to start.

Dr. Bruce will tell you what the FAA wants.
 
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CHF can be fatal. My mom died from the disease when she was only 97, and her 95-year-old brother is now struggling with it.
 
After leaving the ER, saw the primary care doc. He prescribed Lisinopril a diuretic plus scheduled me a visit with a cardiologist. Don't know what the X-ray showed. They did not tell me the results.

Thanks all for the encouraging words.


QUOTE=fnpdoc;954559]CHF is VERY serious. The CEO is not medical and really has no clue. Don't take his attitude to have ANY meaning.
Now, the numbers. I am assuming you are talking about a BNP? I would not be concerned with a BNP of 132. It needs to be > 400 to be concerning, ie: CHF.
More importantly, what did the chest xray show? Did he give you any diuretic like lasix? Any other treatment?
I would strongly recommend getting another opinion from a Internal Medicine or Cardiologist.

RR[/QUOTE]
 
A good GP doctor can ask the questions that will indicate further tests are necessary:
Q: Do you have shortness of breath?
Q: Do you find it difficult to climb stairs?
Q: Can you sleep on your back?
Q: Do you find it easier to sleep sitting in a chair?
Q: Do you wake up often at night to urinate?
Q: Do you experience decreased appetite?
Q: Do you experience nausea?
Q: Do you hurt anywhere?
He (or she) can also perform simple tests:
Listen to the heart, of course, and take BP.
Poke a finger in the leg and watch how quickly it springs back.
Have the patient make a tight fist and then open it palm up, watching how quickly the palm turns pink as blood returns.

But most GPs will not diagnose CHF without further tests, and will send the patient to a cardiologist.
The tests should be interpreted by a cardiologist:
heart cauterization and coronary angiography
nuclear stress test
echocardiogram
X-rays
as well as blood work to measure cholesterol levels
 
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Yes. It is grounding.
You could have had a silent MI.
But the main risk is that you develop pulmonary edema as pilot in command, and suffocate in the left seat.

Get thee to an internist or a cardiologist,
Get the 2D echo so we can look at diastolic relaxation and the valves.
ER docs generally regard the b-Naturetic peptide elevation as diagnostic, but it's FAR FAR more complex than that.

To requal, you will need a cardiologist's letter (if an internist, be better be able to talk the talk and walk the walk), a stress treadmill AFTER your hemodynamics are cleaned up, to the same specs as anyone else....Heart Rate to (220-YourAge)*.9, 9 minutes on the bruce protocol; serum creatinine, Fasting glucose and Lipid Profile.

Sigh.
 
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I'm sitting in an icu waiting room in Memphis tn. My father was diagnosed with the same thing three years ago. He's having an ascending aorta repair in the morning. The drs aren't even sure why he's alive. Take care of yourself.
 
Thanks Bruce, We do know each other. I had a BPN of 136 which ER doctor said was CHF, but at a very low rate. Went back to the ER the following nigh for the same thing BPN rate was 144. I was admitted after exhaustive testing to include a 2nd echo. Cardioloigist said it was basically the same as the one I was forced to obtain for a Mitrial Prolapse. (Sounding familiar to whom I am ?) Tons of X-Rays, a cat scan, probing my chest, groin and legs to look for blood clotting (none found) X-Ray was clear. Nearly 30 different people listened to my chest = Nothing remarkable.

I will ask the cardioligist to provide the words as you indicated. Since I just got a years extension on my 3d class with the SI I will just keep the cardios clearing letter in file for legal protection should I need it. Of course, if he recommends me not flying I will not as as someone said earlier "The ticker is more important than the ticket."




bbchien said:
Yes. It is grounding.
You could have had a silent MI.
But the main risk is that you develop pulmonary edema as pilot in command, and suffocate in the left seat.

Get thee to an internist or a cardiologist,
Get the 2D echo so we can look at diastolic relaxation and the valves.
ER docs generally regard the b-Naturetic peptide elevation as diagnostic, but it's FAR FAR more complex than that.

To requal, you will need a cardiologist's letter (if an internist, be better be able to talk the talk and walk the walk), a stress treadmill AFTER your hemodynamics are cleaned up, to the same specs as anyone else....Heart Rate to 9220-YourAge)*.9, 9 minutes on the bruce protocol; serum creatinine, Fasting glucose and Lipid Profile.

Sigh.
Click to expand...
 
I should have mentioned that Dr. Scott had me undergo an Echo and provide the fasting lipid results a few months ago to again qualify for the 3d class. He signed off on the medical after seeing the results. I will listen very carefully to the advice given by the cardiologist. He too is a pilot. Same qualifications as I have Commercial, Instrument ASEL.

Only wish he was an AME.
 
Hate to hear of your dilemma, sounds like your family doc has things going in right direction. An ace inhibitor (lisinopril) and the diuretic are great choice for starters.

As a family doctor I've taken care and have diagnosed many cases of CHF both in my clinics and the ER. It can be diagnosed without a internist or cardiologist. The cardiologist is a must to do further work up for sure. This would probably include stress testing or thallium study to eval for any coronary insufficiency or silent MI.

One doesn't have to have heart disease to have CHF. Severe anemia, salt overload or viral illnesses can all be causes along with a rediculous amount of other causes.

Your bnp value isn't that alarming and there are several other findings to look for depending on the pathophysiology or cause. I would never dx off a lab value, instead putting all the pieces of the puzzle based on lab, echo and the ejection fraction, myocardial perfusion and most importantly physical exam. A seasoned provider can discern the fine crackles that we hear in bases of lungs when listening as fluid since this is one of the first findings. Simple cxr will show the increased bibasilar markings.

One of my older patients who had no heart disease ate fried catfish and some other deepfried salted items one friday evening only to show up Saturday morning with your similiar symptoms. I helped him rid himself of the extra fluid, his cardiac workup was normal and he had no longstanding problems. This was before our bnp test and was easily diagnosed. Not every circumstance has bad outcome.

I hope your workup is a good one without any positive findings and your health
returns to normal quickly. I also hope your able to navigate the FAA crap in record time with the help of a solid ame.

Good luck my friend:)
 
I grounded myself after the ER diagnosis of CHF. Yesterday, I went to the cardiologist for his determination of the echocardigram I underwent while a patient (had an FAA directed Echo in April) Not only did I have the echo, but two EKG's and about 100 blood pressure readings and a multitude of other tests.

Bottom line. No CHF, not even close Cardiologist and Pulmonologist both agreed it was Chronic Bronchitus interfering with my breathing. Only thing the heard doc suggested was to lower my salt intake.

See you. I am going flying.
 
Unregistered said:
I grounded myself after the ER diagnosis of CHF. Yesterday, I went to the cardiologist for his determination of the echocardigram I underwent while a patient (had an FAA directed Echo in April) Not only did I have the echo, but two EKG's and about 100 blood pressure readings and a multitude of other tests.

Bottom line. No CHF, not even close Cardiologist and Pulmonologist both agreed it was Chronic Bronchitus interfering with my breathing. Only thing the heard doc suggested was to lower my salt intake.

See you. I am going flying.
Click to expand...

Glad to hear you're okay!

-Rich
 
Glad to hear, but dire enough bronchitis masquerading as CHF is also quite serious. Take care of yourself.
 
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Unregistered said:
I grounded myself after the ER diagnosis of CHF. Yesterday, I went to the cardiologist for his determination of the echocardigram I underwent while a patient (had an FAA directed Echo in April) Not only did I have the echo, but two EKG's and about 100 blood pressure readings and a multitude of other tests.

Bottom line. No CHF, not even close Cardiologist and Pulmonologist both agreed it was Chronic Bronchitus interfering with my breathing. Only thing the heard doc suggested was to lower my salt intake.

See you. I am going flying.
Click to expand...
I'm not at all surprised. The BNP test was developed to help determine if breathlessness is the result of heart failure or respiratory problems. A tiny elevation in BNP would almost never be associated with heart failure symptoms.
 
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