Concerned about early signs of heart failure

[Westie2012]

I had a dual chamber pacemaker November 2020, 4 days after that a lead punctured my heart ,I had both leads replaced a week after I’d had my pacemaker . This caused pericarditis and an effusion . A few weeks ago I started feeling more unwell , my heart would go over 130 on slight exertion , this got worse over a few weeks , causing chest tightness dizziness and breathlessness . I went to see my GP after I was waking slowly to my daughters school and I had 4 dizzy spells and could feel my heart pounding , I had to stop and wait for it to pass . I made it to the school , on the playground I had another very dizzy spell where I thought I was going to collapse. Thankfully I didn’t . At my appointment I’d been sitting waiting for over 20 minutes , I’d only walked the short distance to her room , I was so out of breath , she was concerned as my pulse wasn’t slowing after another 10 minutes, she wasn’t happy with my breathing and sent me to a&e with concerns I could be developing pericarditis again or sepsis . I saw an excellent cardiologist , he wanted to rule out a heart attack first , I have got used to seeing my ecgs, this one was all over the place . I had blood tests , chest X-ray and an echo scan . At one point when he scanned below my breast it was so painful I jumped with the pain . The scan showed a small effusion , he’s going to arrange a ct angiogram and more tests . He was very surprised I wasn’t put on beta blockers and prescribed bisoprolol. I’m still getting short of breath sometimes just leaning forward or picking something off the floor , last night I was reaching up to close the blinds and I got out of breath again. When I lie down I get breathless until I move more upright . The blood test was negative for heart failure but I’m still concerned.

[Sunnie2day]

Hiya, Westie, I'm so sorry to hear you're having symptoms! I can't offer much more than empathy and some experience - if it helps any at all when my persistent effusion is slightly increased, if I bend forward I do have some 'bendopnea' symptoms.

My increases can come from too much salt in something I ate, too much humidity thanks to a too-warm shower steaming up the bathroom...the list of what causes my effusion to increase is on the longish side.

What is 'bendopnea' - a recently recognised condition caused by heart strain from fluids (effusions) placing pressure on the abdomen when bending. Symptoms include sudden sensation of breathlessness and sometimes angina-like pain when the bending and breathlessness it causes continues for several minutes. It is common in HF patients - but not all people who experience bendopnea have HF - if presenting in a non-HF patient it is usually caused by either an increasing effusion (usually pericardial) OR overweight primarily situated at the abdomen. (aka 'belly fat', 'beer gut', 'post-natal tum').

Breathlessness when reclined is a symptom I watch out for - in my case as it is a sure sign of increased pericardial effusion and my signal to contact the cardiologist in a controlled panic. I usually sleep with my upper body elevated slightly, that does help the breathlessness until the effusion drains back to it's 'usual' persistent effusion amount.

When I do have effusion increases that worry me and my cardiologist, he usually prescribes a course of Furosemide (diuretic) in varying doses and length of course depending on what a quick scan shows. I can't use Colchicine so it's the diuretic for me in hopes of staving off the need for a pericardiocentesis (my absolute least favourite 'treatment' for complications of an acute flare of the recurrent pericarditis). So far, for me, a five-15dy course of 80mg Furosemide drains the increase off (and I stay VERY close to the WC until a week after the medication is finished, lol!) nicely.