Heart at 18% , diuretic not helping. Why?

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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?

Answers 1 to 10 of 15
Dear Aadriana,

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.
Top Answer
If your dad has a faulty aortic valve then he needs a valve replacement. Without this surgery he will not improve. The diuretics won’t fix this. His ejection fraction is 18% that means his heart is unable to pump a sufficient amount of  blood via  the heart muscle because the faulty valve prevents enough oxygenated blood to be pumped to his body.

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. 
Thank you all for the answers, really appreciate your thoughts and care. I am thinking to use compression stocking for his swollen legs, wonder is that safe enough for his condition? Currently fluids have already come out from his legs and we wrapped it with cotton and gauze. Anyway, we're not in US, so I am not too satisfied with the response from several cardiologist we met. They all suggest to watch the salt intake, but my father himself have lost his appetite and eat really, really few. So once again, really appreciate your answers and thoughts... Hugs
There are other diuretics, Aadriana. Ask if another type might be safe and more effective for your father if he's no longer responding to Lasix (furosemide).

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.
Aadriana, I'm sorry for the challenges your family is facing. I can literally "feel your pain" from your post. You've gotten excellent advice, especially from the medical professionals who post here. I only have a few comments.

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.
Ask the cardiologist to do an echocardiogram; you should be able to get this test- it’s not invasive and like an ultrasound, can be done out patient. No need for hospitalization.
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
Ask the cardiologist to do an echocardiogram; you should be able to get this test outside of the US,  it’s not invasive and like an ultrasound, can be done out patient. No need for hospitalization. They can determine aortic and tricuspid valve patency with this test (& EF).
18% was obtained by echocardiogram. He is essentially a cardiac cripple with low quality of life. He may or may not qualify for a TAVR procedure which will help the valve but not the cardiac muscle function. If he is seen at a quality heart facility and he has few options then perhaps it is time for hospice.
You mention stem cells. Does he live near such a facility that is doing this research? Can you and he afford to live near such a facility. Depending if he qualifies he would have a 50/50 chance of receiving the treatment.  Your profile also mentions stroke so he may not qualify
I don’t think she is in the US. No mention of aortic valve condition as well. Adriana, can you ask his cardiologist what the echocardiogram test provided regarding his aortic valve? You mentioned something occurred 10 years ago to his valve at that time, may be that condition is now worsening. 
Agree it may be time to consider hospice. So sorry for you and your family. 

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