Brother’s mysterious heart failure

Update posted by Ruan Potgieter On Jun 17, 2021

Got an update from Dr. Jane Moses:

"In terms of the results of the tests done so far - the cardiac MRI showed that at some point he had a heart attack. Our current thought is that he initially had a viral infection of the heart in 2019 when there was also clot noted in the left ventricle. This clot must have broken off and caused a heart attack at a later point, accounting for the decline in heart function seen between 2019 and now. The coronary angiogram and left and right heart catheterisation showed that the blood vessels supplying the heart are normal and that the high pressure in Riaan’s lungs that was noted on the echocardiogram is only as a result of the heart and not from additional lung pathology. The transoesophageal echocardiogram (TOE) showed that there is clot present in the left atrium as a result of the rhythm (atrial fibrillation) that his heart is in at present.

In terms of the way forward:

1. We still need to further optimise Riaan’s medications - this can hopefully be done as an outpatient with frequent follow up in our outpatient clinic.

2. We still need to address the atrial fibrillation by way of shocking his heart back into rhythm, but the clot that is there will need to dissolve first, so this will only be in about 6 weeks time."

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Update posted by Ruan Potgieter On May 20, 2021

2021/05/20 he is scheduled to go for a transesophageal echocardiography.

What it is:

  • TEE is a test that uses sound waves to make pictures of your heart’s muscle and chambers, valves and outer lining (pericardium), as well as the blood vessels that connect to your heart.
  • Doctors often use TEE when they need more detail than a standard echocardiogram can give them.
  • The sound waves sent to your heart by the probe in your esophagus are translated into pictures on a video screen.

The detailed pictures provided by TEE can help doctors see:

  • The size of your heart and how thick its walls are.
  • How well your heart is pumping.
  • If there is abnormal tissue around your heart valves that could indicate bacterial, viral or fungal infections, or cancer.
  • If blood is leaking backward through your heart valves (regurgitation) or if your valves are narrowed or blocked (stenosis).
  • If blood clots are in the chambers of your heart, in particular the upper chamber, for example after a stroke.
2021/05/21 he is scheduled to go for an angiogram.


What it is:

  • An angiogram is a diagnostic test that uses x-rays to take pictures of your blood vessels. A long flexible catheter is inserted through the blood stream to deliver dye (contrast agent) into the arteries making them visible on the x-ray.

Video on how angiogram works:

Will report back on the results of the above procedures.


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Update posted by Ruan Potgieter On May 20, 2021

2021/05/19 he went in for a MRI. Previously the doctors thought that he's heart's outside layer is damaged and has scar tissue. With the latest MRI it seems that his Endocardium (inner layer) has damage. Your heart has mainly three layers.

  • Epicardium - the outer layer (previously thought damaged).
  • Myocardium - the middle, muscular layer.
  • Endocardium - the inner layer (damaged).

It was either caused by heart attack or virus. Will report back when I have more details on the MRI results.

*everything stated above is on a phone call with Riaan

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