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Is it possible to have a 'clean' heart cath and normal EF, and still have CHF? 

Is it possible to have a "clean" heart cath, normal EF and still have CHF? I can gain sometimes 6 pounds of fluid in 48 hours, kidney function is normal and I recently had a cardiac work-up with the above results.

submitted by David from Lynch, Kentucky on 7/11/2013


by Texas Heart Institute cardiologist, Domingo Gonzalez, MD  

Domingo G. Gonzalez, Jr., MD The answer is yes, one can have CHF [congestive heart failure] and have a "clean" heart cath with a normal left ventricular ejection fraction. The term clean is not based on science but typically means that the coronary arteries have no or minimal angiographically detectable atherosclerosis. A typical left heart cath with left ventricular angiogram should address the angiographic status of the coronary arteries, the left ventricular ejection fraction, whether there is significant mitral valve regurgitation (leakage / insufficiency) and whether there is significant aortic valve stenosis (narrowing).  

A heart cath does not typically address the following potential causes of CHF:
Aortic valve insufficiency 
Mitral valve stenosis 
Pulmonic valve stenosis or insufficiency 
Diastolic left ventricular dysfunction 
Right ventricular failure 
Pulmonary artery hypertension 
Constrictive heart disease 
Restrictive heart disease 
Pericardial fluid collection

All of the above can cause CHF and fluid retention. To investigate these, a more extensive heart cath and possibly other types of tests would be in order. There would have to be a clinical level of suspicion to direct the more extensive evaluation.

Additionally, other causes of edema or fluid retention not associated with CHF can be the culprit, such as thyroid or liver disease. 

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Updated July 2013
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