Do I have heart failure?

Hey everyone — I’m 33 and working on improving my health. I’ve lost over 40 pounds since May and had a full cardiac and sleep workup recently due to some symptoms (like pounding heartbeat sensations while lying down or waking up). I’m trying to figure out if my heart changes mean I have heart failure — or if it’s more likely from untreated sleep apnea.

ECHOCARDIOGRAM (June 19, 2025)

EF: 60%

LV size and wall thickness: Normal

RV: Severely dilated (5.2 cm), but function is normal (TAPSE 2.6 cm)

LA: Mildly enlarged (4.6 cm)

Estimated pulmonary pressure: 24 mmHg (normal)

No diastolic dysfunction, no valve disease, no wall motion problems

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BNP BLOOD TESTS

May 29: 16 pg/mL

July 1: 34 pg/mL

August 11: 41 pg/mL (I’m overweight, so the BNP cutoff is adjusted to 54 pg/mL. These values are still considered normal.)

ZIO PATCH (7-Day Monitor: June 5–11, 2025)

No atrial fibrillation, SVT, VT, or pauses

Only rare ectopic beats (15 SVEs, 7 VEs)

Normal sinus rhythm throughout

NUCLEAR STRESS TEST (July 8, 2025)

EF: 62% with stress

No ischemia, wall motion issues, or perfusion defects

Test was normal

SLEEP STUDY (August 5, 2025)

Obstructive Sleep Apnea (OSA) with 72 obstructive hypopneas in just 2 hours of baseline sleep

Oxygen dropped to 81% without CPAP

CPAP improved SpO₂ to 87% low / 95.8% average

8 central apneas occurred during CPAP titration only (none during baseline)

CPAP prescribed at 10–20 cmH₂O (starting soon)

OTHER INFO

Resting HR: 57–63 bpm

BP: Usually around 105–110 / 65–70

No swelling, shortness of breath with activity, or dizziness

Walking 1–2 miles a day

Weight down from 343 to 301 lbs

Eating 1300–1500 calories/day, sodium ~3200 mg/day (monitored)

On metoprolol tartrate 25 mg TID and Corlanor 5 mg BID

So… Do I Actually Have Heart Failure?

With all of this, I still worry I may have right heart failure or early heart disease. The RV is severely dilated, and the LA is mildly enlarged. But function looks preserved, BNP is normal, and testing doesn’t show dysfunction.

Could this all be from untreated sleep apnea, or is this early heart failure? Has anyone had similar results or symptoms — especially with pounding heartbeat sensations while lying down or waking up?

Would love to hear your thoughts. Thanks for reading!