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Heart Disease (Expert Forum)
Cardiomyopathy / ICD
Answered by
Cleveland - OH
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
Cardiomyopathy / ICD
by oneheart, Jun 02, 2005 12:00AM
I am 50 yr. old female dx. 5/04, CHF and dilated cardiomyopathy.
My EF at time was 10%. As of 4/05, EF is between 25/30%.
My cardiologist is suggesting I have 2 lead ICD to prevent SCD. I had Cardiac MRI April 05, cardiac cath May04 several EKG's and Echos showing no blockages, worn holter monitor for 24 hrs. and have shown no signs of electrical problems.I did have one episode of VT during initial hospital stay. I have not had any stress tests on treadmill and have been told not to exercise, with the exception of moderate walking. My question is if I have improved and continue on present meds, Coreg 12.5 2x daily, digoxin, aldactone, altace is there possibility of improving EF and not requiring ICD? I'm aware the guidelines of qualifing for ICD is EF < 35%. Read stories of being shocked by ICD when unnecessarty and it's making me anxious about this procedure. Thank you in advance for your answer.
My EF at time was 10%. As of 4/05, EF is between 25/30%.
My cardiologist is suggesting I have 2 lead ICD to prevent SCD. I had Cardiac MRI April 05, cardiac cath May04 several EKG's and Echos showing no blockages, worn holter monitor for 24 hrs. and have shown no signs of electrical problems.I did have one episode of VT during initial hospital stay. I have not had any stress tests on treadmill and have been told not to exercise, with the exception of moderate walking. My question is if I have improved and continue on present meds, Coreg 12.5 2x daily, digoxin, aldactone, altace is there possibility of improving EF and not requiring ICD? I'm aware the guidelines of qualifing for ICD is EF < 35%. Read stories of being shocked by ICD when unnecessarty and it's making me anxious about this procedure. Thank you in advance for your answer.
Doctor's Answer
by Cleveland Clinic, Jun 02, 2005 12:00AM
, Jun 02, 2005 12:00AM
oneheart,
Its a difficult question. We treat patients with ICDs based mostly on population studies and not individual criteria. One day, we probably will have a better way to identify those that will specifically be at risk of sudden cardiac death, but we are not quite there yet.
There are drawbacks to an ICD such as uneccessary discharge and infection risk. These are often not commented on compared with the survival benefit seen in studies.
The improvement of EF is also not predictable. With a low EF and a history of VT, I would be concerned so its probably worthwhile sitting and talking to your physician about the risk and benefits here. I find some patients also have some of their concerns alleviated by seeking a second opinion.
good luck
Its a difficult question. We treat patients with ICDs based mostly on population studies and not individual criteria. One day, we probably will have a better way to identify those that will specifically be at risk of sudden cardiac death, but we are not quite there yet.
There are drawbacks to an ICD such as uneccessary discharge and infection risk. These are often not commented on compared with the survival benefit seen in studies.
The improvement of EF is also not predictable. With a low EF and a history of VT, I would be concerned so its probably worthwhile sitting and talking to your physician about the risk and benefits here. I find some patients also have some of their concerns alleviated by seeking a second opinion.
good luck
I am relatively young and employed full-time plus...I have a dilated cardiomyopathy and do have a biventricular pacemaker and a ICD. My EF was at 30% but with the bi-v pacer and the drug therapy it is now at 40%. I agree with the MD...get another opinion because you really have maximized your drugs yet either. I take 25 mg coreg twice a day. Maybe you'd be a candidate for a bi-v pacemaker. They have had a lot of success with those in people with low EF.
I will post again on my return from Atlanta to let you know the suggestions of the cardiologist there. Thanks again for your response!
Now, at age 41 I felt them coming on strong again, so I did another holter, this time 48 hr. PVC are now 1220 per hour--every hour, and I think are still increasing to regular bigemny.
You are the first person I've come across who has them at this high a frequency, as "normal". I'm not excited by that, in fact sorry that you have them. But I'm hoping you might be able to share some more of your story. I've always been told these are benign. But why are they increasing. I've read they may decrease too. I think stress is a big part. I do feel so much better when I exercise heavily, but it doesn't seem to decrease the PVCs.
How long have you had such a high rate. Do you know, or did your doctor tell you if you developed the cardiomyopathy from the PVCs frequency??
I mention all this to say, the combination of pacemaker and medications have made a difference in the findings of an echocardiogram! Think positive and good luck!
I know the standard line has been "PVCs=benign", but I don't think they know all they can. If they are honest, they will admit that.
I've met a couple of people on this forum (so I know there has to be more in the world), who have developed CM after having high frequency PVCs for years. Coincidence? Maybe. Their doctors are starting to think otherwise, so maybe it's just a matter of time before they change their thought process on PVCs.
Again, thanks for sharing and I hope you continue to do well.
I would appreciate any information that anyone who has one would share, but my question is the implant procedure open heart of laproscopic? I was so overwhelmed at the office yesterday that i forgot to ask. Thank you
Angela
Perhaps doctors are getting too locked into this EF thing. I also heard of someone who runs marathons and has a low EF. I didn't get a number from this cardio tech, however.
My question is "Would any of you worry about a low EF, if you had my set of circumstances?" Thanks.
I hope that you keep asking the question, there's lots of people on this board but it's hard to read through all the threads if they are a little older as this one is. You definetly do far more physical activity than I do, keep it up, sounds like it's brought you this far.
Have you tried posting the questions to the Drs. here to get their opinion?