Will I be able to fly?

I am a 47 year old male patient that sufferd an acute MI.  Stents x 2 placed in my LAD.  My EF was 20% at time of cath procedure.  I know EF doesn't measure "how you feel" but I am a pilot and the FAA requires an EF of >40%. I am in good shape, I almost scare the rehab nurses because I work so hard.  I have done all the life style modifications recommended.   Can I achieve this improvement with meds and rehab, or do I need to start looking for a new job.  I wont give up on my changes, I just want a real answer.  

[Flycaster305]

A couple of questions... what part of the heart was damaged by the MI?  How long ago did you have the heart attack? Do you have other heart issues like heart valve leakage, etc?

It sounds like your rehab is going well, and assume you are taking all the good medications like a blood thinner, statin, beta blocker, etc.  I'm older than you but by doing what you are doing, my EF raised twenty points, and I know other responders on this site have had the same experience.  I was the poster boy for bad heart health and raised my EF while much older than you.  The fact that you are frightening your rehab nurses suggest to me that you will achieve your goal.  

[flyers0313]

The MI was March 13th, it is the anterior wall that is effected... but they are also talking about a potential need for a AICD so I guess the electrical part was effected too.  The next echo to see if there is improvement is in June, 3 months from event... no improvement i was told means no flying ... but good news is, I haven't had any type of "crazy beats".    Yeah I am on all of those meds, and a few more.  I asked them to be "agressive" with me, because flying has been my life...and I want it back!  
Thanks for the encouragement!  Knowing your EF raised 20 points really gives me hope.  Can I ask how long it took to improve?  

[Flycaster305]

I'm glad you have hope, you have every reason to expect to recover those EF percentage points as long as you continue to do what you are doing.  Most of my heart damage is to the lower part of the heart, but I also have damage to the anterior wall, and eventually I needed a pacer.  A danger sign would be low heart beats/blood pressure and light headed moments and also very fast heart beats.

EF can be raised very quickly.  As I understand it, when we have a heart attack, there is of course damage to the heart muscle that can't be repaired.  However there are usually cells surrounding the dead muscle that is stunned, but not dead, and the faster those cells are brought back to life, the faster the EF raises. Others on this board understand this process better than me, I just followed direction.   Drugs that are effective in revitalizing the stunned cells in my case were Coreg, a beta blocker, Linisopril, and Ranexa.  That being said, exercise is simply essential, in my opinion and I'd strongly suggest mixing in a lot of vegetables, salmon, lean chicken and zero salt in your diet.  The Salads should be dressed with extra virgin olive oil and good vinagar.  Stay away from beer and hard liquor, red wine is ok in moderation.  No smoking, of course.  
Hang tough, you will be OK.

[ed34]

"However there are usually cells surrounding the dead muscle that is stunned, but not dead, and the faster those cells are brought back to life, the faster the EF raises"

Spot on. Yes the surrounding muscle soon starts to compensate for any dead areas. obviously the smaller the dead area of muscle, the better the prospects because large areas in turn can cause problems more long term.
The reaction time to a heart attack (acute) is very important. Time is muscle. My cardiologist said if a patient is being treated within 40 minutes, then it's likely the cells will be saved.

[flyers0313]

what if those cells dont "come back" to life... My time was almost 14 hours with pain, and the blockage was complete.  Is my EF going to be able to raise?  

[ed34]

I'm sure if they didn't feel some of the tissue condition was viably reversible, they wouldn't have stented your artery because it would have been a waste of time. It also depends where in the left artery the blockage is. If near the bottom, less damage would occur than if at the top. Your own symptoms are the key to how well you are recovering. From what you describe at rehab, it sounds like you are doing very well. As you exercise, it doesn't matter if not all the cells recover because muscles around the area will become more efficient to raise your EF. In my first regime at rehab, there was a guy who had some dead tissue on the left side of his heart. His EF was a little higher than 20 but after rehab it had gone to 50%. That was in a six week period and they told him it should increase a bit further still.

[Flycaster305]

Ed and I agree.  Stunned cells are usually called 'reversible ischemia' on nuclear stress tests and angiograms, it means cells that still are viable.  They can remain in that state, I believe for quite a while.  I don't really understand it, but that's the purpose of exercising and the meds, to get some life in them.  I do believe your statement that you are giving the rehab nurses pause is a reason to be optimistic.  Don't overly stress yourself with your workouts, but keep your nitro closeby and push the envelope.  I take Imdur, a  slow release nitro pill and also take Ranexa, which somehow works to increase the blood/oxygen to the heart and it seems to work for me.  In the words of Jim Valvano, 'Never Give Up'.  I take that to mean that we can't let our disease beat us, we have to challenge it.  

Trust us, the EF factor can be changed.  You, me and Ed are lucky I have heart trouble, hearts can be repaired.  If we were unlucky it could be our Pancreas or kidneys.  

keep us informed.