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45% ejection fraction
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45% ejection fraction

I had a stress test done last week and the result showed severely tachycardic, nearly syncopal episode on exertion and 45% ejection fraction. My doctor had me run in place at his clinic 3 days before.....I only did 30 seconds and I nearly passed out. The nurse caught me before my face hit the wall. Then he had me do the stress test. Every time I climb a stairs or walk few isle at walmart, I have to catch my breathe and feel like passing out. My dad died of heart attack and my mother has cardiomyopathy. My past echocardiograms showed mitral valve prolapse, mitral valve leaflets thickening, occassional PAC's and tricuspid valve regurgitation. Is it possible that I have stage 1 heart failure? If not , is it possible i'm about to? What would be the best thing for me to do to have a definite diagnosis?  Will a heart catheterization help me? My ecg also showed borderline left atrial abnormality. I am really suffering. Please help!
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Avatar_f_tn
I forgot to mention I am 30 years old,  5ft and 96 lbs.
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Avatar_m_tn
What is the diagnose and treatment that your cardiologist is giving you?

Yes, if all those symptoms are from the heart (keep in mind that can be other reasons) then you are suffering Heart failure (probably stage 2).

Be aware that Heart Failure it is not a disease by itself, but a collection of symptoms that can be caused by many reasons. Also the stages can vary up and down accordingly with the symptoms.

What it is important is to understand why you are suffering that.

If you do not have angina pain, your echo and ecg do not show signs of ischemia, then I do not see the value of the catheterism.

Does the echo report indicate sizes of the heart? A dilatation of it can be a clear cause of what you describe.

Jesus
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Avatar_f_tn
The radiologist told me while she was doing the echo,  my heart has increase in bulk. But she did not put it on the final report. In 2009, my doctor referred me to see a cardiologist for diagnosis purposes. First visit without doing any test or procedure, I was told he won't do it because i'm young -28y/o and skinny. I was hospitalized due to angina in 2009. I was just given toprol -xl to take since the cardiologist didn't want to do the cath. I tried another cardiologist to see if he would do it... he did the exact same thing. He said he won't do it. Neitherless to say,  I do not have a cardiologist that is helping me. Tachycardia was my main issue in 2009. I asked my doctor my options. He said I can get it fix but he do not recommend it. It's better for me to to take a lifetime medication. Now iI am thinking.. if something was done 2 years ago,  maybe it wouldn't have affected my ejection fraction and my physical ability. My doctor did not give me any follow up visit after the hospitalization last week and the stress test.  Am I on my own?
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Avatar_m_tn
The point it is not to do or not to do a cath but to give you a diagnose an a treatment. Also since 2009 there is time more than enough to develop a cardiomiopathy.

I cannot believe that with your issues in the valves and your family history 2 cardiologist refused to check you up and give you a diagnostic.

Also in your last week stress test, where they found out the 45% EF (which by the way it is not too bad) do they also indicate any figure regarding your heart size?

You saw your dr last week, you almost faint, he ordered the stress test... so what was his diagnose and treatment?????

He should have give you something to enhance your short of breath.

If 2 years ago you only had the tachys, you were given a beta-blocker (toprol) and I guest that it solved your tachys, then the only other thing to do, in my opinion is a yearly check up.

Now while you get more medical advise, you can stop salt intake as much as you can it will helps you.

Jesus
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Avatar_f_tn
He didn't tell me anything. The last time I spoke with him was 9/22/11 he was discharging me at the hospital.  The only thing he said I need a stress test in the 2 days. Followed with the words..."hold on a second...let me talk to the nurse" then there he goes. I didn't see him again. That's pretty much it every visit as well. I tried to get my records from his clinic (my only way of knowing what is going). They did not include the doctor's note. According to the hospital records, he admitted me for palpitation and near syncope. On discharge info.. he only said plan is to have a stress test in 2 days. I have looked at the echo results.. it says the dimensions are within normal limits and the EF was 67%. 3 days later, the cardiolite stress test showed 45%EF. Human or machine error? By the way, that's how my dad died. The ecg didn't show abnormalities eventhough he had all the symptoms. Therefore, the hospital didn't do anything. After an hour, he died. Then the blood test came.. it confirmed heart attack. But it was too late. They said they didn't think he was having a heart attack because he was so skinny. It makes me think if I am going to have the same fate.
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Avatar_f_tn
The toprol definitely helped my tachycardia in the last 2years. Infact, I have not seen my doctor since 11/2010. I was doing good until I felt the SOB and CP on exertion. Used to, I was only having SOB from time to time when i'm being awaken by it at night. But recently it had affected my work where my colleagues restricted me from going upstairs. Because they see how it affects me. My husband spoke to our doctor on his appointment and told him my symptoms and he wanted me checked that afternoon and he sent me straight to the hospital. That's about what happened. At this point I feel like if the problem will not get fix, my job is in jeopardy. Because my employers might think I am a burden. Every time I am short of breath they think I am having a heart attack. They are getting so scared. I just keep telling them I will be ok as long as I can sit and  rest for a few minutes. Recently, inspite of the toprol, my heart rises up to 167 beats per minute aside from the SOB and near syncope. It is not something I like to feel everyday. How do I tell or explain my doctor I want to get my life back to normal? Or is that ever possible?
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Avatar_m_tn
Definitely, you need a cardiologist to whom you can speak to and ask for a diagnostic and reasons of  your short of breath and adequate medication.

Of course the cause can be a different one, but heart has to be ruled out first.

Jesus

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Avatar_f_tn
Just for curiosity sake .. is it possible to have a low EF (45% to be exact) and not have a heart problem?  By the way, thank you so much for your responses! I have read the other peoples messages and you are one of the consistent responder. I greatly appreciate that!  God BLESS YOU!
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Avatar_m_tn
To my understanding, the normality range, at rest, it is 55-75%. So your first echo was O.K.

So a 45% indicates that there are some issue in the heart. Another problem is that, if I understand correctly, it has evaluated by echo, and this procedure has a recognized operator error of +-5% . That means that you could be anywhere between 42 and 48%.

Also the EF change continuously (in a margin).

What it is rare, but possible, is to have very low (10-15%EF) and be symptom free. I have 23% and now I have no mayor symptoms.

BTW, Could be the problem with your doctor just a misunderstanding? Perhaps he thought that the nurse will give you a further appointment?

I think you have nothing to lose if you call his office and ask for an appointment to see how you should proceed now that the dr has the result of your stress test.

Jesus.
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Avatar_m_tn
Just comes to my mind....

You say you are skinny and with heart problems, particularly tachys...

Have your thyroid gland been tested??

An excess of thyroxine could give those symptoms.

Jesus
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Avatar_f_tn
I think I am going to do that. I will contact his office and ask what is his next plan. I am very bad on verbal communication I do not exactly know what to ask him. But I am going to write my questions on a piece of paper and go from there. The 45% is the result of the cardiolite stress test.  They took the picture of the heart after the stress test and an hour later using a nuclear medicine scanner to see if there was a significant change on the rested heart and the stressed heart. The result showed 45% ejection fraction. I feel fine if I am doing everything slow ( which is so not me).  The salt thing... I am going to have a real hard time adjusting.  But whatever helps. You were also right about eating small amount instead of large meal. I thought it was just me but it's sure is giving me SOB when I eat too much. It feels like there is not enough space for me to breath if I do.  Everything starts to make sense. Especially me looking like 5 months pregnant most of the time eventhough I am not. It really is embarrassing! I hate to admit it but I guess if I want to be well, I need to help myself as well. I am so glad I got to meet you!  You are indeed a blessing!
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Avatar_f_tn
Yes it has been tested I even seen an endocrinologist to double check. He said everything came back normal. He also told me all my symptoms pertains to the heart and I should see a cardiologist.
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Avatar_m_tn
Be sure NOT to go alone to the appointment. If you are alone, chances are that you miss important parts of what he will say. We all are nervous and uneasy at the doctor.

Yes, write all your questions and use the paper while speaking to him.

Some ideas for the appointment ( I assume that it is with a cardiologist):

1) Make a complete list of ALL your symptoms, even if you think that are not related (eg: in your first post you did not mention that you look as a pregnant and this is important).

2) Make a complete list of all medicaments and complements that you are taking.

3) Take with you the older reports, ask if the condition of your heart is better or worst.

4) Ask if the present condition of your heart justify/explain all your symptoms

5) Ask what is the disease or diseases that you have.

6) Ask if he has a clear dx or if more tests are required.

7) Ask what medication you need to take. Ask and understand the role of each of the medicines that he recommends.

7A) Ask and understand what life style change you need to do (Sleep, stress, diet, salt, exercise, amount of daily fluids intake...)

8) Ask what it is the logical evolution of the disease. Ask how will you note if something goes wrong and when you should go ER.

9) Ask when to go back for next visit

10) In the case that he says that it is nor heart related, tell him that the endocrinologist already indicated that are heart related.

11) If he insisted that your heart it is OK then ask to what doctor you should go to get  your problem solved.

Then do not forget to come back and tell us how it went!!

Good luck

Jesus
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