Heart Failure recovery time

My mother (46 yo), was diagnosed with CHF in December 2010 with an EF of 10-15%. The doctors said they did not know what caused it so they initially diagnosed it as Idiopathic dilated cardiomyopathy. After about two months on beta blockers, ACE receptor inhibitors, and diuretics her HF symptoms ( irregular heart beat, orthopnea, frequent shortness of breath, edema) were gone and her EF went to 20%. After another 6 months, her EF went to 25%. At this point she started taking maximum doses of all her medicines ( she had to build up slowly, as she could not tolerate larger doses initially). After another 6 months ( a few weeks ago) she had another echo done and her EF was reported to be between 25%-30%. All the doctors we spoke are recommending a CRT device with defibrillator.

For the last 6-7 months she has not had any symptoms, she walks about one mile everyday and is able to do all housework without any problems. Since she is feeling comfortable, she wants to wait another 6 months to let her EF reach 35%.

She does not have any other medical problems.


I wanted to know if there is a chance that her EF will increase in the next 6 months, and if there are any risks of waiting longer to get a CRT implanted.

How long does it usually take, or is expected to take, for someone with similar stats to reach an EF of 35%.

Thank You,

[Jonathan D. Rich, MD]

Hello and welcome to the forum.

Your mother's story is an excellent example of the incredible benefits of heart failure medications.  Her heart and symptoms have clearly improved and that is terrific.  What I can not tell you for sure is whether or not her EF will continue to improve or not.  Some patients can actually regain almost normal function, some unfortunately dont respond at all, and others fall somewhere in between.  However, although the actual "EF number" is sometimes what a lot of people focus on, the fact that she is essentially asymptomatic is what is most critical.  People are able to live with an EF of 30-35% for many years.

As far as the CRT and ICD questions are concerned, the approach to each is a bit different.

Regarding the ICD, generally if a patient's EF (with the type of heart condition that you mom has) does not improve to at least 35% after about 6-9 months of excellent medical therapy, most recommend an ICD as an insurance policy against sudden cardiac death.  Delaying this further is obivously up to her and her doctor.

Regarding the CRT, the most important thing is to make sure that there is an indication for it.  Specifically, on her EKG, she should have what we call a "wide QRS" that is greater than 120 milliseconds in duration. Even more compelling is if she has what we call a "left bundle branch block".  If this is indeed the case, then I too would suggest a combination CRT/ICD placement as the benefits of cardiac resynchronization could further improve her EF and possibly prolong her life.

Hope this helps.

All the best,

Dr. Rich

[vik45]

Hi Doctor, thank you very much for your response. My mother does have a left bundle branch block, and we are seeing a electrophyscian soon to get a MUGA done to help us decide on what to do. Again I appreciate your help

Thanks

[Nattles9]

A related discussion, Prognosis of dilated cardiomyopathy was started.