Icd advice

[Gmanral]

Hi,
  I was recently diagnosed with cardiomyopathy with severe biventricular dysfunction three months ago. On cardiac mri, My EF was 30. Lvedd was 7.3 and lveds was 6.5.
Now after three months, with transthoracic echocardiogram  EF is still 25 -30. Lvidd 6.1 cm and lvids 4.96cm. All other measurements are in range. There is no scarring, fibrosis, blockage or stenosis.

My doc advices me to go for icd, I have no symptoms. I haven't started my exercise routine yet. I can walk 2-3 miles at 2mph without any breathlessness.

I am 36 yrs old male, Ten years back I was an athelete, into wrestling, swimming , short put and never had any serious illnesses. Now I am pretty much confined to my computer all day with no excercise.

Do u think there is a risk in waiting for the next three months and watching the EF , in case it goes up by aerobic excersise.


Please advise.
Regards,
GM.

[Jonathan D. Rich, MD]

Hello and welcome to the forum.

The case you present is a common one actually.  A few questions:

1. What are the doses of your medications (ie beta blocker, ACEI, etc) and for how long have you been on these medications?
2. If you pushed yourself even a bit more (ie more than walking 2mph) do you think you would have symptoms?

At the end of the day, if you are truly not having any symptoms and if you have not been on the key heart failure medications at optimal doses for at least 3 months (maybe even 6), then it would not be unreasonable to wait a little bit longer and re-assess your EF again.  However, if you have symptoms and/or you have been on the meds for a while, you probably should get the ICD sooner rather than later.

Regardless, you are having a favorable response to medications thus far and hopefully your heart function and your overall condition will continue to improve over time.

All the best,

Dr. Rich

[Jonathan D. Rich, MD]

Hello.

I wouldnt be worried about the BP or HR.  These are normal, especially if not having symptoms.

While we like to see the EF go up, sometimes this doesnt happen even when the heart gets stronger.  I would say that your heart has improved significantly with meds.  If you dont want to have an ICD placed yet, I would have an echo repeated in the next 2-3 months and then discuss with your doc whether you need one at that time.

Best,

Dr. Rich

[Gmanral]

Hello doc,Thanks doc, I have been on the below listed medication since last three months.
Medications:
lisinopril 10 mg tablet 1 tablet by mouth twice a day
carvedilol 25 mg tablet 1 tablet by mouth twice a day
aspirin 81mg one tablet by mouth daily
ergocalciferol (vitamin D2) 50,0000 iu one tablet by mouth weekly
spironolactone 25 mg tablet (Also Known As Aldactone) 1 tablet by mouth daily
magnesium once daily

  Today the Bp was 103/73 and heart rate 56 after I came from work . Is this anything to worry about? Could the heart rate get even lower while sleeping and be dangerous? I am on meds to reduce the high Bp and heart rate. The meds I am taking is 50mg carvedilol daily. Lisinopril, asprin.

Also one question I had was , if the lvidd reduced from 7.3 to 6.14 and lvids reduced from 6.5 to 4.96 in three months, aren't there chances that it will get better in next three months. And shouldn't be the EF be more than 30% now! considering with older measurements it was 26%. Even with the new measurements it shows 30, which is confusing.

Thanks so much  for your time and advice!
Regards,
GM.

[Gmanral]

Thanks doc, I have been on the below listed medication since last three months.
Medications:
lisinopril 10 mg tablet 1 tablet by mouth twice a day
carvedilol 25 mg tablet 1 tablet by mouth twice a day
aspirin 81mg one tablet by mouth daily
ergocalciferol (vitamin D2) 50,0000 iu one tablet by mouth weekly
spironolactone 25 mg tablet (Also Known As Aldactone) 1 tablet by mouth daily
magnesium once daily


For the exercise I haven't really pushed myself hard since I was diagnosed with cardiomyopathy. I can do a 10 mins walk at 2mph without any symptoms, my heart rate goes to 100 with this, now increasing it slowly and watching my heart rate.

Thanks again.