Low Ejection Fraction and leak in mitral valve

I am a 47 years old male and here is my heart condition.  I had a heart attack in 2001 and two bare metal stents were placed at that time.  One in the circumflex and one in the right artery. The stress echo in May 2006 was OK. But in september 2008, both the stents were found to be fully blocked by CAT lab procedure and could not be opened or fixed at that time. Both the locations have developed some minor colateral blood supply.  The block could have happened earlier but did not give any symptoms.   By october 2009, I had a nother major cardiac event. This time, the left main artery has blocked and I had a total cardiac arrest.  This time I was revived by CPR in the hospital emergency room and was put on a breathing machine and a stent was placed in the left main artery.  I am now back home and going through cardiac rehab.  But my left vendricle ejection fraction in October 2009 after the cardiac arrest event was about 20% and my follow-up echo in 5 weeks (done in November 2009) also showed the ejection fraction as only about 20% (no post procedure improvement).  Also there is moderate to severe leak in the mitral valve.  I used to smoke about 15 cigarettes a day till October 2009 but now I have fully quit smoking.  I am taking my medicines and exercising regularly (about 45 minutes aerobic every day).  Any suggestions and input to make my prognosis better will be greatly appreciated.

[Dr J Singh]

Hi,
It’s great to know that you have quit smoking and are doing aerobic exercises regularly. If you drink alcohol, I’ll suggest to cut down upon that also and if possible to quit the same as alcohol also suppresses the ejection fraction. The best way is to ensure your blood pressure & lipids are under control. You are taking the medications like ace inhibitors & digoxin both of which are known to improve the functioning of the heart in CHF. Please also ensure you are not taking excessive salt & water as that also tends to put load on the weakened heart. I sincerely hope that helps. Take care.

[jak2009]

Thank you for your suggestions.  I do not drink alcohol.  Can and will the ejection fraction improve over time with medicine and exercise?  Can I still have any open or by-pass surgery with low (20%) ejection fraction?  would such procedure improve my ejection fraction?  Would a procedure such as E-valve (clipping of the mitral valve through catheter) be of any benefit in my situation (moderate to severe mitral regurgitation and low EF)?  Would fixing the mitral valve improve ejection fraction?  Thank you and sorry for the many questions.

[ujjainih]

My father, 62 Indian, had exactly similar conditions (low EF, Severe MR Lekage), he already had a CABG and doctors were against another open heart for valve repairing within one year. Luckily we found Essen Heart Research Center in Germany and they performed a non invasive MR clipping together with the doctors from USA, to significantly reduce the MR. It has helped my father but in post intervention stage his EF has not increased significantly, only slightly it is increased. He however, is almost asymptomatic now. Though he has an enlarged heart but he at least has a good quality of life and able to do normal work.
Therefore there are ways to avoid surgery when you have a low EF
Hope this info helps
ujjainih

[Rene88]

I am a 39 year old female with 4 children and a very busy lifestyle.  I was having shortness of breath more often than usual and also feeling
fatigue just going up my steps.  I saw my family Dr. and complained also with my hands and feet feeling cold all the time, and palpitations at least 20-30 time a day, and they blamed it on my hormones.  After 2 years of these symptoms I took it upon myself to make an app. with a cardiologist.  Had an ultrasound or Echo and she thought I needed to come back in for a Nuclear test which showed my EF at 47% with the diagnois of a weak heart.  Does this mean I have suffered from a heart attack before? Will my EF % go up at all with the medications?  My cardiologist put me on Coreg and Lopresor.  I am very scared.  Can excercise improve my EF?  Could the meds slow my heart too much?