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ejection factor and life expectancy
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ejection factor and life expectancy

My hushand has been a diabetic for approximately 30 years. Recently he has suffered 3 bouts of congestive heart failure in one year. His ejection factor is 28%. What is his life expectancy? He is on many medications and uses oxygen daily. In the days 2 units and at nights he is 3- 4 units.

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Avatar_f_tn
Hi,
      Ejection fraction is the amount of blood ejected from the left ventricle into the systemic circulation per beat. Normal values are in between 55-70%. A low ejection fraction does not by itself mean reduced life expectancy. Other measurements may show increased risk for death - a high QRS interval, high CgA level, low heart rate variability, T-Wave Alternans, very low Vo2max, etc. Medication therapy, low-sodium diet, well-planned exercise, and other life style changes such as stopping smoking, stopping drinking and losing excess weight can help improve ejection fraction. Hope this helps. Best.

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367994_tn?1304957193
The underlying cause for the low EF could provide more information regarding prognosis.  About 6 years ago I was hospitalized with CHF with an EF 13-29%.  I had a dilated left ventricle that caused the systolic impairment.  

Treatment to reduce the heart's workload enabled the heart to reverse remodeling, and today my heart is normal size and EF is 59%.  What happens with CHF is the heart does not have the strength to pump into circulation the amount of oxygenated blood received from the lungs.  This causes blood to back up in lungs and fluids leak into the tissues.  

An EF of 28% should be adequate to pump sufficient blood into circulation if the demand for oxygenated blood is reduced.  Heart failure range is below 30%, but there are estimates of about 25% individuals of the heart disorder population perform their daily activities without knowlege of a medical condition and not being treated.  I did not know I had a heart problem until I had CHF symptoms.

Thanks for sharing, and I wish you and your husband well.  I know you are under much stress, take care.
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Avatar_n_tn
Thank you for taking the time to respond. My husband's EF is due to the fact that his heart muscles are weak due to the fact that he has been a diabetic for a long time(my evaluation) His entire body seems to be breaking down despite the many interventions of Medical Doctors,Naturopath, Chiropractor, massure, natural remedies . I am afraid of the outcome.
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1293682_tn?1311959671
hi there,
I have one question for ya. You already know that my EF was 27% so its technically in the heart failure range.  Now, is CHF just more of an acute problem when the fluids build up?  I read that here in the info on it, and wondered if that was the case.  I now am on a potassium sparing diuretic and my doc did say it was the best one to help with CHF.  So, do I technically have CHF with my DCM or are those terms interchageable at this stage?  Or is CHF more of an acute thing when the fluids build up to dangerous levels? I did read to not exercise when the fluid is there... and that makes sense, since when I do exercise, I already get some fluid gain... that has always been the case and RA can cause that to happen anyway.  So, I will avoid that.  But, I always have the fluid in the morning and then the diuretic seems to help thu the day.  But, I think I need to call to get my dosage raised... since some days it just doesnt help.  THose are the days I have more DCM symtoms (symptoms) too... and feel awful.

Anyway, I knew you could answer this...

thanks, take care and hope you are feeling good today!
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367994_tn?1304957193
Good questions.  Technically, one is in heart failure mode with an EF below 30% as knowledged by SSA and some insurance policies, etc.  The condition of heart failure can be chronic without symptoms (no angina, fatigue, shortness of breath etc.), and with a triggering event can go into congested heart failure...the prevailing symptoms would be pulmonary congestion with a dry cough, shortness of breath, etc.  That's my experience.

MedicineNet: "Many people with DCM have no symptoms or only minor symptoms, and live a normal life. Other people develop symptoms, which may progress and worsen as heart function worsens."

Yes, technically you have CHF with your DCM when you have pulmonary edema (congestion).
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1360950_tn?1277660203
Hi, I was dx with heart failure due to cardiomyopathy 10 yrs ago, (age 48).  My doctor put me on Coreg,(was a new med at that time) and it saved my life.  Coreg also lowers the heart rate and helps the heart to pump more blood with each beat, basically it helps the heart from wearing out so quickly.  It took a few years but now my ejection factor is up to 55.  The only issue I have now is the top left part of my heart remains slightly enlarged and my valve is leaking.  
I wish you and your husbad the best and don't give up hope, sometimes it just takes awhile.
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1293682_tn?1311959671
yeah! Another success story!  I am on 40mg of Coreg (and Lisinopril) so I hope it works for me too!

to Kenkeith, thank you for the reply.  I do have shortness of breath a lot and a dry cough. I noticed some water gain for a few days that didnt want to go even via the diuretic.  I thought I just put on a few lbs.  Then, Friday, I had a bad episode all day from my heart... shortness of breath and chest pains.  I had to sleep most of the day.  When I slept for a few hours after taking my diuretic, those few lbs were gone!  So, I know that it was really water.  Those days preceded that episode.  Its hard to see what is really going on since RA can also cause water retention during swelling of joints.  Ugh!  Anyway, I almost went to the ER but was better the next few days.  I probably should call my nurse and tell them about that event.  I was bad when laying down and sleeping... couldnt get my breath.  I just dont know how to tell if you have fluid around the lungs when I have the dry cough a lot of days and shortness of breath.  Is there another way to tell or do we just have to go to the ER?  I hesitate to go sometimes since I have to pay a LOT for one visit there.  Of course, I want to save my life too... but I am just not sure how to tell when to go.  If I ever call my doc (nurse rather) and tell them I am in bad shape, they just say, go to the ER if you are that bad, even during business hours. Then the ER has told me on two visits to just go to my doc the next day!  Doc office says, go to the ER, the ER says, go to the doc!  razzafrazza!! (my diuretic might need to be upped on the dosage too... have to call today and ask)

Anyway, if you have any info on what else to look for, let me know.  In the meantime, I hope I am getting better!  I worry since I have so many symtoms (symptoms) without exertion like it has been from the beginning... but of course, I have positive outlook and hope! :)

how are you doing Kenkeith?
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Avatar_f_tn
I have an EF of 15%, with stage 4 heart failure, stage 5 renal failure, and CHF pops up ususally when I get a little complacent about my diet.

Salt is my Frankenstein, and seems to be at the bottom of all evil with reocurrence of CHF when it's least expected.

I've been to the ER twice in the last 6 months for CHF and I think I can safely say that if you need to see a doctor in the ER you will know it.  You will not be able to take a good breath, nor feel any benefit from trying to breath.  It is then that you'll need to get to the ER and have a breathing treatment, which will reopen your lungs and dry them out.  Don't try to drive yourself, and if you have no one to take you, then call an ambulance.


One thing I have learned over the last 3 1/2+ years is, when I start having troulbe, or start feeling the symptoms of CHF, I stop, take inventory of exactly what is going on. Then if I find that breathing isn't do me much good, I head for the ER, otherwise I take an extra lasix and a wait and see attitude.  Sometimes the extra lasix is all I need to pull the excess fluid out of my body, other times I just can't get a good breath, and the latter is a red flag for treatment in the ER.

So, stop, take inventory, and then react.

I hope this helps.....
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367994_tn?1304957193
Hi Athena, I feel fine, thank you for asking, and good to hear from you.  Sorry to hear there are so many variations of  symptoms for you.

Coreg blocks adrenaline and that should keep your heart rate low, but do you have a fast heart rate with your shortness of breath?  What is your heart rate at rest?

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1293682_tn?1311959671
hi there,
My HR at rest is usually around 80 or 90.  I used to take Nadolol for a mild form of tachycardia for years since it would get high at rest.  It would get the HR down further than the current meds, but of course they are super important in my new situation.  My HR with the shortness of breath?  I need to check it more during those times, but it can be around 90.  Its just that feeling of not getting any oxygen.  That day I was really bad a few weeks ago, even laying down and sleeping I felt so short of breath.  I think I should have probably gone to the ER that day.  I sure felt like I should have.  Luckily, it did get better.  
Now, I seem to have problems getting rid of edema, when I didnt at all a month ago or so.  I wonder if you can get into a rebound effect from the diurretics?  I just switched to Lasix from the other one.  They both seem to get rid of water for a few hours and then it comes right back.

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1293682_tn?1311959671
"Other measurements may show increased risk for death - a high QRS interval, high CgA level, low heart rate variability, T-Wave Alternans, very low Vo2max, etc"

how do I get these results? Are they found on reports from the tests I get done?  Stress Test, Echo and MUGA?  I need to ask for a copy of my file.

My doc didnt even tell me my EF till my Rheumatologist asked me what it was... and then they only sent it to her.  I had to get it from her.  I think if I would have asked my CD the next visit, he would have told me, but I think he should have let me know when he gave me the diagnosis.
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1293682_tn?1311959671
hi,
I take it that the meds did not help in your case then?  Did you take the usual ones?  I feel like I am getting worse sometimes.  I am due to find out in a month.  Did you have to get an ICD?

I had no idea a hospital could do that kind of lung treatment, thanks for the info.  I was bad enough that day to go.  What bugs me is that the ER's in this city are notorious for being horrible.  I went in for super high blood pressure and HR a month or two before showing signs of DCM and they did NOTHING helpful. I even had to go back two days later since I was the same, and they still just gave me meds and watched as the BP monotor beeped and beeped when too high.  I paid them almost a thousand dollars for those two visits... and no heart tests done but for an ECG and my rhythms are always normal.  Ugh!
Then, on an unrelated event, I went to another ER for angiodema not too long ago, swelling in the face from some reaction.  They did even less... giving me prednisone and benydril which I had at home! I could have done that.  I was more swollen when they told me to go home than when I went in.  They got over 400 dollars from my insurance for that.  

Sooo... I am leary of the ER actually doing what they should.  At least I know what to ask for.  It also frustrating since they never call one's docs or specialists when you are in there, unless its a long stay.

Rambling on there... anyway, I do have a thing with salt too.  I have been watching it more closely than I already was.  My prob. is that I love hot salsa and peppers in jars and those have so much salt, so I have to limit them and count the salt.  Salsa has a lot too but  I found one that was low enough, but of course its not as good.

I hope you are ok.  Is there any hope that you will get better at all?  My heart goes out to you, no pun intended.  Take care.
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Avatar_f_tn
I honestly don't know if there is any hope for me or not.  My doctor doesn't talk about dying because it has a negative effect on me.

With the renal failure, I could live for several more years, provided I do well on the dialysis and follow my diet.  However, the EF of 15% isn't very promising.  I am scheduled for an implant consultation next week, but who knows what good it will do.

The Coreg didn't work for me like it was suppose to, but I'm still alive, and that's a positive.  I now take Enapril, diltiaziem, lasix, and coreg, and at times my BP is around 80/40, which leaves me feeling dizzy and weak.  I feel my best at 120/70, but my BP is allover the board most of time.


Yes, the salsa probably isn't helping you at all, but I know how hard it is to give up something you love.  I've been changing my lifesyle a little at time for over 3 1/2 years, and now I'm getting flak from my dietician because she thinks I'm too thin.  She is pushing meat with no salt, and expecting me to eat a ton of it.  I might as well be eating cardboard.  I would rather have fruit, veggies, and sweets, of course, but renal failure takes it toll on muscle mass, and the only way to combat it is to eat lots of protein.  I don't eat eggs for reasons I won't go into, but all that leaves is meat, since cheese is too high sodium.

I would love to bite into a huge piece of sausage pizza right now. :)
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1293682_tn?1311959671
hi,
I am sorry, I hope I didnt ask that with insensitivity.  I didnt mean to. I hope I didnt have any negative effect on you either.  It can freak me out to have EF of 27% and the other diseases I have, but I shouldnt complain so much.

Yeah, I hear ya about the protein.  I eat more veggies and fruit than meat and would feel the same way.  

mmmm... pizza.  I indulged in some the other day... I only add tomatoes to mine, but still the sodium there.  I didnt even know that things like milk have so much sodium!  I never would have thought to look at that.  Everything has so much of it!

Hope your consult goes well. Let us know how it goes.

Take care.
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1293682_tn?1311959671
wow, I went to the nearby mountain for an afternoon the other day and elevation is around 8000 ft for the area we went to... just to have picnic and be with the trees... but whoa!  I had the hardest time breathing.  I expected the elevation to make it a bit harder, but it really hit home how bad I was doing.  That was a bummer but I still managed to enjoy it.  My RA was acting up too so it was hard to move.  Geez- all at once.  

I really hope my meds are working but worry when I have so many short of breath days even at home at rest.  I will keep a positive attitude tho!

Cheers everyone, hope you are doing well.
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Avatar_m_tn
What kind of steps , measures ie, .. treatment did you employ to reverse your loe EF.

Thanks  R.C.D.
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Avatar_m_tn
I am 73 yrs old and have EF of 22% for 10 years. I am relatively asymptomatic (no apparent external symptoms). I have an implanted CRD device for 8 years and my meds are coreg, quinnipril, inspra, and lipitor. My BP is 110/70 with pulse between 62-68.
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Avatar_f_tn
Just learned from pulmonologist that anything that ends in "pril" can cause a chronic cough. My mother, age 83, who is being treated for CHF was placed on Lisonpril and was coughing to the point where sleep was interrupted. Pulmo had us contact cardio, who stopped medication, and the cough is gone! There are other medicines that do the same thing as Lisinopril and do not have cough as side effect.
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Avatar_n_tn
that is one of the few encouraging words I have heard. I had a heart attack 6 weeks ago and after many tests they did confirm it was a heart attack. My blood pressure was normal, my blood oxygen 97 at time I was admitted and no blocked arteries.  But did have damage to left ventricle with 20% ejection fraction.  Is that determined by the ECG or blood test?
I quite smoking and drinking 20 years ago and am losing weight but not heavy anyway.  I am hoping that I can get the EF up higher n next few months so I dont have to have a defib put into my body.
Whats your feeling about internal defibs?
Irene
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159619_tn?1318997813
EF% is best calculated with an echo.
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