% of those with morbid obesity and dilated cardiomyopathy

  I am a 33 year old white male. Prior to August of 1998 I weighed 500lbs, frequently consumed four to five drinks daily, and averaged five to six cigarettes per day. In August I experienced an episode of atrial fib that required electrocardioversion. Prior to the procedure, a TEE was completed. The TEE indicated that I had dilated cardiomyopathy (all four chambers) with an EF of 45%. At that time it was extremely difficult for me to walk distances of two or three blocks or climb more than one flight of stairs at a time without becoming short of breath. Since that time I have lost over 100 lbs, and continue to lose weight, I exercise daily, no longer drink nor smoke, and have seen my stamina for walking increase dramatically. I am no longer limited by shortness of breath when walking, but am limited by leg, back, and mild sternum pain and strain (after walking considerably longer distances or standing for extended lengths of time). My questions are:
  1. Could the pain that I experience in my sternum be caused by obesity? It is relieved immediately once I sit. My electrocardilogist does not believe that the pain is cardiac related.
  2. How prevalent is atrial fib and dilated cardiomyopathy in someone my age and size?
  3. How likely is my increased tolerance for walking as a result of an improved EF?
  4. Is Coumadin the only anticoagulant available to people who are predisposed to atrial fib?
  5. Is atrial fib a precursor to more serious heart rhythm disturbances?
  6. How will continued weight loss impact my heart size and cardiac electrophysiology.
  Thank you for your time.

[CCF CARDIO MD APS]

_
Dear Scott,
First, CONGRATULATIONS ON THE LIFE CHANGES!!!!!!!!!!!!!!!!!!!!!!!!
You have made serious steps toward improving your health, giving up alcohol and smoking as well as losing weight (by diet and exercise) are the best things you could have done for your heart.
1.I can not say for sure, but yes more than likely your sternal pain is related to the excessive pressure from all that extra weight and not related to the heart getting enough oxygen.  Without a stress test and a full cardiac evaluation, it really is impossible to answer this question.  Ask you cardiologist at what weight he would be able to have you do a stess test, also have your cholesterol checked (coronary artery disease is brought on more prematurely in those with elevated cholesterol.)
2.A.Fib is quite common in those with dilated upper chambers of the heart.  It is uncommon in young individuals who have no cardiac structural abnormalities.
Dilated cardiomyopathy is not "common" with any condition per se, but it is in no way unusual to have such a diagnosis in a person so overweight (the extra pounds create serious strain on the heart and lungs.)  Keep in mind Scott that the cardiomyopathy could also be a result of your alcohol intake.
3.The increased tolerance  for walking is likely due to the combination of your having lost weight, stopped smoking, and the improved EF.
4. Coumadin is the only proven anticoagulant (taken orally) that reduces the incidence of stroke in patients with a.fib.
5. A.fib if not treated aggressively can lead to chronic a.fib, however it is not a "precursor" to other arrhythmias.
6. Continued weight loss and cessation of alcohol and cigarrettes will only continue to improve your overall health as well as your cardiac health.
I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.