DCM, ejection fraction, icd

[rrobpaul]

I'm 41,Although asymptomatic I have been I have dcm with an ef of 36. I went to get checked out about 16 months ago after my 52 year old brother died of a sudden heart attack(no autopsy). I had a normal exercise stress test but my ech showed a dcm with an ef of 36. I had a cardiac catherization in June of 04 which said i had an ef of 50 and clear ateries. I was told I was fine except for a slightly large heart which may be because of my being athletic and size 6-4 210pounds but to follow up with another echo on 7 months. the follow up echo in march 05 showed an ef of 36 lvid size of 60. I was given 10 mg of lisinopril for 3 months and the follow up echo in june 05 showed no change. The ep has recommended an icd because I my holter monitor reading showed multifocal pvc's which are all nonsustained. I dont notice the pvc's unless i put my had over my heart. I've known I had them for 20 years. My bp before medication was 130/80 known it is 110/70. ( I increased my dose of lisinopril through my internist in july). My resting pulse is between 65 and 70. My qustion will adding a beta blocker like coreg have any benefit to me. I really would like to avoid the icd but it sounds like my condition will not improve only decline even though physically I still feel fine. I should add that although we dont know what caused my brothers death. He was a heavy smoker, got no exercise, had sleep apnea and was 40 pounds overweight.

[Cleveland Clinic]

rrobpaul,

I have a hard time making recommendations from your case as there are some conflicting details.  Patients with nonischemic cardiomyopathy and an ejection fraction under 35% have been shown to benefit from ICD therapy.  

I am a little confused by the exact reproducibility of your ejection fraction at 36%. Usually an echo is not reported as an exact number.  PVCs in themselves shouldnt require ICD therapy. However, NSVT would be somewhat worrisome, but also in itself shouldnt require ICD therapy. Also, your family history of sudden death is also worrisome.  Beta blocker therapy is a must in patients with CHF and has impact on both symptoms and mortality.

You have a somewhat complex case and the details are a little confusing to sort out from your post. It might help to seek a second opinion if you stil have questions.

good luck

[EchoTech]

A second opinion might be helpful.  A ventricle that is 6.0 cm is considered mildly dilated.  The cath showing an EF of 50% is not normal either.  55% is considered normal.  I cannot help you with the choice of an ICD or not.  That is beyond my expertise as is whether the beta blocker will help you or not.

[rrobpaul]

the ef was estimated at 36 each time. The holter monitor before any meds were prescribed showed frequent multifocal pvc's all nonsustained. ( I only notice them when I put my had over my heart to listen) they dont seeem to be more than one at a time.

[Gui]

Hello, I am 6'2 205 exercise routinely, bike for 40 miles a week, don't drink, smoke or do drugs. I turn 40 in Feb and then in April I had a echo and heart cath that reveiled Non eschemic Cardiomyopathy, no clogged arteries, EF of 45% second echo in April show ef 30 to 38% been on Diovan, and was also place on coreg, my BP was already low, 127/66 cholesterols good, heart rate range 55 and when I sleep drops to 49. This was all prior to meds.

I am scheduled for another echo next week, but I am scared to see what they find.  Anyone have any idea what I could do, or what I can expect as the next stage of this process.

My family history is not the greatest either, my nephew just had a hole repaired in his heart at 17. My other nephew has a mumur. My mom indicated that we do have some cardiac history but really doesn't know what it is.

I am just looking for some kind of information that I can use.

thanks
Gui

[rrobpaul]

hi gui,
you can e-mail me if you want. It sounds like your situation is similiar to mine. ***@****