Ejection Fraction

[steve]

I am 39 y/o and had a routine exam for indigestion.To make a long story short, My Dr. felt I should have a work up with a cardiologist because of early family history of heart disease.Several tests were performed to include a MUGA and Thalium stress test. The tests were normal,however, my EF was 45% on both tests. The cardiologist doesn't feel this number is alarming since I am Asymptamatic. I have been on a beta-blocker(Corgard, 60mg) for the past 15 years for my blood pressuure. The Dr feels my low EF is attributed to the beta blocker( I thought a beta blocker helps raise your EF). He switched me to Altace(10 mg) and Maxcide hoping the combination will increase my EF. I am scheduled for an Echo in 2 weeks to see if the meds raise my EF. My questions are: 1)If the new meds dont raise the EF, is it possible to go back to the beta blocker; it keeps my BP under control and gives me a sense of "calmness"? 2) If I maintain the 45% EF,can I expect to live a long healthy life or will the low EF eventually do damage or get worse? 3) Is it possible I was born with a low EF and if so, will the long term affect shorten my life even though I have been on meds? 4) What is a better med for a "Mild" EF, beta blockers or Ace inhibitors? Sorry about all the questions, but my Dr doesn't seem overly concerned with this condition and avoids my questions.Unfortunately, being in the military doesn't entitle me to a second opinion if there is only one Cardiologist(Specialist) assigned.

[Penny To All Above]

My EF is also high at 80%.  My Cardiologist seemed quite happy with it though, I can't find anything anywhere about high EFs, it you find anything please post
thanks

[Linda Underwood]

When I was diagnosed with cardiomyopathy six years ago, my ejection fraction was 17.  I just had an echogram and it's now 35. A great improvement, I think

[Nita McVeigh]

My husband of who is 32 years old, has Idopathic subaortic cardiomyopathy.  Last year he underwent Septal Myomectomy which did not help him in anyway.  We recently had a Heart Cath done and his ejection fraction was 91%!!!!  I know that 60-65% is good, but both of his cardiologist have told me that his ejection fraction this high is not good.  Can you please tell me why in medical terms that I can explain for his Disability Hearing.

Thank you very much for your time and your help.

Nita McVeigh

[CCF CARDIO MD - DLB]

If your EF is abnormal, I would stick with an ACE inhibitor. If it does not control your blood pressure adequately, you could also be on a beta blocker. The EF of 45% if it stays as such will not shorten your lifespan. It is unclear what the cause is in your case, maybe just the years of high blood pressure. The EF is unlikely to worsen.

[Bill Serrahn]

Hi Lin,

These are the symtoms which I experienced.  

After bending down and lifting a box of camping equipment, I experienced a bout of extreme dizziness.  

I had to sit down for fear of falling down and felt that I would pass out at any moment.  I was overcome by nausea and began to vomit.  My pulse dropped into the low 40's.  Within a few minutes I had an overwhelming need to defecate.

Because I had never experienced this before and had a prior heart attack, It felt like I was going to die at any moment.  It's a real scary experience when you don't know what it is.

When I explained the symptoms to my cardiologist he told me that this sounded like almost textbook vaso-vagal reponse.

I had a couple of other experiences as bad as the one that I described and some lesser ones, but never completely passed out as some people do.

Usually there were a combination of triggers.  I got it a couple of times by just sitting down in the car - this must trigger the vagas nerve.  Lifting also did it for me.  Once I just opened the car window when it was 100 degrees outside and It triggered a severe episode.  During most of these episodes I had worked up a level of stress prior to it, by some interaction with people.

In my case, these started after I finally tapered off of Atenolol after 9 months of usage.  I confirmed that last July, when I began using a small dose of Atenolol again to help me spend a week hiking at 10,000'.  The day after discontinuing it I had a severe episode and haven't had one since.  Ironically beta blockers are prescribed for this condition.  My layman's theory is that 9 months of use of a beta blocker deconditioned my autonomic system, which I have since learned has a very delicate balance.

Here is one URL on the subject:

http://www.geocities.com:0080/HotSprings/Resort/4554/nmh.html

You can find more on a search.

[Robin]

I read your post with interest. I am 36 y/o with an ef of 46%, mildly dialated left ventrical altough it has enlarged another 10mm in the past 6 months. The dialation when mild was in the upper normal limits and now all my numbers are several mm over normal, my dr didnt say if it was still mild. My EF hasnt changed. I am considered to have mild idiopathic cardiomyopathy. I also suffer with arrythmias and am undergoing an EP study. I would recommend doing some research of your own. Getting copies of all your test results would be a great place to start. You seem to be a healthy person and i for one cannot see why your EF would be mildly low. 45% is not normal for your age and you need to go a little further. Ask about your heart measurments. If they are also even mildy dilated more attention should be paid to this matter. Your meds will depend on your symptoms or the results of your tests. Everyone is different. I know of people with EF's as low as 20% and feel fine and others, like me in the 40's and seem to lack energy. What i am really trying to say is that you may be very lucky to catch something really important so early. Be sure you have follow ups and proper meds. Always remember that you are in control of your own health. Keep informed and good luck to you.

[Cuore]

Hi Bill, can you please explain what vaso-vagal response is?
Thanks, Lin

[Terry]

Lack of symptoms do not mean that there is no problem.  I had severe mitral valve regurgitation which I recently had repaired.  My EF was also 45% with no symptoms although I had a major problem which needed to be fixed.  I would get a second opinion even if you have to go outside your insurance coverage.

[Bill S]

It sounds to me that your cardiologist is very good.  I don't think that beta blockers are a good first choice to control blood pressure and are probably the cause of your low E.F.

Although effective BP meds vary with the individual, Altace is a good choice to control BP and also has beneficial effects on the health of the myocardium and endothelial cells.

Your E.F. number will probably improve after you get off the beta blocker for a couple of months.  I had a rough time getting off Atenolol because my autonomic system had become desensitized by it and I suffered some vaso-vagal response episodes within the first month after discontinuing it.  I doubt that I would ever go on one again, unless I had severe arrythmia.
    

[My experience]

I believe an EF of 60-65 is "normal."  40-55 is mildly impaired, 25-39 is moderately impaired, and below 25 is severely impaired.

[TSM]

I thought an EF of 45% was pretty darn good! I think < 40% is getting on the lower end of normal. I'm interested to see the drs response.