Fatigue, Shortness of Breath AGAIN !!!

[Konopka1955]

Hi Doctor, History:MI,ICD-VT-Monomophric- St. Jude Mitral Valve Replacement last May due to Rheumatic Fever. Post surgery intermittent full heart block but EP programmed my pacemaker to DDD program-still not getting my energy level back so then I got the DDDR program and I breathed better when I got that. But I still get bouts of fatigue and shortness of breath. EP prescibed a different beta blocker(coreg)in hopes it will raise my EF rate which is now 35%. I can't exercise well at all. EP said I am programmed optimally but suggested "av association" echo test. I get to many beats going downstairs + to few beats going upstairs. The FDA is requesting Guidant do a recall on my ICD -(ventak prism 2) My EP said I do have the recall model. But surgery is risky.

CRT echo showed EF 35% and Moderately (2+/4+) tricuspid regurgitation? Would I have more energy if EF was higher?Why didn't my enlarged ventricle decrease + my EF rate go up after mitral surgery? EP diagnosed congested cardiomyopathy-He said I don't need a CRT-D device? My left + right ventricles are IN sync. I just need my ICD. Is it common for the tricuspid to leak after they replace the mitral? It didn't show up before my surgery? Should I ask for a TEE test? Will I need OHS for my leaky tricuspid valve like my mitral? Is minimally invasive surgery done on tricuspid valves? Is the degree of regurgitation and symptoms the factor in determining timing of surgery? Can meds alone take care of the leak and low EF rate? I'm alittle disappointed that things are not going better since my surgery.
Thanks
Marilyn (runner)

[CCF-M.D.-MJM]

Hi Marilyn,

Sorry you aren't feeling well again.

Would I have more energy if EF was higher?

EF is a subjective measure of heart function and cardiac output.  We all meet patients that do better with EF's of 10% than patients with EF's of 40%, although this is not the rule.  What I am saying is don't focus on the number.  We read an EF as X +/- 5%.  Your EF is likely somewhere between 30 and 40.

Why didn't my enlarged ventricle decrease + my EF rate go up after mitral surgery? EP

I am not sure why your LV didn't get smaller, but it is common for EF to decrease after MV surgery.  With leaky mitral valves your LV sees I hear volume of blood with each beat -- this stretch can cause the dilation and makes the heart work hard.  Following the surgery there is less preload (blood in the LV before each beat), giving the appearance the EF has actually decreased.

Is it common for the tricuspid to leak after they replace the mitral?

It is not common for TR to increase after MV surgery.  A TEE is not that helpful here.  You see the tricuspid valve pretty well on Transthoracic echo, besides, surgery is almost never done to repair a tricuspid valve unless it is extremely severe and causing significant symptoms of fluid overload.

I doubt they would do a minimally invasive surgery as a reop to repair a tricuspid.

Meds and time can improve heart function, but it is also possible that it may not improve.  Not everyone responds as well as we hope.  I hope you feel better soon.

Good luck and keep the faith.

[tickertock]

Best wishes Marilyn sorry to know you are not feeling well, as the good doctor said , keep the FAITH.

[Konopka1955]

Thank You ThCCF-M.D.-MJM - for you kind words.  :-)  I really appreciate your honesty and your vast knowledge of information.  The good news is that in all probability I will NOT be looking at surgery in the foreseeable future.  :-)  I guess my best 'bet' is to try to find the right medication combination and then to focus on what I can DO and not on what I can't DO..  and I'm glad I don't have to pay any attention to that stupid EF rate anymore.  Thanks Doc.. :-)

Thank You Tickertock for your best wishes..  :-) That was sweet of you to say.  I have FAITH and fortunately for me I have a very supportive family to help me along...  

[marching on]

Hi Marilyn,
Sorry you are not feeling as better as you hoped. You're in my thoughts.  Thanks for asking the ? about the EF.  I always wondered about that, and now I know.

I have taken Coreg and it has helped me.  Did it work for you or are ou still in that trial phase?

Thank God you have "faith" and "family".  What a great combination.  
I appreciate your perseverance.

Thanks,
marching on

[chrisr]

You mentioned in your last post that Coreg did help with your EF%. I am very interested in this medicine since I have not had good results with other BBs and was just 2 weeks ago prescribed Coreg after a stent implant and a stress test showing an EF of 42% when it was always 55-60 in previous Echos. Did you have poor results with other BBs before going on Coreg and if so what were they like? I had severe bouts of PVCs. I have been prescribed a starting dosage of 3.125mg. Is this a good initial dose and what if any side effects I should expect? I also have annoying pounding heart beats which I hear very clearly. So I am a bit skeptical but willing to try it out. Hope you don't mind my rambling along but I am never lucky to get a post through and hence my questions. Any advice here or via email would be highly appreciated.
Thanks,
ChrisR.

[marching on]

Hi,
Yes, I did have difficulty with other BB's.  I tried atenelol, Toprol, Inderal (the worse) and a couple calcium channel blockers.  The Coreg 3.125 was a good fit. My EF went up 10-15%, but it took a little while.  Hope it helps you. I will say though I have not had a stent procedure, so I don't know if the ramifications are different. Hope this helps.
thanks,
marching on

[TL]

I thought that the ef was decreased after MV surgery because the number measured before the surgery was artificially high due to the left ventrical pumping blood back into the atrium instead to the rest of the body. Pumping into the atrium is relatively easy compared to pumping into the body.  The ef after surgery however is correct.

Is this correct?

[Emmaj]

Hi Marilyn,

I'm so sorry to read you are having these problems now. Keep your upbeat attitude and enjoy the good life -- even if it doesn't involve marathon running. Walking is way cool too! :) Especially in this heat! Take good care! E.