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From transplant to bypass....
My sister, age 53, had a heart attack in September, 07.  She was told there was extensive damage to her heart and that bypass would not help her.  Docs said her only option was a transplant and said she had 5 years at most to live.   She went to another doc 2 weeks ago and he looked at the same test results and advised triple bypass. He also said her heart is functioning @ 20% (whatever that really means) and that she could drop dead at any moment. He said there would be no warning, no pain, nothing, just dead.  So, my question is, what does all of this say to you?  Does she need to seek another opinion?  Please explain as much as you can. Thanks
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61536 tn?1340701763
The 20% is in reference to cardiac ejection fraction, the percentage of blood pumped out with each beat.  A normal heart ejects 50-70% of blood with each beat.  A damaged heart ejects less than 45%.  At 20%, your sister's heart function is very impaired.  While I don't know if she is a candidate for transplant based on that number (I think it's 15%) I think I might want a tie-breaker opinion.  A bypass may establish better blood flow which could lead to an inrease in her EF and take it above 20%.  That in conjunction with heart failure meds to treat the symptoms of her weakened heart muscle (from the heart attack, I am assuming) may be enough to sustain her health beyond the grim 5 years she was told.  It really depends on what the cause of the 20% EF is - if it is all damage due to the heart attack or if some of it is related to reduced blood flow due to her coronary artery disease - whether or not it will improve.  With two dramatically differing opinions from each doctor, it's hard to even guess which is accurate.  The bypass does seem logical, especially if they think it could improve her heart function.

I wish her the best.  I'm sorry she's going through so much.
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Transplant is not based on EF.  While the normal is 55-70%, 20 isn't  terrible, not good, but could be worse.  The statistics are sometimes outdated and some doctors are crepe hangers.  To determine if she needs a transplant, she would need an eval by a transplant center, which I would advise if I were her.  They do a test called a VO2 Max, which is a cardiopulmonary stress test, where you are hooked up with a breathing thing as well as cardiac monitors and BP cuff.  The transplant cutoff is usually 14, I believe.  Since she is well under 35%, she really needs an ICD, (defibrillator)  which has been proven to prolong life .  I think they recommend a certain time frame for that after an MI and it could be it's too soon.  At any rate, it sounds like she certainly could use another opinion.  She needs to be an ACE inhibitor and a beta blocker at the minimum.  I was at 15% and told I would need a transplant and they were wrong (so far anyway!).  It has been over 5 years now and I am hanging at 40% EF now.  It's waaay too soon to throw in the towel!
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My EF 4 years ago was  20%, now normal, over 55%
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maggie is right as usual.  I still have to do the VO2 stress test once a year.  I hate it.  Your mouth dries out and it makes it hard to breathe.  I keep telling them if they had a different mouthpiece I could walk that treadmill forever.  

Like maggie, I was told I needed a transplant by local cardios.  I was evaluated at a wonderful transplant center and sure enough, Coreg and Altace, ICD, diuretic and I am good to go.  EF in mid to high 30s now and feeling great.  I am doing pretty much anything I want physically.  Some rare days I have to watch it, but usually function on all burners.  Two years plus and no one has mentioned transplant again.  Yay us maggie!!!
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I had a major heart attack 4-1/2 years ago with emergency bypass x 5.  I ended up with lots of damage and like your sister was told I would need a transplant and without that I would be dead in 3-5 years.  Since that time I have had an ICD implanted, worked hard on the exercise and diet end, take lots of drugs and feel great.  My EF is up to 30 from a low of 10%.  I wasn't a good pick for a transplant anyway because of blood type issues.  4 of the bypasses don't do anything because 60% of my heart is dead and yet I still feel great.  According to their initial diagnosis I have 6 months to live.  I think they were wrong.

So much of what your sister is facing is really up to her.  Her attitude and motivation to work hard goes an awful long way toward how she feels and how long she lives.  You HAVE to be a fighter.  Most everyone that posts on this site is a fighter and won't give up under any circumstance.

Your sister needs to be aware of her condition and limitations but she shouldn't let them ruin her life.  I would suggest she finds a good cardiologist that she trusts, who is aggressive in the treatment plan that is pursued and that she works hard to stay fit and healthy.  Hard-YES, Doable-definitely.

Good Luck to you both.
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