Heart Failure + Ejection Fraction

I have heart failure, the original diagnosis was cardiomyopathy. My ejection fraction has improved from 14% to < 30% with meds alone however I can't really say that I feel any better overall (still get out of breath on only minor exertion). My doc said that by controlling certain parameters of the disease through meds that lower B/P, relax blood vessles and allow the heart to work against less resistance that ejection fractions often improve while the patient doesn't always feel that much better.
      My question goes out to all the others out there with heart failure, how common is this, has your ejection fraction improved but you still feel as crappy as ever or is it just me?

[FAnn]

I'm a 61 year old female who just found out my ejection was between 25 and 30%. I have recently started taking lisinipril 10mg to strengthen my heart but I also have irregular beats - some slow and some fast (mostly fast to 112 at times).  The young cardiologist I saw said I should be on a beta blocker as well but my slowest heart rate is about 45 at times.  At that first visit when he told me I had a weak heart he said the medicine should help my heart pump better and strengthen it.  My second visit a month later - showed my blood pressure within reason but still had the fast heart beat.  He seemed lost as to how to get that beat down without creating a problem when I get the slower beats.  I don't have much faith in him.  He has no bedside manner,brisk, to the point and seemingly very "cold" and the last thing he told me was I was in danger of a cardiac arrest.  He wanted to do a catheter test on me and mentioned it twice.  I told him I wanted to wait to see if the blood pressure medicine helped first.  He gave me the impression he was just looking for more money.    I am going to another doctor next week and taking my records with me.    

To answer your question, thank God, I feel good.  no swelling, no tiredness, no chest pains, -I do get a little out of breath climbing 13 to 14 stairs in my hourse.  I just have a lot of anxiety from that cardiologist who intimated that I was an accident waiting to happen.  I have been told by pharmacists  that the blood pressure medicine should improve my heart.  I hope so.   I plan on taking another echo in about 5 months.  Do you think it will show improvement by then?   Any comments out there would be appreciated as well.

[FAnn]

Forgot to ask you how long it took your blood pressure meds to work before it raised your ejection to 30.  Thanks

[kenkeith]

I was in congested heart failure mode more than 4 years ago...EF was 13% to 29% with dilated left ventricle  Dilated cardiomyopathy (DCM) manifests hemodynamically as decreased cardiac output and increased pulmonary venous pressure (pulmonary edema). The pathophysiologic mechanisms associated with CHF may be considered secondary to a dilated physiology or to a restrictive physiology.

You didn't state the nature of your cardiomyopathy, but all cardiopathology conditions impairs contractility and fails to supply blood/oxygen to meet system's demand, however, dilated cardiomyopathy can be reversed (reverse remodeling).

The left ventricle often pathologically enlarges due to overwork, stresses and strains of pumping against high resistence such as occluded, narrow vessels, pressure from valve stenosis, mitral valve regurgitation, etc.  The heart dilates and this is early compensation for systolic dysfunction and decreased cardiac output is accomplished by increasing the stroke volume, the heart rate, or both (cardiac output = stroke volume X heart rate), which is also accompanied by an increase in peripheral tone (dilation). If the underlying cause for compensation is not treated there is overcompensation and the left ventricle dilates to the degree that impairs contractions.  Low cardiac output casues a faster heart rate,  triggers the kidneys to produce more volume and the additional volume stresses the heart as well and heart failure ensues.

Treatment is to reduce fluids, dilate vessels, slow heart rate, sometimes meds to strengthen contractility, etc.  The treatment can/will provide relief to the heart's workload and in time the heart will/can reverse the LV enlargement.

Currently, my heart is normal size and functionality with the exception of MVR.  I never had any symptoms until there was CHF.  I was in ER for several days to reduce fluids, etc.  and post CHF I feel healthy and that may be contributed to proper diet, exercise, meds, etc.

I have heard/read there are approximately 26% of the heart population eel well and don't know they have a heart problem even though their EF is in the failure range (below 30%).  And read there are people who have raised their EF to normal and do not feel well!