Heart Failure with low EF

  I was diagnosed with CHF in 1989 along with Post Partum Cardiomyopathy.  
  I was 26 at the time and gave birth to a healthy boy.  My EF at that time
  was 19%.  For the last 8 years I have been fairly A-symptomatic and, extremely active
  with an average of about a 35% EF.  One year ago (age 34), my symptons began to increase
  substantially and I began more aggressive drug therapy.  Because of severe congestion, in September of 1998
  I underwent a valve repair for my Mitral and Tricuspid valves with an EF of 15%
  at the time of surgery. My medicines now include lanoxin, vasotec, demadex,
  potassium, pacerone, lipitor, coumadin and coreg.
  Since my surgery, I actually feel very good, I follow a good diet and rest
  frequently and try to enjoy life.  I do everything most adults do am a single mother
  and work full-time.  Lat week another echo was done that showed my EF as still only 15%.  Without
  the regurgitation, I feel so much better -almost normal-, but now what.  I have just started coreg again ( I took this
  drug all last year with rapidly increasing symptons and no improvement)  We have started again with my
  increased failure and I want to know if the coreg will possibly help improve
  my situation or if it could contribute to the weakening of my muscle. Since I began coreg
  again last week, I still feel so much more tired with headaches and dizziness.  My concern
  is that I don't have far to go without needing a transplant...do I keep tryimg the coreg or
  is there something else that might help?
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Dear Linda,
Thank you for your question.  Ejection fraction is only a marker of heart function and I would put more weight into how you are feeling and your clinical picture.  Coreg has been shown to improve outcome in persons with heart failure and is well tolerated by many but not all individuals.  Specific advise on starting or stopping medication is up to your doctor.  Below is some additional information about peripartum cardiomyopathy.  God Bless.
Post-Partum (or peripartum) cardiomyopathy is a relatively rare form of heart failure that affects women during or following pregnancy.  Establishing a diagnosis requires 1. The absence of a determinable cause for cardiac failure, 2. Absence of preexisting heart muscle disease, and 3. Time limitations of onset of illness from the last month of pregnancy to the first 5 post-partum months.  Peripartum cardiomyopathy complicates 1 of 1300 to 4000 deliveries in the United States.  This condition may affect women of any race, age, or number of prior deliveries; however, older, multigravida, African American and twin pregnancies are thought to represent predisposing features.  The cause is unknown.  
The treatment is standard heart failure medication (diuretics, digoxin, ACE inhibitors, low dose beta blockers) and in severe cases heart transplant.  Approximately half of patients with this diagnosis will return to normal within 6 months.  Of those who do not return to normal the prognosis is poor with an average survival of 4.7 years after diagnosis (without transplant).  Repeat pregnancies are not recommended for women who have had peripartum cardiomyopathy.  You can find additional information in the following articles.  (your local medical library should be able to help you find these).
Lampert, MB Lang RM. Peripartum cardiomyopathy. Am Heart J 1995; 130:860-870.
Huerta EM, Erice A, Espino RF, et al. Postpartum cardiomyopathy and acute myocarditis. Am Heart J 1985; 110:1079-1081.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.