life expectancy

[benstung]

I'm a 62 year old male that has had an ejection fraction decrease fron 40% to 20% in 14 months. What causes this significant loss?  Based on case study what is life expectancy of a patient with a 20% EF and seven years into a a major heart attack {widowers heart attack} resulting in severe damage to heart muscle.

[ed34]

First I have to ask what else causes heart attack apart from blockages? An MI (Heart attack) is defined by lack of blood. I think what you are confusing are the 2 terms heart failure and heart attack. Heart failure is to do with the EF. I take it that he is taking aspirin and a beta blocker? these are the bare minimum requirements and aspirin should really reduce the risk for another clot.

[Kimtwest]

I sure hope in 10 years he will be telling me he is fine!! They have tried so many different medications and all have caused other problems. He knew the first 2 times that he was having the attack but the rest either came while he was dealing with kidney failure ,one when his appendix ruptured which lead to peritonitis, or this last one was when his defibulator shocked him. Not all heart attacks are caused by blockages. His heart muscle was weakens from a virus many years ago. That and family history of heart disease and diabetes for over 20 years makes treating him very difficult. I'm just worried more now because of the EF decreasing so much in such a short time.

[ed34]

Well that is a bit of a difficult question really, very difficult. There are so many variables to the answer, and yet no one knows the value of those variables. For example, will a cure appear tomorrow or next year? Will his heart get any worse? No one can answer these questions but don't be shocked if he is still telling you that he will be fine in 10 years time. I do have a question to ask you though. Why so many major heart attacks? After the first one didn't they put him onto the right meds? A full blown heart attack is very rare when you are on the right meds and this situation should be a gradual build up. Didn't he feel any prior symptoms to the heart attacks? I trained my kids to deal with heart attacks as quick as possible. They first put 3 aspirins into my mouth and they give me several squirts of GTN spray under the tongue. They did this just over a year ago and I survived. In fact, by the time I reached the hospital the blockage had dissolved.

[Kimtwest]

My husband has now had 6 major heart attacks. Triple bypass and 2 stints not to mention kidney failure from the meds for his CHF. He has an internal defibulator that shocked him twice saturday. He was having ventricular arethmia every 3 seconds until the med Amiodrane was administered. He was in cicu for several days then stable enough to go to step down now home. He is on 400 mg of this med which I know is very toxic to other organs. His EF was at 25% in June now we are told it is at 20 %. How long can a person live with all of this?! I'm afraid to leave the house but he keeps telling me he will be fine.

[kenkeith]

I take and have been taking an ACE inhibitor to lower blood pressure, a beta blocker (coreg) for a lower heart rate, lipitor (lipid profile couldn't be better), a nitrate before exercising (3 X a week...aerobic and weight resistance).  Fruits, vegies, chicken, fish and very little red meat.  I love sweets though and very little sodium.  I've never had a weight problem.

About 4 years ago, I read the stats referred to and thought I wouldn't survive a year.  I agree the stats may be out dated and medication makes a difference (especially coreg) as I understand.

Thd doctor stated my recovery and current health status is "golden".  I do have MVR that is closely watched.

[often]

Have you been on meds for CHF during this time?  Have you been following a low sodium diet?  Getting exercise?  I started out at 10% and am now back to normal.  I know that the stats for CHF are all outdated and the quoted 5 years is probably wrong, due to the new meds, beta blockers in particular.  What is your cardio doing for this condition?  Or is it failing despite all attempts?

The variables are too great to come up with an answer.  

[kenkeith]

The percentage is about 35% (if I remember correctly, I don't dwell on that aspect) survival rate after 5 years (I'm going on 4 years and EF has gone from below 29% to 59).  
If the EF is less than normal, the heart may be overcompensating usually with a dilated chamber (increases contractions, but eventually there will be decompensation if not treated) and a faster heart rate.  Because damaged heart muscle impairs contraction, the heart overworks to supply blood/oxy.  Medication can reduce the afterload and the heart can find relief and function successfully for a long period.
Just to focus on EF is probably not a very good indicator, but instead the focus should be on how well a person feels.  There are estimates that 24% of the heart disorder population don't know they have a medical problem.  There are some individuals that have a low EF and when the EF is raised with medittion don't feel as well!

EF's are an estimate, and if one considers the possiblity of the margin of error, the difference may be insignificant, also the EF is not static and will vary normally.