How to increase your ejection fraction after a heart attack.

[Michael O]

Back in Feb 2004 I had a infarction with cardiac arrest and underwent a procedure to have 3 stents installed. An echocardiogram showed an ejection fraction of 40-45%.I have been exercising about 6 days a week for about an hour, since the event. Another echocardiogram was performed just recently and it showed an ejection fraction of 45-50%, My question is that, me being an airline pilot how can I or is it possible at all to get that ejection fraction above 50%? Do I need to up my cardio workout? The 45-50% was the doctor's estimate, however it was calculated at 44%. Thanks for your time, Michael O.

[Cleveland Clinic]

michael,

sorry to hear of your events.

Unfortunately, an infarction means that some of the muscle dies and that portion may effect the ejection fraction observed on the echo so that the ejection fraction never comes back to normal. Truthfully, the most important thing is not the EF but really the presence of symptoms related to the EF. If you are asymptomatic it portends a better overall prognosis.  That said,
the heart does have some ability to remodel and recover function after an infarction.  This is probably a combination of things including: recovery of stunnded areas of the heart, and the effects of medicatons that we use after a heart attack.  2 of the common medications that help the process are ace inhibitors and beta blockers, both of which you should be on. Your exercise program is the best thing you can do for all of your health and optimal recovery after your heart attack.

good luck

[Healthyself2]

Consider changing your exercise habits to long duration moderate aerobic exercises such as walking a hilly course, hiking, x-country skiing, swimming, etc.

After my heart attack 5 years ago.  I made several mistakes which delayed my recovery time.  One was not agressively pursuing the correct medications to get an ideal lipid profile.  Another was pushing myself too far physically too soon.  A third was letting my cardiologist put me on a beta blocker.

My regimin is two 1.5 mile walks per day through a hilly wooded park.  I do one on the way to work and the second at lunch.  I try to do at least one hike a week with at least a 2,000 foot elevation gain.  In winter, I switch to x-country skis or sometimes downhill.  Downhill tends to be high demand aerobic at times.  In the summer, I try to take a lot of time off and hike a lot of elevation each week.  I believe the relaxation factor is as important as the exercise and outdoor activities are much more relaxing than a gym.

Of course when I first started, I couldn't walk up-hill as fast as a 6 year old girl.  I had to stay under the angina threshold, which meant walking and resting, walking and resting.

My E.F. has increased over five years from 35 to 50, which is low normal.  I hope to be a little higher when I take my ultra-sound this fall.  The motility of the area affected by my infarc has improved over the years.  I've also got a good collateral vascular system in that area now, which I think is a benefit of my type of exercise.

My main concern is Left Ventrical size, which has remained normal.  That's another reason that I don't pursue high demand aerobics.  Another is that I am just getting to that age (55) where it just doesn't make sense anymore.  I like having good knees:)

I consider myself lucky that I am five years out from a heart attack and serious 3 vessel disease, with one total occlusion, have not stents or bypasses and remain in good health and physical ability.  I also believe that almost everyone can do it with agressive lipid and bp control and daily moderate exercise as the main components of their recovery.

Good Luck to You.

[Erik36]

Did you ever have problems with the Niaspan? Before you started taking it on an empty stomach before bedtime did you try the way they suggest by taking it with a low fat snack and an aspirin 1/2 hour before? And if so, did you ever have flushing symptoms prior to you figuring out the trick to taking it without getting the flushing? I still have Niaspan but have not taken it yet because I'm afraid it will aggravate my PVC's and A-Fib(which is under control).

[Healthyself2]

I am alergic to aspirin so that's out.  As far as taking it with a low fat snack, I think any food with it is just going to spur the digestion process and release the Niacin too quickly.

I just take all three cholesterol meds and two bp meds before I go to sleep.  If I have eaten or drank to close to bedtime, I only take 750mg on the Niaspan instead of 1500mg.  

I hadn't heard of Niacin aggrevating rythm problems.  It's never done that for me.

[Michael O]

Thank you for your comment. It did give me some light at the end of the tunnel. Being an airline pilot and out on extended medical I find out in late Nov on their decision about my case. It was nice to know that your EF increaed 15 over 5 years. I don't know the severity of your heart attack, but I was dead and they finally got me back. I was 99% blocked on on main artery. I have a good lipid profile, except for that darn HDL sitting at 42. Total is 123, LDL 57, tri 128. Good BP 110/60. If the FAA does not clear me in Nov, it is nice to know in your case with diet and exercise that your heart responded positively for you. I am only 44 so let's hope mine will do the same. That being said I'm out for a 5 mile jog. Thanks again...

[Healthyself2]

With those type of cholesterol readings, I wouldn't think you a likely candidate for CAD.  The HDL is borderline but the ratio is ok.  I believe that HDL levels are the best predictor of future cardiac events.  I also believe that familial low HDL (29-33) was the main cause of my CAD.  My mother had bypass at 57 and died of heart failure at 64.

The best current drug for raising HDL is Niaspan.  The torcetrapib/Lipitor combo should be better if it makes it to the market in 2006.  Niaspan is a little tricky to get used to however.  I found success by taking it all a bedtime with no food or drink (except water) at least 2 hours before.  Two readings ago my HDL had risen to 55 and last time was 50.  Each percentage point of improvement reduces risk significantly.

Five years ago, I had a moderate heart attack primarily affecting the right bottom of my heart.  I didn't suffer cardiac arrest however.  

I have a 100% occluded RCA which hasn't been fixed.  The attending said that the blockage was long standing and different doctors had told me that I had a previous heart attack.  I remember a similar episode in my early 30's, after running, that I toughed out by laying in bed for 4 days - probably ws the first one.

I'm quite a lot older than you, but I just don't do extremely demanding aerobic activities anymore.  Pretty much everything that I do is long duration moderately aerobic.  I think that they have the greatest value for overall improvement of heart function without causing further damage.

In your case, I would encourage jogging and not running.

If you don't live in an area with mountains, consider moving to one.  I live in Seattle and plan on taking a short hike in the nearby Cascades later this afternoon.  

Best of Luck to You.
Keep it slow and steady.