Possible Transplant 38 y/o female

[shelley828]

I am a 38 y/o female. I have had known atrial fibrillation with rapid ventricular response for ten years. Afib symptoms were rare, so did not take medication on regular basis. 01/05/11: Sent home from ER on low-dose meterprolol.  Two days later end up in ER again, admitted for cardiomyopathy (which was news to me) and heart rate that was 118-130 sitting still.  Echo performed and sent home by the cardiologist and told to eat more salt. Was not told the results of the Echo.  Eight days later, seen by different cardiologist, and within ten minutes of being in her office, she was sending me to hospital, because I was still in CHF and EF was only 20-25% (taken from the echo performed the previous week and read by different cardiologist).  All labs are normal and heart cath showed all pressures to be normal and no blockages.  I have been placed on Aldactone, Digoxin, Coreg. Lasix and Coumadin.  I take all of them daily expect for the Lasix.  If heart hasn't strenghtened in 6-9 months will be looking at being placed on transplant list.  Dr. wants to place me on Lisinopril also, but blood pressure drops with all the meds, to a level that I can't function.  I know it is a wait and see process as to whether my heart will strengthen. I also have mitral valve damage, but they don't seem to be too concerned about this right now.  They say if my heart back to a normal size the mitral valve might return to its normal position or might not.  Can you tell me how serious mitral valve damage can be?
I have two children and am concerned about my quality of life with my health current problems.  The nausea kills me, the tiredness is overwhelming at times. What should I expect in the upcoming months?  Can my heart actually be damaged more while waiting the 6-9 months to see if it is going to strenghten?  

Thank you in advance for any information you can give me.

[CCF HeartMD-1]

I would recommend you seen an electrophysiologist (special cardiologist in heart rhythms) or talk to your cardiologist about trying to get your heart rhythm out of a.fib with anti-arrhythmic medications possibly because this may be contributing to your lower EF of 20-25%.  Likely you had peripartum cardiomyopathy (heart failure related to pregnancy) which is rare and unfortunately in some cases does not improve, however your lower EF I am guessing is due to the a.fib.  The a.fib is also likely what is contributing to your lower blood pressure which then does not allow coreg and lisinopril on board.  

Hope this helps.  Good Luck!

[CCF HeartMD-1]

At what ages did you have your children??  Was your EF ever checked prior to January 2011?  The Coreg and Lisinopril are more important than the aldactone unless you have extra swelling/fluid on board in your legs.  But, my underlying suspicion is that your EF has been low for a long time possibly related to your pregnancies and that is why you developed a.fib.  Are you still in a.fib and is the rate controlled?

[shelley828]

Yes i had an EF of 35 - 40% in 2008. I had my children at age 22 and 26.  The afib seems to be controlled somewhat....checked it today and rate was 96. In the past week it has been in the 80s. At times I will wake up with my heart racing...any ideas why?

[shelley828]

The afib started two years sfter my last child. The EF is a new finding as of Jan. 2011. My blood pressure drops too low with the coreg 3.125 mg and lisinopril at 2.5 mg taken at the same time along with the aldactone.  No one ever questioned why i had afib at 28.  What r my chances of strengthening without coreg/lisinopril combo

[CCF HeartMD-1]

Hmmm.  Well, did you ever have any one evaluate you as to why you were in atrial fibrillation as a 28 year old woman? That is very rare to have a.fib for no reason as a young person unless you have hyperthyroidism, congenital heart disease or possibly even peripartum cardiomyopathy (heart failure related to giving birth).  By any chance, did you have one of your children around the age of 28 when your a.fib started??

I would be suspicious that you may have had peripartum cardiomyopathy (heart failure related to pregnancies) or the heart failure is related to the atrial fibrillation and this needs to be controlled much better.  Would recommend trying to get you out of a.fib if possible.  In terms of the heart damage, the ejection fraction (EF) can sometimes improve with medications like coreg and lisionpril (the combination) so this is why your doctors want you on it and sometimes people can only tolerate 2.5mg of Lisinopril and 3.125mg twice daily of Coreg in order to get both on board.  If this is a new finding (the EF of 20-25%), I would probably recheck this in 3 months on the combination of Lisinopril and Coreg to see if it is better (there are definitely cases where it gets better).  The heart function should not get any worse but your a.fib needs to be controlled because if it is always between 118-130 then this could be contributing to your low EF.

Hope this helps.  Good Luck!