I'm a morbidly obese man with an ejection fraction of 45%

[Scot__0__0]

  I am a 32 year old, 500 pound man. Despite my size I lead a fairly normal life. I have had atrial fib for the past 15 years.My blood pressure is generally 150/85 or so.  About one month ago I had an episode of a fib which lasted for about 72 hours. After a TEE was performed the cardiologist infromed me that all four chambers of my heart were enlarged. The chambers are LV internal dimensions (diastole) 7.3, LV internal dimensions (systole) 6.6, Interventricular Septum 1.5-1.6, LV Posterior Wall 1.3, Left Atrial internal dimension 4.7, Aortic Root internal dimensin 3.0, RV internal dimension 2.7, mitrial valve, slightly thickened leaflets.
  I had cardioversion...360 joules did the trick on the first shock. I returned to sinus rhythm and have maintained since.The cardiologist told me that I am must lose a significant amount of weight, QUICKLY, in order to avoid further damage to my heart. When asked to prognosticate, he would only say that if I lost 250 to 300 lbs in the next year to year and one half, I would most likely increase my life expectancy by 40 to 50 percent. He refused to discuss actual life expectancy. He said that unless I lost weight my chances of having another bout of a fib were 100%, and that my heart would fail within a short period of time soon after.
  Accoding to my Internist, this cardiologist is not known for his people skills, which explains why he would not talk to me about my prognosis...other than the weight loss. I have attempted to schedule an appointment to speak with him; each time his office has referred me to my Internist. Today I spent 30 minutes discussing the results of my TEE and the aforementioned information with my Internist. He helped to inform me and alleviate some of my fears, while emphasizing the fact that unless I lose weight, quickly my condition will most certainly deteriorate. He indicated that he did not believe that my enlarged heart is ischemic and that my heart size would most likely reduce after the weight loss thereby improving my ejection fraction. He also indicated that it was highly unusual for someone my size to be as ambulatory and active as I am.
  For the most part, I am asymptomatic. I am able to do low impact aerobics for approximately 15 minutes per day with a pulse rate in the range of 120. I become out of breath when I walk up stairs more than one flight of stairs at a time. I sometimes have slight edema in my right leg )I have excessive scar tissue from an automobile accident in that leg), but not in either ankle nor my hands.
  I currently am on a medication regime of Rythmol 300mg p.o. T.I.D., Cardura 8mg, p.o. q.d., Coumadin 7.5mg, p.o. q.d., Toprol XL 200mg, p.o. q.d., Diazide 25/50, 1 p.o. q.d., Aspirin, 325, p.o. q.d.., Bentyl 20mg, P.R.N., Xanax, 2mg 1 p.o. q.d. P.R.N. not to exceed 8 mg per day.
  My questions to you are: Do my medications seem appropriate given my circumstances? If I am successful at this dramatic weight loss will my heart size decrease and my ejection fraction increase? Is my blood pressure too high; should it be treated more aggressively? How quickly must I lose the weight to avoid further catastrophic damage to my heart, or is it permanently damaged?
  Thank you!

[CCF Cardio MD - MTR]

_
Dear Scott, thank you for your informative question. I hope I'm able to provide information that can help you.  First, I agree wholeheartedly with your internist and cardiologist.  Your extreme weight is damaging your heart and increasing your blood pressure and needs to be addressed immediately.  The dimensions of your heart indicate that it is thickened and dilated, but I suspect your heart will improve with weight loss.  With extra weight, the heart has to beat harder each time to supply enough blood to the entire body so it wears down with time.  This problem is compounded by the high blood pressure, which presents an increased stress the heart has to pump against with each contraction.  You do need to lose 250-300 pounds but I don't think that you can do it on your own.  Fad diets that promise rapid weight loss will not work in the long run for you.  What you need to do is to dramatically decrease your caloric intake and participate in aerobic, moderate intensity exercise for 45-60 minutes per day.  The only way to lose weight and to keep it off is to eat less and exercise more.  The most suitable way for you to do this is to enter a structured rehabilitation and diet program where you work with nutritionists, exercise therapists, physicians, and physical therapists.  Your internist should be able to refer you to such a program.  However, you must remember that this will be a lifelong problem for you so you'll have to adopt permanent lifestyle changes that you should not waver from.  These changes will require incredible will power on your part, but the improvements in your health and well being should be a strong inducement for you to continue.  It's hard to determine how quickly you should lose weight because if you lose weight too fast, that can adversely affect your health.  Once you are able to get into a structured dietary program, you physicians can then determine the rate at which you should lose weight.  Secondly, your medications do seem to be appropriate to treat atrial fibrillation and hypertension.  Ideally, your blood pressure should be below 130/80 but I think you should start to lose weight before another medication is added.  You may find that losing weight alone will dramatically reduce your blood pressure.  I hope you find this information useful and good luck with the weight loss program - you sound like you have the strength and character to accomplish this goal.  Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies.