Is it really cardiomyopathy?

[laurie1966]

13 years ago my husband had an episode of afib that lasted 8 hours.(Oct of 1998, he was 37) In the ER he was given procanamide IV that stopped it. Soon after this an echo was done and he had an EF of 40%. We were told by the Dr (who was very somber) that he had congenital cardiomyopathy. Later that day he had a stress test done. He made it to level 5 and it was considered "borderline" because he had ventricular tachycardia with increased frequency of PVC's toward the end of the test. He had no ischemia and, normal EKG's and normal heart rate and BP in response to exercise. A MUGA scan was done (I think it was the next day) and his EF was higher, I think in the 50's.  He was put on a low dose of lopressor.

6 days later he had a cardiac cath done. All vessels were normal, EF was 41% and it showed mild hypokinesia of the anteroapical wall. Everything else was normal. He always has had bradycardia. His resting heart rate is in the 40%. He is 50 now and does very physical labor. For example he can dig for an entire day! He has only had one more sustained episode of a-fib in Sept of 2007. After that he was put on coumadin, coreg and lisinopril. Recently he went down to 1/4th of the dose of lisinopril because he felt tired. He feels much better now.

Even though he doesn't do aerobic exercise other than his age work he is in very good shape and on no other medications. He doesn't ride a bike regularly, but can easily ride one for a long distance at a moderately fast rate.
I have always questioned the diagnosis of cardiomyapathy because he is in excellent shape.

He had an echo done in May of 2008 that was called "technically difficult" and the EF was estimated at 40 - 45%. He was having PVC's (asymptomatic) and because of this the LV function was difficult to assess but "appears mildly reduced".He had moderate mitral valve prolapse, trace mitral, tricuspid, and pulmonic valvular regurgitation. It showed mild global hypokinesis of the left ventricle and it was moderately dilated with normal LV wall thickness. Everything else was normal.

We have always been told that the EF in his echos are difficult to estimate because of his low heart rate and also that echos done right after an episode of afib can show a reduced EF. Recently I have found articles that say that the physical exam and history are more important than the EF in determining cardiac function. Also I am wondering if he needs to be on medication since he has only had 2 episodes of Afib in the past 13 years. (Also, he knows when he is in afib)
Tomorrow he is getting a second opinion and I want him to have a test done that will show a more accurate EF. (a MUGA scan?)

Does anyone have any information regarding my husbands situation? What tests should be done at this point? Is it possible that he has a very conditioned heart and not cardiomyopathy? Any information would be helpful.

Thank you,

Laurie

[kenkeith]

An athlete's heart is not patholoically enlarged.  Contractions are stronger (fewer heartbeats required to meet blood/oxygen demand) and heartbeat rate is less than 60 at rest.  Also, EF would be in the normal range, and the heart would return to normal size if and when an athlete reduces the vigorous activity.

Your husband may be well compensated with other physical attributes that may reduce the demand for blood/oxygen and the low EF meets the demand.  It is estimated about 25% of the heart disorder population has an EF less than 29% and don't realize there is a weak heart issue.

Your husband should see a cardiologist to find the underlying cause for the low EF and fast heart rate.  

[laurie1966]

Thank you for your post. I don't understand why Scott is in excellent shape. Absolutely no symptoms, and he can do very physical labor for hours. He is 50 yrs old and he has no other health problems. His only surgery was for a herniated disc in 1992. Is it really possible for him to have it? I wondered if he could have more of an athletic heart. I just want to make sure this the right diagnosis. Thank you for any input. Do you think he should see a cardiomyopathy specialist? We live in Toledo, close to the U of Michigan and The Cleveland Clinic.

Laurie

[kenkeith]

QUOTE:
"He had an echo done in May of 2008 that was called "technically difficult" and the EF was estimated at 40 - 45%. He was having PVC's (asymptomatic) and because of this the LV function was difficult to assess but "appears mildly reduced".He had moderate mitral valve prolapse, trace mitral, tricuspid, and pulmonic valvular regurgitation. It showed mild global hypokinesis of the left ventricle and it was moderately dilated with normal LV wall thickness. Everything else was norma"l.
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With a fast beating heart it is difficult to get a good estimate of dimensions (chambers)
because the fast beating heart causes the borders of the outer wall to be clearly delineated, therefore, the exact size for capacity is obscure and EF is generally a less acurate estimation.

Hypokinesis is damaged heart cells, but may not severly impair heart wall movement.  That condition would be consistant with an EF 40-45% (normal is 55 to 75%).  Moderately dilated LV would also be consistent as the heart's capacity enlarges to compensate with less blood pumped with each heart beat. A grossly oversized heart will weaken heart contractions and eventually lead to heart failure if not successfully treated.

Mild and trace regurgitation is considered medically insignificant and almost always never progresses.   MV prolapse is due to valve leaflets not closing to prevent blood flowing back into the upper atrium rather than pumped into circulation...adds to the burden of the heart and LV dilatation.  Moderate MVR should be watched for any progression.

I recently had a CT scan 64-slice angiogram.  It was necessary to inject an agent to lower heart rate (below 60) for good clear images,  Images were very good and an evaluation was made with some confidence for accuracy.