LVEF dysfunction

[vikramdawar]

Sir/madam,
         I want to get your advise regarding the case of my sister.She had her first delivery on 27/11/2003.On 30/01/2006,she delivered her second baby.When she was 6 months pregnant during 2nd pregnancy,she complained of breathlessness.Her gynae said it was due to bay gaining weight and she ignored.In Nov'06, she complained of the same problems and hence Echocardiograph was done with EF<26%.In the report it was clearly mentioned that there was no valve prolapse and neither any artery was blocked.Doctor's advised himthe following medicines:Valent 80,Lanoxin,Dyter 20 and Cardiovas.She continued taking these medicines till March'07.During this period he had cough with watery discharge/mucus.She had also limited her intake of liquids and sodium.During this period when she used to have Cardiovas,she used to feel as if her heart is sinking.When she told this to her doctor in March'07,the doctor stopped Cardiovas and told her to continue the other medicines.Since the last 20 days she started having excessive swelling in her legs and feet.She went to the doctor on 5/05/2007.The doctor advised her to get the following tests done:Echocardiograph,Peripheral Doppler,Blood test and urine test.The report of Peripheral doppler test was normal and so was the blood and urine test.However,it was surprising to note the the Echo report showed a lower EF of 15%.It is here to be mentioned that NOW SHE DOES NOT COMPLAIN OF BREATHLESSNESS.She has cough.The doctor advised her to go for transplant/stemm cell.Her daughters are very very small,elder 3 yrs old and the younger 1 yr.She is greatly disturbed as she does not want to go in for surgery.I request you to kindly advise whether the medicines she is taking is ok and whether her EF can improve with time and medicines.She has limited her intake of liquids and sodium.She had been under emotional stress also.It is quite surprising that neither her artery is blocked and neither her valves are defective but still the problem of lower EF has arisen.KINDLY ADVISE.

[Forum-M.D.-bkj]

vik,

Sorry to hear about your sister.

It sounds as if she has a prenancy associated cardiomyopathy. While the underlying etiology of it is unclear, it is most likely a direct disease of the cardiac muscle, so it's not unusual that her valves and arteries are normal.

This is obviously a very serious condition. On medications and with time, a certain number of patients do recover function. Although, it sounds like your sister is getting past that point.

If her EF is truly that low, the physicians will continue to manage her with medications, but are probably undergoing early trasplantation evaluation so if she were to require transplant, the inital evaluation would be complete.  As I mentioned this is a serious condition and it is important for her to be seen and evaluated by a heart failure specialist that can help follow her over time.

good luck

[vikramdawar]

This is in continuation of my earlier question.I had forgotten to mention the age of my sister.She is 29 yrs old.

[vikramdawar]

Once again continuing with my earlier question.Actually I am quite tense due to condition of my sister.I would like to state THAT THERE IS NO SWELLING IN HER LEGS/FEET SINCE THE LAST 10 DAYS,NO BREATHLESSNESS SINCE THE LAST 3 MONTHS.Sometimes she has cough.Kindly advise.

[Fionajnz]

I had this, after the delivery of my third child.  I also complained of breathlessness and tachycardia but it was dismissed by my OB office too.  When it was found (6 wks post partum) my EF was 45% but it was thought to be improving at the time.  I was treated with meds and now my EF is back to about 60%.  I then developed what they think was a pulmonary embolism, (suspected by National Jewish hospital) and my other organs were failing too, especially my liver.

You sister needs to be closely monitored by a cardiologist and heartfailure clinic, she needs to be weighing herself daily and recording that, if there is a 3-5lb or more weight increase she needs to let someone know in her health team so her meds can be altered as needed.  Meds are very important in managing post partum cardiomyopathy.  She will be feeling pretty awful with an EF of 15%, especially her fatigue levels.  I had severe breathlessness for mths and swelling for at least 6-12 mths and I still take lasix if I have a big weight shift, a 7lb weight gain can happen overnight for me.

It took 18tmhs or so, for my EF to improve and I am being monitored for the next 3 yrs or so.    

I wish and your sister you well. There are a few people including me, who have successfully managed this condition on the board, they also post on the patient forum.  You and your sister could find some good information on this condition and some hope too, which I am sure you could all use a good dose of at this point.

Fiona

[vikramdawar]

Sir,
    Thanks for your reply.I would like to ask you that inspite of low EF why my sister now does not show signs of breathlessness.Further,what is the minium time period of getting a donor of heart for my sister.I had mentioned to you the medicines she is taking at present:Valent 80-od,Dyter 20-twice,lanoxin-5/7days.Are these medications ok.Since she has lost a lot of weight and has had 2 caesarian operations during birth of her children,,at present she does not want to go in for surgery.What about stem cell procedure.Is it successful in these cases.Kindly advise.the whole family is under great stress and whenever we see her children so small,we cry that why god had to do this to our sister.Is it possible,that if she takes the medicines as mentioned above and neccessary precautions regarding salt intake,liquid intake and changing her lifestyle and being happy and not getting emotionally disturbed,she can improve.Her age is only 29 yrs.Kindly advise.

[anacyde]

In Peripartum Cardiomyopathy (PPCM), symptoms often do - but do not always correlate with EF.  Some women feel extremely symptomatic at 45%, while others have only mild symptoms ar 20%.

Please Google "A Mother's Heart".

[Brothabill]

Coreg, if not improved, heart transplant, if not available, prepare as if she has inoperable cancer and prepare your family for death of your family member. As an emprical scientist. The circumstances your present leave that unless you or family  make extraordinary healthsaving measures, of which are dependent on YOUR actions, then with an EF of 15%.
A years time she will die, with three years, she will most certainly, as a biological creature cease to be able to function at that level of circulation with that pump.
I will not say I am sorry though, that is just stated facts. To get transplant surgery, it is very very expensive.
I also noted that you perhaps live in India, given name and also how the date was stated differently.
Standards in India are much poorer and healthcare is much poorer as well, although, the doctors are, simply by being run through so many patients, second class only to the Western Countries.

I know several India trained physicians who I'd let treat my family. But depends on your financial commitment or wherewithalll.
Money gets you treatment

[dee gee]

Geez.......who are you (Brothabill)......   you sound like you bumped out "God Almighty" with your comment.  

[Btill]

I need some information. My husband has an EF of 45% with a multitude of symptoms. Nausea, weakness, breathlessness some time, dizziness, nervousness and fatigue. These symptoms come on quickly and go away just as quickly. He is taking 160 mg of diovan, he was initially given 50 mg of metoprolol twice daily but changed just recently to 25mg of toprol xl, plavix, one aspirin perday, potassium 10meq, spironalactone 50 mg and simvastatin and zeta 10 mg each. My question is: Is his EF causing the symptoms and just won't get better until the heart gets better or is it the medicine. These symptoms came on a full year after a heart attack and the insertion of a ICD and pacemaker. He had been doing great for a full year and went to the dentist for a tooth extraction and was given a large dose of antibiotics. He has gone downhill eversince. Someone, please give me some feedback.