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Start of heart failure ?
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Start of heart failure ?

59 yo white male. MI 10 months ago and 2 stents in RCA.  The damage was on the left side.  

hours after the MI an echo indicated a LV Ejection fraction of 50% with normal LV size and normal LV systolic function.  Normal RV and atrial size.   mild mitrial and tricuspid regurgitation.  Mild hyperkinesia of interventricular septum and anterior wall.

At 13 hours after MI during the angiogram, the cardiologist noted  LVEF of 60%.  No mitrial or aortic valve deficiency.  The difference in ejection fraction is puzzling.

Two months later echo reports what appears to be a worsening condition.   LV EF of 45.   LV diastolic function impaired.   Mitrial valve leaflet thickening.  Cardiac rhythm is normal sinus with frequent PVCs   5 of 16 LV walls indicated as hypokinetic.

plant based diet last 10 months and kept LDL under 70 and TC under 130.  TG is < 140.  walk 1 to 2 miles daily with no problem and do 10 to 15 minutes of light weights in the morning.   BMI is 25.  sleep issues the last few years and attributed my being tired to that, but now cannot tell if the way I feel is due to a weakening heart, or if the meds are partly to blame.  On coreg (6) and effient;.   off of lisinopril a few months back due to cough and had coreg raised from 3 to 6.  

recent minor changes have me concerned and thinking about heart failure - increased urination day and night.  Until recently did not get up at night.  Throat feels constricted, not sore just notice a very slight discomfort when swallowing.  A little tightness in my chest. flesh under my large toenails is purplish, but no other discolored areas.  BP is good, ave115/75.  HR of ~ 60 which is up a bit.    

Seeing my cardiologist in 2 weeks but would appreciate any perspective/advice about what I should discuss with him and whether anything seems potentially problematic.  Does it make sense for the LV EF to be    somewhat normal right after an MI and then drop off later as scare tissue set in?

thanks

pete
Avatar_dr_m_tn
Generally speaking, the ejection fraction on the angiogram is not as accurate as one from an echocardiogram. On an echocardiogram, the general ejection fraction is listed as a number, +/- 5%. Thus, a difference between 5 and 45 is no real change. If you are having swelling in your legs, or waking up short of breath at night these cold represent signs of heart failure. It sounds as if you have good exercise tolerance, and this is great. I would suggest you to be on an ARB (angiotensin receptor blocker) given you are post a hear attack with a somewhat lower than Norma ejection fraction.
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