What causes heart ejection rate to go lower?

I am an 81 year old male, had double-bypass surgery with aortic valve replaced over 3 years ago. Heart has been in
A-Fib, since surgery, and on warfarin, but able to live a normal life, and participated in a cardio exercise class 3 times a week. Six months ago my echocardiogram ejection rate was 58%.  I was fine until Oct. 2010, when I began feeling very tired, & noticed the beginning of edema in my feet and lower legs. In Jan.2011, I had a grand-mall seizure & have not gained my strength back, or able to go back to the exercise classes. A new echocardiogram showed an ejection rate of 37%, an enlarged heart and thickened heart muscle.  I do not drink, smoke or have high blood pressure.  What could cause such a drop in ejection rate and an enlarged heart? Is there anything that can help bring up the number?
The doctor thought it might be amyloidosis,  a biopsy taken from the abdomen, was negative.    
If anyone has had similar symptoms, I'd like to hear from you.
Skip81

[kenkeith]

Q: "A new echocardiogram showed an ejection rate of 37%, an enlarged heart and thickened heart muscle.  I do not drink, smoke or have high blood pressure.  What could cause such a drop in ejection rate and an enlarged heart? Is there anything that can help bring up the number?

>>>>>>>>The lower than normal ejection fraction appears to be due to an enlarged heart and thickened heart muscle. Usually the underlying cause for enlarged heart chamber and walls is due to high blood pressure. The condition develops as the heart is pumping against higher than normal resistance and the heart is overworked and compensates by enlarging and the enlargement causes weaker than normal conractility to pump blood into circulation. Cardiomyopathy is disease of the heart muscle that results in abnormal cardiac function with lower than normal ejection fraction. Sometimes the pathology is not known and can be secondary to another health problem.


Source: "The secondary or specific cardiomyopathies are often associated with disease involving other organs (e.g. sarcoidosis, amyloidosis, systemic lupus erythematosus, systemic sclerosis and polyarteritis nodosa), or with specific cardiac abnormalities (e.g. hypertension, ischaemic heart disease (occluded coronary vessels) , valvular dysfunction  or abnormalities of the pericardium (excessive  fluids around the heart).

About 7 years ago I had a lower than normal ejection fraction (EF), an enlarged left ventricle, occluded vessels, valve dysfunction.  My problem was I had had a silent heart attack that impaired heart cells to properly contract.  I was in ICU for several days with congested heart failure (<29% is considered heart failure), there was a stent implant to increase blood flow, and medication has returned my heart to normal size and the EF is 59%).  I still have mitral valve regurgition.

Thanks for sharing, and if you have any further questions or comments you are welcome to respond.  Take care,

Ken

[Skip81]

Thanks for your informative reply. How old were you when you had the low ejection fraction and stent implant?  Do you recall how low the ejection fraction was?

My echo report: Normal sized Ventricle cavity. Severe left Ventricular Hypertrophy.  Severely reduced systolic function. Dilated Left Atrium (diameter 4.30 cm) (What is normal diameter?) Moderately dilated Right Atrium.

Normal sized Right Ventricle.  Reduced Right Ventricular systolic function.
Bio-prosthetic valve in Aortic position.  The valve is well seated.  There is good range of leaflet motion.  Valve appears to be functioning normally.  No Aortic valve stenosis.
Trace Aortic valve regurgitation. Mild to moderate Mitral valve regurgitation.
Mild to moderate Tricuspid valve regurgitation.  Right ventricular systolic pressure 33.5 mmHg. Normal right ventricular systolic pressure.  No pericardial effusion. Dilated and non-responsive Inferior Vena Cava. Previous Echocardiogram in 8/2010  showed normal left ventricular systolic function. Left ventricular myocardium has thickened significantly with echo reflectile appearance.This finding is probably consistent with infiltrative cardiomyopathy such as amyloidosis.

I hesitated to send such a long report, but thought it might be of help.
Thanks,
Skip

[kenkeith]

I was in my lower 70's of age .  My my EF was 29% with an echo, and the cath for RCA stent implant report states above 12%. An EF below 30% is considered heart failure range by most insurance underwriters.  It is at this measurement it is assumed  the heart is not pumping enough blood into circulation to meet the system's demand.
__________________________

Q:My echo report: Normal sized Ventricle cavity. Severe left Ventricular Hypertrophy.  Severely reduced systolic function. Dilated Left Atrium (diameter 4.30 cm) (What is normal diameter?) Moderately dilated Right Atrium.

>>>>>>Normal LA measurement is (1.9-4.0 cm).  What appears to be the issue for you regarding the slightly enlarged LA is due to the higher than normal resistence the LA pumps against to pump blood into the lower chamber.  The higher resistence is due to the rigidity of the thickened left ventrical's wall (LV hypertrophy).

Right atrial pressure can cause the Inferior Vena Cava to dilate.

Hope this provides a perspective, and if you have any further questions or comments  you are welcome to respond.  Take care,

Ken

[jojo19702003]

hi my dad is 80 years old and has suffered with a grossley enlarged heart for the past 10 years, he is on all sorts of tablets and has a difibrilator fitted inside his chest, his specialist told him the tablets are just slowing the process down but his heart at max now thats why gave him the defibrilator but recently he has stopped eating and not drinking much and i just wanted to know if anyone knows if this is the last stages of this disease as the doctor said they can give him quality of life not quantity and i am worried sick about him as i live away from him and he is in bed all day as he always tired please any answers would help me so much thankyou my name is joanne xxx

[kenkeith]

I answered your other post on the subject.  If you have any further questions please post on that thread.  You could be better served if you started your own thread that would focus on your specific question...and not why an ejection fraction reduces.  Thank you for posting.

Ken