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declining ejection fraction causes
I was researching my information since my heart attack on 8/7/2010. Upon release from the hospital an echo stated my ejection fraction was 50%.Meds 325 asprin, lisinopril 10mg daily, lipitor 40 mg, metorolol 25mg daily, Plavix 75 mg daily zetia 5mg daily.
Then I began cardiac rehab for 6 weeks and was working out at 60 minutes a day at achieving a MET level of 7.5
On 11/3/2010 had a nuclear stress test that stated my ejection fraction was 36%. It also stated "there were no abnormal ST segment changes in response to exercise. The EKG was abnormal at baseline , therefor, no interpretation can be made." INTERPRETATION: Stress tmographic images of the left ventricle revealed inferior and lateral wall defects seen of moderate size. The resting tomographic images revealed normal perfusion. Gated images revealed abnormal systolic thickening in the inferior and lateral walls. The ejection fraction is calculated to be 36%.
CONCLUSIONS: A) No anginal symptoms in response to exercise and with evidence of ischemia.
B) The isotope study revealed evidence of ischemia in the inferior and lateral wall of large size.
C) Left ventricular ejection fraction is 36%.
Clinical correlation is required. Recommend medical therepy with continued observation. This is likely representing stunned myocardium. Cardiologist had me stop all excersize at that time. same meds as above but took me off lisinopril.
Went to Mayo Clinic for second opinion and they did cardiac MRI.
Cardiac MRI on 1/31/2011. this indicated ejection fraction of 25%, large area of damage, ie scar tissue on left side and bottom of heart. now on the 25mg coreg, 30mg lisinopril, 325 asprin, 75 plavix, 40 lipitor and 5 zetia. Supplements are 100 mg co-q10 bid, 2500 fish oil bid, HDL RX 2 tabs BID, vitamin E 400mg daily,
My question is why does it seem my ejection fraction is getting worse since heart attack on 8/7/2010? This progression is getting me worried that there is a blockage in artery to heart thus damage to the heart muscle is continuing. Would these tests and numbers indicate a cardiac cath is in order now to dtermine if there is blockage affecting the heart muscle? As a layman I am looking at this saying how will the muscle improve or ejection fraction improve if a blockage is still present. Cardiologist doesnt feel cardiac cath is needed right away, he said we could do it, find blockage and stent it just to provide the blood flow to dead tissue which will not help it. I worry that some of the muscle is still viable and that the possible lack of blood flow will ensure it does not comeback. Any ideas on this would be greatly appreciated. Thank you.
I looked it up and it seems to be related to discoid lupus which I do have. Isolated on scalp I have 2 patches about the size of half dollars that alll the hair has fallen out.Biopsy confirmed discoid lupus. I use steroid cream when it flares up which is often since i live in Florida and it is exacerbated by sun exposure. I will look into the APLS further though, thanks.
not that I know of. Ever since I was a kid though if I would get cut it would clot almost immediately. I thought this was healthy but obviously I was wrong.
Thanks Jesus. I am reading the study and it is very informative. I have "thick blood" and I have told cardiologist of all my supplements. He did not tell me to stop them so I thought it was ok. I need to re-evaluate what I am putting in my body and make sure I am not setting myself up for another problem here. The stroke risk you noted is appreciated and I need be aware of this since my father had a stroke at 36 which killed him and my cousin, my dads brother's son, had a stroke at 40 but survived.
I do use the Ubiuinol CO-Q10. Even now on 30mg lisinopril and 12.5 coreg twice a day my BP is 110 over 74. Without those meds it was 120 over 80. Cardiologist says this bodes well for me being able to handle the max dosages as we bring them up weekly. Doing blood tests each week to make sure no problems with potasium and creatinine levels as well as liver functions. Thanks for the link I will be reading and re-reading to ensure i grasp it all.
I do use the Ubiuinol CO-Q10. Even now on 30mg lisinopril and 12.5 coreg twice a day my BP is 110 over 74. Without those meds it was 120 over 80. Cardiologist says this bodes well for me being able to handle the max dosages as we bring them up weekly. Doing blood tests each week to make sure no problems with potasium and creatinine levels as well as liver functions. Thanks for the link I will be reading and re-reading to ensure i grasp it all.
Let me tells you a few interactions ... Q10 200mg (if it is in the form of Ubiquinol it is a fairly big dose), Oil Fish 5000mg a day it is also quite high, both of them will lower you BP in addition to what the ACE-I and BB are already doing ... so if you get very low pressure and dizziness can be due to the combined effect of the 4 products.
Oil Fish and Vitamin E have the effect of blood thinners which in addition to the aspirin and plavix, can make you bleed very very easily. In this regard, the more dangerous potential side effect (due to the combination of the 4 ) is an hemorrhagic brain stroke.
Since you are worried about EF, you could be interested in reading this:
http://eurheartj.oxfordjournals.org/content/26/21/2238.full.pdf+html
Jesus
Oil Fish and Vitamin E have the effect of blood thinners which in addition to the aspirin and plavix, can make you bleed very very easily. In this regard, the more dangerous potential side effect (due to the combination of the 4 ) is an hemorrhagic brain stroke.
Since you are worried about EF, you could be interested in reading this:
http://eurheartj.oxfordjournals.org/content/26/21/2238.full.pdf+html
Jesus
First off thank you for responding to my questions, I really appreciate it!
The HDL RX has been my own doing since 2006. I did a lot of research after doing cholestrol tests finding my hdl was 28. I read the clinical trial of HDL RX done by scripps institute and gave it a try. it raised my hdl #'s from 28 to 36. Now I also take Niaspan 2000mg and HDL is at 44, my highest ever. My LDL is 57. I have never eaten fast food but was a smoker till 2006. That was biggest mistake. My mayo cardiologist thinks my root problem is the low HDL. Family HX is father died at 36 from stroke after high blood pressure since age 18.His father, my my grandfather died of heart attack at 58. We are all in good shape and nobody in family has been overweight. I am 5-6 and 145pounds and active.
The MRI did show the damage to muscle was through entire depth of muscle. I believe that is why cardiologist is not keen on doing cardiac cath right now. He feels that the coreg lisinopril combo will help with the blood flow. He wants me in cardiac rehab for the exercise so yes it would be monitored.
I am having a hell of a time getting my head straight right now. I am usually the type of person that says I will beat whatever it is I am facing and go full boar. I just cant seem to get my mental strength back, I worry that I am going to die from this in short order. I want to live again but cant seem to get out of the house. Started Pristique 50mg for depression and it seems to help a little but not enough.
I have a high stress job and have not returned to work yet. Worried the stress will cause me to decline further.
Again thanks for the help.
The HDL RX has been my own doing since 2006. I did a lot of research after doing cholestrol tests finding my hdl was 28. I read the clinical trial of HDL RX done by scripps institute and gave it a try. it raised my hdl #'s from 28 to 36. Now I also take Niaspan 2000mg and HDL is at 44, my highest ever. My LDL is 57. I have never eaten fast food but was a smoker till 2006. That was biggest mistake. My mayo cardiologist thinks my root problem is the low HDL. Family HX is father died at 36 from stroke after high blood pressure since age 18.His father, my my grandfather died of heart attack at 58. We are all in good shape and nobody in family has been overweight. I am 5-6 and 145pounds and active.
The MRI did show the damage to muscle was through entire depth of muscle. I believe that is why cardiologist is not keen on doing cardiac cath right now. He feels that the coreg lisinopril combo will help with the blood flow. He wants me in cardiac rehab for the exercise so yes it would be monitored.
I am having a hell of a time getting my head straight right now. I am usually the type of person that says I will beat whatever it is I am facing and go full boar. I just cant seem to get my mental strength back, I worry that I am going to die from this in short order. I want to live again but cant seem to get out of the house. Started Pristique 50mg for depression and it seems to help a little but not enough.
I have a high stress job and have not returned to work yet. Worried the stress will cause me to decline further.
Again thanks for the help.
My experience tells me that echos around the date of MI are not reliable... there are many things that can distort the image and also in the days after the infarct many things can settle and change it. In the Car. Rehab. center that I was in, they only start to look at echos 2 months after MI.
So assuming that the 50% is irrelevant still a decrease from 36% to 25% in 3 months it is very relevant. By any chance did you got a flu or any other infection around this period?? Viral infections are a well known cause of EF decrease.
Are the supplements that you are taken ordered by Mayo drs.??
It sounds to me strange that they recommend things like HDL RX that as far as I read has an not specified amount of certain components.
If they have not been ordered by drs., why are you taking each of them? Are you aware of how they do interacts with your meds.?
Jesus
Jesus
So assuming that the 50% is irrelevant still a decrease from 36% to 25% in 3 months it is very relevant. By any chance did you got a flu or any other infection around this period?? Viral infections are a well known cause of EF decrease.
Are the supplements that you are taken ordered by Mayo drs.??
It sounds to me strange that they recommend things like HDL RX that as far as I read has an not specified amount of certain components.
If they have not been ordered by drs., why are you taking each of them? Are you aware of how they do interacts with your meds.?
Jesus
Jesus
I don't believe that stopping exercise should lower the EF by that kind of degree, if any at all. My EF was 70% after my MI in Feb 2007 and remained at 70% in all that time. There was a year where I hardly did any exercise after a triple bypass which failed after just 3 months. A heart with no damage is being exercised all the time, at least 60 beats per minute 24/7. A lowered EF has to be the result of heart muscle problems or valves etc.
"Went to mayo clinic for second opinion did cardiac MRI. said ejection fraction was 25 and half my heart was scar tissue"
If the MAYO clinic found half your tissue to be 'scar' then your MI caused a considerable amount of damage to the heart muscle, a large section has died. This tissue will never re-generate unfortunately. Even more stents or bypass will have no effect on this because dead tissue will not require oxygen.
"New cardiologist wants me to workout and said there is no enlargement of heart and that we need to focus on making heart stronger with excersice "
I hope using professional heart management, you have been told the limits to your exercise. With a lot of scar tissue, I would have thought too much exercise would force the heart to adapt by enlarging. Perhaps they feel the necrotic tissue is nontransmural? A transmural MI means tissue death has occurred through the complete thickness of the heart wall, whereas nontransmural has not. If they have determined you have nontransmural then there is a good chance EF can be increased over time.
"Went to mayo clinic for second opinion did cardiac MRI. said ejection fraction was 25 and half my heart was scar tissue"
If the MAYO clinic found half your tissue to be 'scar' then your MI caused a considerable amount of damage to the heart muscle, a large section has died. This tissue will never re-generate unfortunately. Even more stents or bypass will have no effect on this because dead tissue will not require oxygen.
"New cardiologist wants me to workout and said there is no enlargement of heart and that we need to focus on making heart stronger with excersice "
I hope using professional heart management, you have been told the limits to your exercise. With a lot of scar tissue, I would have thought too much exercise would force the heart to adapt by enlarging. Perhaps they feel the necrotic tissue is nontransmural? A transmural MI means tissue death has occurred through the complete thickness of the heart wall, whereas nontransmural has not. If they have determined you have nontransmural then there is a good chance EF can be increased over time.
The test in hospital in august was an echo. cardiac cath done immediately upon arriving at hospital. No additional stents placed at that time, the blockage was blood clots in 2 areas due to being off plavix for 3 weeks. The said they pulled out the clots during heart cath. I had been on toporol xl 25mg already due to 6 stents placed in 2006 for blockage of 70% in 3 areas, these were kissing stents placed back to back in 2006. no new stenting for heart attack. er cardiologist upon discharge from hospital had meds of effient(new blood thinner), toporol 25 mg, lisinopril 10mg, lipitor 40mg, zetia 5mg, 325mg asprin. Went to my cardiologist at home 1 month after heart attack, he took me off lisinopril but did not replace it. Had allergic reaction to effient and replaced with 75 mg plavix. Did cardiac rehab for 6 weeks achieving met level of 7.5 for 60 minutes. went to cardiologist in November and had nuclear stress test done, thats where he found damage and ejection fraction of 36. said go home take meds dont exercise. Found it strange since I felt better than I had in 10 years. Went to mayo clinic for second opinion did cardiac MRI. said ejection fraction was 25 and half my heart was scar tissue. Further he said my meds were BS and placed me on coreg, lisinopril, continued lipitor, plavix, zetia, asprin, stair stepping lisinopril and coreg up to max doses each week, going higher after blood work to check potassium and creatinine levels. New cardiologist wants me to workout and said there is no enlargement of heart and that we need to focus on making heart stronger with excersice and med therapy.He recommended ICD implant for defibulator and that was done2/2/2011. He did tell me that he disagreed with former cardiologist on meds and that after heart attack I should have been placed on lisinopril and coreg as that is the protocol that is proven to help after MI. I have been asking for another cardiac cath to check blockage thinking the ejection fraction has dropped and could be due to blockage. He said echo's and nuclear stress tests are not as acurate as cardiac MRI and are in the eye of beholder or test reader. Since I stopped all exercise in Nov. due to cardiologist rec. maybe thats what caused ejection fraction to drop? Just a bit scared since I am only 45 yrs old and have kids.Thanks.
You mention that you went through cardiac rehab, but do not mention any intervention. I take it nothing was bypassed or stented at that time and you feel there may be a need for that now?
"Cardiologist doesnt feel cardiac cath is needed right away, he said we could do it, find blockage and stent it just to provide the blood flow to dead tissue which will not help it. I worry that some of the muscle is still viable and that the possible lack of blood flow will ensure it does not comeback"
If the area is diagnosed as scar tissue, then necrosis has resulted and opening any vessel to give a blood supply will have no effect.
You say that in Aug '10 you had a heart attack, and discharged with EF 50%. What intervention did they do at that time to stop the heart attack? what tests were performed before discharge?
Although things seemed to look fine at this time, I suspect this is when the problem existed and seemed to slip through the net of diagnosis because three months later your EF dropped to 36%.
If the area is diagnosed as scar tissue, then necrosis has resulted and opening any vessel to give a blood supply will have no effect.
You say that in Aug '10 you had a heart attack, and discharged with EF 50%. What intervention did they do at that time to stop the heart attack? what tests were performed before discharge?
Although things seemed to look fine at this time, I suspect this is when the problem existed and seemed to slip through the net of diagnosis because three months later your EF dropped to 36%.
That's quite a history, I'd have lots of questions as well. This forum is for general information, not an experts board. You might try and copy and paste this question on the Expert Forum. To find it, scroll down on the right side of this page and you will find it.
Taking what I say with a grain of salt, I'd guess that that what was considered stunned heart cells initially were really cells that could not be revived with medication, exercise, etc. My guess is that the the latter diagnosis is what I would accept.
Keep in mind, the EF diagnosis is a transitory thing. It can be improved even with damaged heart tissue as the remaining heart muscle is strengthened with good drugs, exercise, and as always diet. My EF raised from the high 20's to a recent diagnosis after an angiogram of 41%.
There are people on this board that can intrerpret your post better than I, but I'll simply mention that if we have to have trouble with an organ, those of us with heart trouble should be thankful we live in an age where hearts can be made serviceable to our bodies. That's not the case with some of our other organs. I hope you keep us informed.
Taking what I say with a grain of salt, I'd guess that that what was considered stunned heart cells initially were really cells that could not be revived with medication, exercise, etc. My guess is that the the latter diagnosis is what I would accept.
Keep in mind, the EF diagnosis is a transitory thing. It can be improved even with damaged heart tissue as the remaining heart muscle is strengthened with good drugs, exercise, and as always diet. My EF raised from the high 20's to a recent diagnosis after an angiogram of 41%.
There are people on this board that can intrerpret your post better than I, but I'll simply mention that if we have to have trouble with an organ, those of us with heart trouble should be thankful we live in an age where hearts can be made serviceable to our bodies. That's not the case with some of our other organs. I hope you keep us informed.
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