early heart failure

Coming up on 5 years I had been diagnosed with early stages of heart failure stemming from a viral myocarditis  as a baby. So there was definated probability that I would run into problems as an adult which I did (age 29)now am 34. The problem is I have no been feeling well lately. I went to the doctor and he did an echo and it showed 25% functions in the left ventricle, 3 years after being on medication for a while my ejection fraction was 35-40%. Why is it going down again. My doctor didn't give me a definate answer. My resting heart rate is 80-100 on 12.5 mg. of coreg and 100mg of toprol xl.I am not responding to the medications as well as I should.They are trying to get it down to a more suitable rate of 65-70. Can a elevated resting heart rate cause your ejection fraction to deminish? I have felt tired and have had tightness in my chest for 2 months now. Doctor has ordered a stress test to see how my heart is. He said there is nothing to worry about right now. Also the echo report said moderate to severe hypokenetic, while the earlier echo showed mild to moderate hypokenetic. What does that exacly mean? To me there sounds like a problem he does not want to address yet until the stress test is done and he has more information, this is turning out to be scary. He didn't want to call it heart failure yet because I was not showing all symptoms, but I didn't before 5 years ago either. Also I am quite overweight always have been, more so the past 3 years, could this contribute to the medications not working as well as they should. Thank you.

[CCF-M.D.-RCJ]

Oliver,

Sorry to read of your ordeal.

I'll try to answer your questions in order.

(1) The EF could be going down for a variety of reasons.  One possibility is that you stopped the medication that you had been taking?  Another possibility is that you are on a lower effective dose of the med now than before, which could be caused by the weight gain.  Other possibilities include undiagnosed coronary artery disease, high blood pressure, and the weight gain itself.

I have some patients whose EF varies somewhat from echo to echo.  If the person has no new symptoms, then I usually elect to follow up with an echo.  If new symptoms are present, as in your case, then a more aggressive strategy is in order.

(2) An elevated heart rate can cause the EF to diminish, but not at the relatively low heart rates you describe.  However, a heart rate in the 80 - 100 range indicates that your dose of beta-blockers is not blocking the beta-receptors, otherwise the heart rate would be lower.

(3) Hypokinesis means that a wall of the heart is not moving as much as it should.

Hope that helps.