ejection fractions and prognosis

  My mother was just diagnosed with dilated cardiomyopathy.  Her
  ejection fraction is 25%.  We have been given very little information
  regarding what this means related to severity and prognosis.  Please
  respond with any information related to these topics.

[CCF CARDIO MD APS]

Dear Lindy,
The information provided to you by that nurse manager was right in that cardiomyopathy
is for the most part an incurable disease.  It was wrong however in stating that
patients seem to do better on IV inotropes as this is her anecdotal observation that
happens to be WAY OFF BASE.  And I will tell you why, of the little that we know of
cardiomyopathy, the therapies that should be given to the patient have born out in large
clinical trials across the U.S. as decreasing the known increased mortality (death rate)
in all patients with cardiomyopathy.  The most important medicine to give a patient with a reduced
ejection fraction (cardiomyopathy) is an ace-inhibitor. There are many different ace-inhibitors, some
examples are zestril, lisinopril, and acupril.  So long as the drug is not contraindicated (bad reactions to such
drugs, and the like), there is NO reason why a cardiomyopathy patient should not be on this drug.
The ace-inhibitors have multiple actions, one of which is to lower blood pressure, so often people think it
is for their blood pressure, when really it is for their heart problem.  The diet instructions your mother was
given are very important, as is regular follow-up with her physician.  Since cardiomyopathy tends to be a
life-long problem that often progresses to heart failure, it is very important that your mother see a physician that
she feels comfortable with, and she should consider a second opinion if that is necessary to find a doctor who explains
things in such a way that she can be involved in her own treatment.
Ionotropic drugs as that nurse spoke of are used as a last resort only, as they are known/proven to increase death rates in
patients with cardiomyopathy.
Other  than an ace-inhibitor, heart failure drugs of choice for patients with cardiomyopathy are diuretics, digoxin, and the one
other drug proven to reduce death rates (carvedilol-a beta blocker drug.)
A daily exercise program is usually prescribed for all heart failure patients, a specific type of cardiac
rehab.  
As for when a patient is considered for transplant, these patients in general are the ones who on all possible medication protocols (including IV ionotropes)
are still very very sick.  There are of course certain criteria to qualify as a transplant patient, but we will not get in to this
as your mother is not currently  in that state.  It would help greatly if someone in the family could go to the appointment with your
mother to ask questions (a reasonable number of course divided among the different visits.
I hope you find this information useful.  Information provided in the heart forum is for general medical informational purposes only.  Only your physician can provide specific diagnosis and therapies.  
Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your problem.