has has cardiomyoapthy 30% EF and Im scared

Hi, my husband is 37 yrs old on dec 29 2007 he was doing some heavy manual labor and went into V-tach he drove to the hosp, heart was 325 bpm, they cardioconverted, kept for testing,cath was normal other than it showed EF of 30%.  He had a pacer/defib put in on Jan.  Other than that episode there has never been another attack.  He is on prinivil and coreg 25mg 2x daily.  Since he was at work when this happend WC has been covering it, saw the Dr. on Monday and he told my husband, they will do an echo in Jan and if there has been no improvment, he will need to start seeing Dr. at Tampa General Hosp. to start the process for a heart transplant.  Needless to say we have closed the WC file and have an apt on the 17th with a cardiol. I use to work for.  I know 30% is not good, but if it has not gotten worse, why jump to the heart transplant.  He feels fine no adema, gets tired if he over does it but other than that he feels good.  He feels that his arrythmias have become less frequent.  I am very scared about the future.  We have a 2 yr old little boy and he has a 15 and 11 yr old with his ex wife.  They have no idea what has caused the cardiomyopathy, no durgs, alcohol abuse, he was adopted so no family hx.  I guess thats called primary cardiomy.  Does Coreg have a good success record over all, I know each case is different.  I have done so much reading about cardiomy and get different stories, some sites say its hopeless for the most part others that with time and treatment the heart can heal itself.  Just need some adivce, cant wait to hear yours.

[kenkeith]

V-tech will reduce cardiac output as measured with EF calculation...below 29% is considered heart failure although some individuals function very well belwo 29% (well compensated).  It does appear to be a gigantic jump to go from an arrhythmia (possibly under control with meds) and a heart transplant.  Without knowing the underlying cause for cardiomyopthy it is considered ideopathic and it is true it is a primary condition...unfortunately being primary and ideopathic there is no underlying cause known that can treated.

But it is possible that an arrhythmia problem can dilate the left ventricle causing a lower than normal EF, and a dilated LV can cause arrhythmia!

[Momto3]

Hi ameek320,

I am very surprised that the doctor has suggested a transplant may be necessary if your husband's EF does not increase by January.  My Dad EF was about 24% for a LONG time, and with the help of medications, he was stable and doing well.  He now has an ICD because current studies indicate it is a good idea for EF of 30 of less.

Coreg is supposed to have an excellent reputation for helping raise the EF.  From what I understand, it is most effective to titrate the dose as high as tolerable (I'm sure within guidelines).  

Does your husband still experience tachycardia?  I actually developed what is called PVC-induced cardiomyopathy.  Came pretty much outta nowhere.  I was pretty shocked when I got the phone call letting me know my EF had dropped to 40%, and they weren't sure why.  Long story short, I had so many PVCs that my left ventricle dilated and could not function properly.  I had 2 procedures (ablations) to ablate the foci (irritable spots causing the arrythmia) and over the course of about a year, my EF slowly returned to normal. This is a rare result of tachy and/or frequent PVCs, so it might be worth asking about since your husband has a HX of tachycardic episodes.

I think I would try and consult another cardio group for a second opinion.  I also thing jumping from a tachycardic episode and a low EF to a heart transplant is quite a leap.  

Take care and please let us know how he is doing.

[amm2001]

they checked his pacer/defib on monday and his last arrthy was recorded on June 21 lasted for 1 hr and 10 min.  thank you all so much for the reassurance.  About titrating the coreg, thats what we thought.  The Dr. I use to work for said that is how it is to be done and could take 1 to 3 yrs to see the improvment.  Then workers comp took over the case and we could not see Dr. Elchahal anymore.  The Dr's he is seeing now said his Coreg does not need to be titrated up, he has been there 3 times and has seen a different Dr. each time and they all say something different, the one thing they all agree on is that his coreg does not need to be titrated up, that lack of confidence and the big jump from now to a heart transplant is just crazy and why are now using our private insurance so we can start seeing Dr. Elchahal again.  Every dr. who has seen him  believes he either developed the cardiomy from chemical exposure (a suage bypass exploeded on him in Oct of 2007 (again while he was at work) and it could have had toxic chemicals it as who knows what all people dump in the toilet/sink) or right after that he got the flu really really bad, 2xs like 4 weeks apart and they say the flu could have infected his heart.  But then again since he is adopted it is all a big guess.  I will keep you posted, we see Dr. Elchahal on next wednesday.  I cant wait as I am a budle of nerves

[Momto3]

Do you suppose Dr. Elchahal would see your husband for one visit at a reduced rate?  It does not sound like you guys are confident with what you are hearing (and I don't think I would be either based upon what you've said).

The chemical exposure very well could be the answer, but as you say, it's a tough call at this point.  Hang in there and try to enjoy the weekend with family and/or friends.  Do something fun, take in a new movie, go out for breakfast, invite friends over....but, take some time off (even if it's just a teeny bit) from your worries.

connie

[maggiemag]

The target dose for Coreg is 25 mg. twice a day unless he weighs over 225 lbs I think..  
So it may very well not need to be titrated up further.  His Prinivil may need to be increased, but you didn't say what dose he is on.  It has only been a little over 6 months since diagnosis, and they sure are jumping the gun to talk transplant, IMO!!  It can take several years for the EF to respond.  I went from 15% EF to 55% in about 3 years.  Back down to 35% but that is still plenty enough to function well for me.  Go to a board certified cardiologist who follows the treatment guidelines.  Your husband should closely watch his sodium intake and take the drugs as ordered, exercise after an ok from his doctor.  His EF may very well rise to normal in a few years or even less.  If he has only some fatigue after overdoing it, that is common on a beta blocker like Coreg.  And I have never heard of a chemical exposure causing CM, unless it was from chemo.  Many times we  just never find out why we have it, and it is best to not waste any time wondering, IMO.

[Momto3]

I'm SO glad you stopped by!!  I was hoping you and some of the others who have a really good understanding of CM would see ameek's post!!  

Hope you are feeling well and enjoying the summer!

connie

[amm2001]

Hi every one!  I wanted to tell you my husband had an echo and guess what!  His EF is at 55%, they believe his cardiom. was caused by a viral infection.  We were very happy to hear the results as we were very worried by what the Dr. in lakeland told us about the heart transplant.  He will have another echo in Jan and if it is still good, I think that are going to wean him off of his coreg.  Any ways I wanted to say thank you for all your support and words of wisdom, you were all right!

[Momto3]

This calls for a celebration!!  Great news ameek320!!

Enjoy the day!