Low ejection fraction

[dswife1]

Please forgive my spelling etc as I am new to these things and am typing very quickly.

March 2011 my husband  (60 years old) was admitted to the hospital with congestive heart failure and non-sustained ventricular tachycardia. He had only symptoms of fatigue and shortness of breath. When we got to the heart hospital he was off the charts with the tachycardia and had an ejection fraction of 10%. At that time they could only put "the balloon" in to help his heart. He a tuff go of it for a while but has gone brilliantly to the good side. He has worn a Zoll external defibrillator for 3 months now and has had all good heart rhythms since coming home. No shocks were necessary. This appears to be controlled with his medication. He has stayed strictly on a cardiac diet and has lost 55 pounds and counting. He feels better than he has in years. He had an echo done last week and much to the surprise of his medical team his EF is still only 15-20%.  His appointment this week is to see about an internal defibrillator. He does not want one. He feels great. His work benefits are up and he drives for a city employer.

Geez, I can't seem to get this all to make sense.  

If his heart rhythms are controlled does the defibrillator help ? It doesn't do anything for his EF?  I guess I'm just looking to find out what his options are. I sure wish I would have found this site months ago.

Does the defib help him live longer ? Can he drive in a municipality with one ? Can he ride his motorcycle with one ? How long is the recuperation REALLY take.

I know that this is a lot so any bit of answers will be greatly appreciated.

dswife

[dswife1]

Thanks for your quick reply. His arteries are fine.

I thought they might give him more time for the medications to increase his EF. He has only been on the full doses of carvedilol 25 mg and enalapril maleate 20 mg for a month. He is on other meds but the ones I mention were specifically for EF and what we were told was it takes around 3 months on full doses to get good results.  As far as the driving goes I will check with the city and see what they say. I am thinking that if they do allow the internal def. then why not allow the external one for a few months to see what happens.

Any other suggestions are welcomed.

[jrbon]

I am sorry to hear that you have to face that difficult decision.

I assume that since you do not mention it, their arteries were all clear.

Let me try to clarify, as far as I know,  some of your questions:

1) The general rule says that below a 30% of EF, the def. it is indicated to avoid ventricular fibrillation and sudden death.
2) This is only based on stats, but your husband already have, at least an episode of ventricular tachys.
3) The defibrillator will avoid the sudden death.
4) The defibrillator ONLY will not enhance the EF.
5) However, depending on the situation of his heart, he may gets a defibrillator with pacemaker and even bi-ventricular pacing which may enhance the EF.
6) If there is no complications, he should be OK in 4-6 weeks after the implant.
7) Regarding driving situation you should check with your local traffic authorities what the policy is after the implant and after any possible fire of the def.
8) Some docs.  wait a longer, before the implant to give more chances to the medication to work. But this depends on the doc and the patient situation.

As I set do not forget that it is your husband final decision to accept it or not.

I know it is not and easy one because I also had to decide on it.

Good luck,

Jesus