Are there other options first?

[Preciousdays]

I am a 46 year old (mostly) healthy female. Last Oct. I developed pnemonia (pneumonia) and was hospitalized, an EKG at the time showed a lower left bundle branch blockage.  A subsequent echo revealed cardiomyopathy and an EF of 45%.  A holter monitor shortly afterwards recorded at least one episode of non-sustained V-tach.  A heart cath was done - it was fine.  - I was sent to an EP who wanted to hospitalize me immediately.  I sought a second opinion, and a new cardiologist suggested a more conservative approach. Keeping me on meds (toporol and altace, as I developed fluid on my lungs and confusion with coreg) for 6 months, and then repeating the echo.  My July echo showed an EF of 35% and I am now often short of breath and easily tired. No other symptoms. This cardiologist sent me to her in clinic EP who wants to do and EP study as well as a biventricular pacer / defib. combination. As the approach with meds was so conservative during this time of rapid decline, I am wondering if a more aggressive medication approach would be worth trying prior to implanting the pacer.  Thanks for your time and suggestions.

[Michael J. McWilliams, M.D.]

Hello,
I am sorry hear about your cardiomyopathy.  It is important that you be on maximal doses of tolerated medications including beta blockers, ace inhibitors, aldactone, as well as making sure that your blood pressure is controlled (if it is elevated).  If you are on maximal medical therapy and your cardiomyopathy is progressing, an ICD and possible BIV-ICD is reasonable.  There is very good data that people with LBBB, New York Heart Association class II or III heart failure on maximal medical therapy for at least 3 months befit from these devices.  Some people experience dramatic improvements with BIV pacemakers.

If you are on a stable dose of a good medical regiment, it is definitely worth considering.

I hope this helps.  Good luck and thanks for posting.

[Preciousdays]

I guess that's my concern:  I have no idea whether my medical regiment is maximized at this time. My blood pressure is extremely low - often less than 100/ less than 60. -  Thanks for your time and answers.

[degrassi]

The usual optimized med schedule should included an ACE and a Beta Blocker titrated up to the maximum dose..........for me it was 20mg of my ACE and 20mg bid of my BB ( Coreg)......I have had dramatic improvement with my Bi V pacemaker, and have been able to reduce both meds to the lowest dose........my heart is back to a normal size, and my  ef is 55-60%............I am also able to do daily aerobic exercise.  I still have frequent arrhythmia's but I have an ICD, and they are not that dangerous with a better cardiac function.  Good luck.