Interventional Cardiology Expert Forum
Low EF
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Questions in the Interventional Cardiology forum are answered by medical professionals affiliated with the Truman Medical Center. Topics covered include acute coronary syndrome, angina , atrial fibrillation , cardiac catheterization , cardiomyopathy , drug abuse & cardiac disease, echocardiography , heart failure , hypertension & heart disease , lipid management , minorities and heart disease, peripheral vascular disease prevention, valvular heart disease , women’s heart health, and the warning signs of a heart attack.

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Low EF

I am a 52 year old female.  I have had a mi in 8/05 with one stent in the back of my heart.  I had 2 more stents added in 01/06 to the front of my heart.  I had a double mi in 4/07 because 2 stents failed simultaneously.  I had 3 more stints added at that time and was on life support for 8 days.  I had an arteriogram in 8/07 at which time one of the new stents was blocked with scar tissue.  It was cleaned out.  My ef at that time was 15%.  They have done a platelet study which shows plavix to be ineffective on me and they increased my asprin to 325mg but advised me to continue to take the plavix "just in case".  I have since developed shortness of breath, difficulty in walking any distance and am extremely fatigued.  I take the following meds:Zoloft 50mg; Lipator 20 mg; Amiodarone 200mg x2; Furosemide 80mg am & 40 mg pm; Aldactone 50mg x2; Plavix 75mg; Toprol; XL 12.5mg; Asprin 325mg; Nitropatch .2mg; Diazepam 10mg; B-12 1cc month; Lantus 80 units.  My cholesterol is 153 and my A1C is 7.5.  I was on Altace but was taken off because of my low blood pressure.  I can not take Coreg because I have severe breathing issues on it.  My BNP was up to 737 but was down to 345 after my diaretics were increased(in 3 weeks). I quit smoking on 4/07 when I had the last mi.  My blood pressure is low and always has been, now averages 85/60, heart rate is 49-51.  Is there anything you can suggest that I can do differently to feel better, I was very active and independent before my last heart attacks.
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This is a very complicated past medical history and it would probably be in your best interest to discuss this with a physician who is more familiar,but I am happy to try to help-

It  sounds like you are having worsening heart failure symptoms. I would ask your physician whether or not you are a candidate for aldactone and / or digoxin therapy. I am surprised that you are not on an ACE inhibitor (lisinopril,for example)--is this because you have kidney problems? I would ask about this as well.

You may be feeling tired because your pulse is so low; interestingly,amiodarone can cause thyroid problems so if this hasnot been evaluated I would suggest it-- low thyroid levels can make one feel fatigued and cause a low heart rate (or it may simply be that you are getting too much beta blocking: the combination of amiodarone and toprol)

YourA1c needs tighter control--- goal of </=6.5% and your LDL cholesterol should be </= 70.
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