EF lower still lower 10 months after open heart/valve replacement surgery

[Mel043]

My father currently has an EF of 19% which has remained unchanged since Feb 2010.  He had open heart surgery and had two valves replaced along with 2 bypasses.  Prior to the surgery he'd had several stents (7) and his EF was 45%.  Right after surgery is was 20% and has not improved any.  He has a lot of fatique and generally feels bad.
His meds daily include: asprin 81 mil,  glipizide 2.5  (for diabetes sugar), Heart meds (coumadin -for mechical valves, lasix 20 mg, metoprolol 75m (beta blocker), amiodarone/cardavone 200mg, spironductne - 12.5 m)
I'm not sure what all these are for...he does have a pacemaker/difib device that was put in mid-july.

My question is 2 fold:  Is it typical to see a worse EF after procedures designed to help?  Is there a problem with his meds?  We are in a remote area and I'm wondering if our cardiologist is really doing everything they can.  Seeking advice on next steps to improve his chances.

[jrbon]

I am just a patient, but I have been reading uses and side effects of amiodarone/cardavone
here: http://www.rxlist.com/cordarone-drug.htm and I wonder if this medication is left forgotten from before the implant of the defibrillator. It seems that it can produce the reduction in EF.

The question as already said, is what your doctor says.

[gmachris518]

If you don't trust the opinion of the doctor who is taking care of your dad, then be all means finds another one, and get a second opinion.

I've been battling CHF for almost 4 years, now, using Coreg, lasix, and several other drugs.  I also have a defib/pacemaker in my chest.  My EF went from 15% to between 20- 30%, yet I'm still stage 4 heart failure.  I also have stage 5 kidney failure, and have dialysis 6 days a week, which is supposed to increase my EF....but nothing.  

I don't think the doctors really know what to do for a patient with CHF.  They just do what they know has worked for others, and hope that it will work for their patient, which a lot of the time isn't the case.  


Does his doctor give any reason for the lower EF?  The treatment as you have conveyed it, looks right, but it doesn't work the same for everyone.  How old is your father?  Does he follow a strict diet, and take all meds on time everyday?  There are a lot variables to deal with when you are fighting CHF, and if you don't deal with all of them, CHF may win the battle.

I hope the best for you and your father.

[SLadylani]

Mind you, I am just a RN, but 19% EF after having 45% in february? The surgery should not be decreasing EF and certainly not that much. I am glad the stents helped. Fatigue and generally "feeling bad" would be expected with that EF. His medications-lasix (diuretic used for high blood pressure and other diseases), beta blocker, amiodarone (antiarrhythmic for heart disease), and spironductone (potassium sparing diuretic used to limit the amount of potassium lost with most diuretics) all seem to be what I would see my patients on. I guess my question is, how old is your father and what would he like to do at this time, continue aggressive management for improvement or try comfort measures to treat symtoms?