30% Ejection Fraction

[meme2008]

My dad is 53 years old.  He had a quadruple bypass when he was 39 and a second heart attack in 2000 in which two or the original bypasses were blocked, one fixed with a stent and the other unreparable.  He has been a heavy smoker for most of his life and had high cholesterol that he has been prescribed medications for.  He has not been extremly compliant with the cholesterol medication because of experiencing muscle and joint pain side effects.  As a result, he took himself off of all medications last November 2007.  Now, end of January 2008, he finally went into see a cardiologist because of experiencing intermittent angina.  They did an angiogram and found that now 3 of the 4 original bypasses are completely clogged.  We were told that redoing the bypasses is not an option because of the damage done to the heart.  He has an ejection fraction of 30%, total cholesterol in the high 300s and his LDL is 254.  The cardiologist also said that he had 70% heart damage.  My questions are: what prognosis could you derive from the above conditions and is there any newer therapies that he could try instead of drug therapy?

[Sirenet]

Thank you very much for all the info and taking the time to research. Certainly give me much food for thought and point me in direction for more research of my own. Infinite thanks ! and enjoy your weekend...-Steve

[kenkeith]

Thanks for your kind words.  I have particiapted in this forum and another for 3 1/2 years, but your condition is unfamiliar so I researched with the attributes... congested heart failure and arrhythmia and early onset (3 and 4 decade) without prior symptoms or known heart condition.  The result that considers all attributes is a rare heart disorder that is genetic termed arrhymogenic right ventricle cardiomyopathy (ARTC) a rare disorder that is believed to be genetic.

It begins with the right ventricle muscle is replaced by fat and fibrosis which causes abnormal heart rhythms.  One can go for a long time and be unaware until arrhythmia episodes.  Eventually the left side is affected and congested heart failure ensues.  It is the second most common of unexpected sudden death in the young.

What treatment is available?

The majority of patients with ARVC are asymptomatic for many years unless arrhythmias develop. Treatment in the majority then aims to prevent or at least control arrhythmia with drugs. When drug treatment is unsuccessful, an implantable cardioverter defibrillator and other specialized treatments may be necessary, these include:

Catheter Ablation – This involves the delivery of electrical energy via a catheter inserted in the groin to the area in the right side of the heart where the arrhythmia is originating from. The overall effect is to create a small scar which is incapable of transmitting any arrhythmia.

Surgical Ablation – In individuals where the arrhythmias are originating from many different sites in the right side of the heart. Occasionally it is necessary to perform open-heart surgery. During the operation, the electrical pathway of the arrhythmia can be mapped, identified and destroyed.

An ICD may not be necessary if the operations are successful?!  Take care.

[Sirenet]

First, to meme2008; I am new to all of this so I am very limitedin my own info and not in position of offering any help for you. However, I am very sorry to hear of your Dad's condition and I wish the best, hoping he will improve soon.
To Kenkeith ;  Wow, I am both very sorry to hear of your condition, but also absolutely amazed at how well you are doing. How fantastic. You certainly seem to have been doing your homework. I am quite impressed at your knowledge as well as compassion.
   Your history remind me somewhat of myself, except for the CAD. My arteries are clean. Don't know if you remember, but you answered one of my posts.
  You must do quite abit of research, your answers/posts truly show your knowledge. Are you at all familiar with ICD's? I am told I need one  ASAP, but still unsure if it is for hypokinesis or the fact that I have arrhythmias ( MANY PVCs, Vtach, and SVTs). Reason I ask is if my meds (coreg,accupril,spirinolactone,simvatatin) raise my EF (down around 15-20% presently), is it possible that there may be no need for ICD in say, 3-5 yrs?
  Well, that's again.  Truly admire your insightfulness  and helping others.
  And CONGRADS on your success ! Glad to hear ..

[kenkeith]

Sorry to hear of your father's condition.  When the EF is <30%, it is considered to risky to operate.  There is EECP therapy that has helped those with angina who find no relief from medication and at a high risk for surgery or where surgery is not an option.  And there is a heart transplant.  

No one is able to prognosticate the time left very accurately.  Four years ago, I was taken to ICU with congested heart failure.  I had an enlarged left ventricle, EF29-13%, and coronary artery occlusions, and severe mitral valve regurgitation.  The LAD was/is totally blocked (collaterals bypass)  and the RCA was stented.  Surgery was not an option because of the enlarged heart and low EF.  Everyone including myself believed I had only months to live, but medication, healthy life style, exercise and diet has reduced heart size and EF to normal.  I feel very well every day since leaving the hospital, and no longer think in terms of months, but now in terms of years of survival...but I followed and am following the recommmended regimen!  If I hadn't, I'm sure my fate for survival was inevitable in a matter of months or a year or so...but who knows!