47 Year Old Male with 35% EF

[slrow1]

I was diagnosed in 2001 (age 36) with Cardiomyopathy / CHF caused by a virus in my heart.  My EF was 10%. I was on a Heart Transplant list but have never had a transplant.  In June of 2002 I had an implanted pacemaker ICD.  I've been on Coreg, Furosemide, Lisinipril, Crestor, etc ever sense. In 2007 I had a replacement pacemaker/ICD.  My EF has been monitored regularly with some increase from the original 10% up to 40% at one time, but for the last two years has been constantly between 30% -35%.  I'm now 47 years old.  Still working and plugging along the best I can do to enjoy a "normal" life.  My questions are straight and contrite. What is my longevity?  Will I live another 5 years? What can I expect in the ways of my declining health?  Thanks in advanced to those who read this and thanks in advance for your comments.  All the best-  

[CCFHeartMD20]

Hi Sirow1,

Given you've had a change in the way you feel recently, I would make an appointment to see your cardiologist.  They can always do a a type of stress test that looks at your lung and heart function and can better assess your functional status to see if it has changed over time (a cardiopulmonary stress test).  If they are particularly concerned, they can do further invasive testing to see how well your heart is perfusing your organs, etc.  He/she can also check and make sure your medications are maximized.  The other thing I would focus on is your weight.  You should talk to your cardiologist about ways to modify your diet and get on an exercise program.  You may qualify for cardiac rehab, and they could help you with safe exercise regimens.  

That being said, again, just your age and your EF are not enough to determine your life span.  Your functional status (how much you can actually do), the number of hospitalizations you've had, etc. play a huge role in determining your prognosis (based on a large body of research).  Your cardiologist will be better able to answer these answers based on all these other factors.  I know how hard this can be, so I suggest you be very frank with your concerns with your cardiologist.  If you see a general cardiologist, they can also always refer you to a heart failure specialist who could further answer these questions.

Hope this helps!
CCFHeartMD20

[slrow1]

Thanks for your response.  I have been to the ER only twice with irregular heart beat or AFib.  I cam climb stairs slowly OK. I'm 6'1" and about 245lbs.  I work for myself as a salesman so I habe some flex in my day depending on how I feel. I do have a coach in my office and I lay down for about 45 minutes in the afternoon. I do notice now that it's getting morr difficult to breath and very easily fatiqued I've read that the average life span of someone in my age group with 35% EF is approx. 11 years. Any other suggestions or comments would be appreciated

[CCFHeartMD20]

Hi Sirow1,

It's always difficult to answer these types of questions online without seeing you, examining you, and having your full history in front of me.  That being said, I'll give you some of my thoughts.  First off, I would make sure with your cardiologist that you are maximized on your medications.  It sounds like this may already be the case, but it is worth mentioning.  

As to survival with heart failure, this is always the million dollar question.  They have actually done studies asking doctors to estimate the survival of their patients and have found we are wrong most of the time.  This is particularly true with heart failure as it can have a waxing and waning trajectory.

I am not sure what your functional status is like (how far you can walk before you have symptoms, etc) or how complicated your course has been (in terms of hospitalizations, etc), but your prognosis largely depends on these factors and not just your ejection fraction.  It sounds like your doctors are following you closely and that you have minimal symptoms (if any) at this point.  

It's good you are plugged into the transplant system should you ever need it down the line.  Remember, you are no longer on the transplant list presumably because you are too "well" at this point for a transplant.  Transplants are not without their own complications and risks, so we usually wait until you absolutely need one before proceeding.  That doesn't mean you wouldn't be a candidate down the road if you need it.  So, I wouldn't necessarily look from now towards issues of survival and longevity.  Instead, continue to do the things you should be doing: exercise per your cardiologists recommendations, take your medications, watch your salt intake, stay away from tobacco/alcohol, etc.

Hope this helps!
CCFHeartMD20