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Avatar universal

Heart Transplant

hello all,

i am in the process to see if i am a candidate for a heart transplant. I went to see 2 surgeons , one is in favor of heart transplant and the other one says that she can agressively treat me with drugs. My EF is under 20, and the lung pressure what that means is 12 and it should be 15. the suregeon who wants to treat me with drugs only did visual physican examination and MVO2 test. The other surgeon did heart cath. On echo my ef is between 20% to 25 percent, on nuclear stress test my ef is 13%,  I able to do all the day to day chores without any problem. I am able to do all the daily chores without any problem,, i do get a little out of breath under exertion, like climbinng stairs or running. My EP and cardio says there is not other meds that we have not tried. I went to the second surgeon because he is in my insurance network. I also have a dual chamber medtronics defibrillator, I was shock free for 31/2 years., then last dec i got 9 shocks with one being a storm of 6 shocks. Now im shock free for approximately 6 months.

I am on following meds:
sotalol 320 mg twice/day    Mexiletine 200mg 3/day    Niaspan 1000MG 1/day, coreg 12.5 mg 2/day. digoxin 01.25mcg 1/day, spironolactone 25mg 1/day, warfarin 3mg 1/day zocor 40mg 1/day lisinopril 10mg 1/day. My question is what i sould do, go for a heart transplant or keep things the way they are. Thiis my first post thats why it's so long

God bless us all
david1
4 Responses
242509 tn?1196926198
MEDICAL PROFESSIONAL
The decision to transplant is not one left to a single person or surgeon. It is a dedicated team effort involving psychologists, physicians, nurses and clinical specialists. The medical part of the issue is easier to understand than the others, which are often dictated by socioeconomic status, support systems, abstinence from smoking, etc.
Quite simply you do not seem to have progressed in your heart failure to the point of needing a transplant. You are NYHA class II it seems from your symptoms, and have not ( appropriately received a BIV-ICD yet). The EF number is not as important as your functional capacity or symptoms: I would not use it as a measure of how things are going. Notice how different the echo and nuclear numbers are, for instance. I would continue with your medical regiment, all the while starting to get all the pre-transplant test done over the next 2-3 years. If your conditions worsens tot he point where you cannot maintain your current lifestyle, you may then be listed.
I think that you need to see a CHF specialist who can guide you through this difficult process: surgeon's are usually not people who perform this sort of service.
Avatar universal
According to my EP, Bi ventricle ICD is not going to help me after he reviewed my EKG. I do have a dual chamber ICD. Once again thank u so much for ur response..
Avatar universal
I have to agree with the CC doctor.  You are not on the target doses of the Coreg or the ACEI, your Lisinopril. The Coreg target is 25-50 mg. twice a day.   I think the Lisinopril would be 20 mg. per day.  Now that may be because you absolutely cannot tolerate a higher dose, like me.  Nevertheless, a CHF specialist would be a good start.  I didn't qualify for a bi-v either.  What is your BP?  They want you as low as possible without passing out.  I most commonly run about 90 systolic at home, and that is fine.
Avatar universal
thank u so much for ur response. MY BP is quite low without the lisinopril. i am normally average 90/60. I did talk to my ep abt raising my Coreg, he is hesitant because im also on another beta blocker at more than max dosage(320mg sotalol 2/day. Also there is some confuison whether u should regularly exercise or not , coz we are advised to rest our hearts, then why exercise. I am able to walk more than a mile without any problem.

david1
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