Low Blood Pressure, High Pulse, Ejection Fraction <26%

[simohammed]

Hi all,

My mother is 57 years old, she was a very healthy woman, does not smoke or drink, very active and eats healthy, she does not have heart disease in her family history. Last week, she had a mini stroke (lost ability to speak for about 15 min where she forgets words but came back and she was normal) , took her to ER to be checked, an Xray shows an enlarged heart, EKG shows incomplete bundle block and Echogram was normal, no blood clots, no blockage, blood tests are also normal, no enzyms of heart attach or anything. They also do a TEE and AngioCardiogram no heart blockage but they are saying she has an EF of 26 % or less.
Doctors are saying that an ICD ( pacemaker) will help, I need your advice if we are missing anything and if an ICD is the best way to go. or if I should ask her doctors further questions.

Thank you very much!

Simo

[simohammed]

Updates:

Mom is doing much better, everything is back to Normal, she sometimes feel dizzy, breathing much better  (BP 101/76) Pulse 102, we have an apt next week with a cardiologist for the first time after ICD was implanted.

Thanks to all for info

[simohammed]

Thanks guys for all your replies: My mom never had arrhythmias but we decided to go with the device, it's the Bi-V pacemaker and ICD, the electrophysist said that she had 2% chance of survival reason why we decided to do it. We did not want to take any chances. She was also given Coreg, Plavix and aspirin. Her Shortness of breath is much better but her BP is still low probably due to Coreg (90/60) and her pulse is almost always (100 - 125) depends on activity.
One thing i noticed is that her left arm is swollen, I'm not sure if this is normal after the surgery (cardiologist said it's no big deal) , it's getting better day after day but she still have a big mass in her elbow area.

Any advice for us?

Thanks!

[kenkeith]

QUOTE:
____________________________________________________________________
"Except for occasional spells of fatigue and listlessness, everything seems okay. Further investigations or interventional procedures not suggested by the consultant cardiologist. Can I live more anxious-free".
______________________________________________________________________


Your medication is likely the cause for fatigue and listlessness.  Many individuals with a low EF do not have any symptoms.  

My suggestion for less anxiety is to get into an aerobic exercise program.  Also, there is medication for relief.

[maggiemag]

The gold standard is a cardiac cath.  If her cath shows enlarged heart and a lower EF, she needs to be on a beta blocker like Coreg (Carvedilol), an ACE1 inhibitor, possibly Aldactone, diuretics, needs to follow a strict low sodium diet, and try to exercise.  Sometimes no cause is found for dilated cardiomyopathy.  I think a complete bundle branch block would be more worrisome, and possibly you might want to wait 6 months or so before jumping into an ICD.  That jumpstarts the heart if it would go into cardiac arrest, while a pacemaker is different.  A biventricular pacer has helped numerous heart failure patients but I think there are strict criteria for that, which she may not meet yet, like 6 months of optimal drug therapy and a complete bundle branch block. They can implant a combo ICD/pacer.   Sometimes with correct drugs and treatment, the EF can rise rather quickly to near normal, especially if the CM was due to a virus.    In other patients it may gradually creep up.  I think I would wait, but I am not a doctor.  Does she have runs of serious arrhythmias like V tach?  Maybe a visit with an electrophysiologist would help.

[sukumar794]

Which cardiac investigation can tell us in clear terms about the level or degree of heart muscle damage.?Ejection fraction 26% following a heart attack .It is almost seven months since the onset. Live entirely on dietary restrictions ,medications for hypertension,diabetes(lasix,aspirin,clopidgrel,carvedilol,stator,Glimipride and nitroglycerine).No breathlessness felt during walking sessions. Except for occasional spells of fatigue and listlessness, everything seems okay. Further investigations or interventional procedures not suggested by the consultant cardiologist. Can I live more anxious-free/

[kenkeith]

An EF below 30% is considered heart failure range and usually that reduces cardiac output to the degree that will cause shortness of breath, muscle fatigue, etc..  

An enlarged heart is almost always secondary to heart failure, but it can be primary and cause heart failure and a low EF.  Also, an enlarged heart, left ventricle, can cause arrhythmia, and the EKG indicates an incomplete BBB.  An ICD is recommended and advisable.  

You may want to ask the underlying cause for the heart enlargement.  Sometimes the enlargement can be reversed and the EF can rise to normal if there is no heart muscle damage.

Your mother is relatively young and if seemingly healthy otherwise, there is a good chance for a complete recovery.  Sorry to hear of you and your mother's experience.  

[Momto3]

WELCOME to the Heart Forum!

I have been told that an ICD is considered when the EF drops below 30 or 35%.  My dad had one implanted in 2006 for the same reason.  The theory is that someone who has a low EF is thought to be at higher risk for serious arrythmia or sudden cardiac death.  Will your Mom have a pacemaker also?  My Dad has a Bi-V pacemaker and ICD and his EF has improved!  We're waiting for the second series of tests later this year to be more certain, but so far all indications point toward improvement.

Good Luck!