Next Step?

[Karissloane]

Hi,

I am a 27 year old female, 5'5 and 125lb. Last year my doctor detected that I had a fast pulse of 120 at rest. She sent me for an ECG and Stress test which both confirmed the high pulse rate. I was than sent for an echo which showed that my EF was 35% but everything else was fine. I was put on Mavik and another drug, but on very low doses because the meds lower my blood pressure. I than went for another Echo 6 months later. My EF at this time was 65% and so they left me on the pills. I was wondering what my next move should be, because I really don't want to stay on these pills any longer than I need to be because of how low they make my blood pressure, I often get light headed. Any suggestions would be a huge help thanks.

[CCF HeartMD-2]

Many times the cause of the heart failure is deemed to be idiopathic.  The heart rate elevation may have been related to the poor heart function.  You could have had a case of myocarditis or inflammation the of the heart muscle that has improved.  The issue here is that although you improved significantly, back to normal that is, you were put on medications that may have assisted or played a large role in returning your heart function back to normal.  We do not have good data on what we should do in these situations.  Should we wean the medication, should we continue it?  No one knows the answer to that.  Anecdotally, there are some doctors who have patients who improve on ace inhibitors and beta blockers, and when they are stopped, the patient has a severe bout of heart failure.  In other cases, some people wean the medicine and there is no problem.  While you are very young and you probably do not want to be on medications lifelong, you and your physician should talk frankly about the possibilities that may arise if you continue medications or wean them.  This is not an wasy decision and there is not much data guiding this decision.

[CCF HeartMD-2]

Happy to help, best wishes to you.

[Karissloane]

Thank you for the information and your advice, not to mention the quick reply. I really appreciate you taking the time to offer your expertise.

[Karissloane]

They said the cause was idiopathic, they had no idea what caused any of it. They did the echo to find out that the EF was low, they also did blood work and such. Everything was normal aside from the low EF. They said all the chamber walls looked fine, cholesterol levels were good, I had no risk factors so they were baffled. They are going to send me for another echo just to make sure the EF is still normal but I'd really like to find out the cause. This all came out of the blue and I don't really know the right questions to be asking.

[CCF HeartMD-2]

Was the fast heart rate thought to be caused by the heart failure or a consequence of the heart failure?  Was it sinus tachycardia or another arrhythmia?  These are important questions related to the cause of your transient cardiomyopathy and also has implications with regard to whether or not you need to stay on medications.  What work up was done to figure out the cause of your heart failure?  Cardiac biospy?  Catheterization?