Questioning echo readings.

[sm347]

I am a 53year old that is doing really well considering my cardiac issues.
At 28 years old I qualified for a transplant and was put on experamental medication.  My first cardiac arrest was at 27 year on the job and I was placed with one of the first 2000 Defibulators. (the original AICD)  My EF then was 19 by mugga scan and 16 per echo. I still have defibulators to this day and I am currently in echo school and learning how to scan hearts.
Through time my EF slowly rose to 53%.   My measurement at school have not been looking to good.  I went in to have it professionally done again.  Questioning deterioation.   Yes they use contrast on me now.   My LV measurements being LVIDd 5.5 and LVIDs 4.8.   We are placing these numbers in our EF calculations and my calculated EF is 24%!  My sats are good, still throwing PVC's this is normal for me.    What blows me away is the visual EF is 45-50%.   Meaning I am normal.  We are all blown away with this.   Anyway other than getting winded at times, I am compensated.   Any remarks???    How can there be so much of a difference between calculated and visual EF?   Another thing, I have a "dent" in my right ventricle?   No I do not have pectus extravatum, or what ever you call it.  Any ideas?

from Lucky to be alive!

[sm347]

I have an idopathic DMC, Dialated cardiomyopathy.  It appeared after the delivery of my last child when I was 28y.  At this time I had an EF of 19 per mugga scan and 16 per echo.   I had the choice of experimental medication or a heart transplant and went on the femaldapam study, which was taken off.  (This was after I had my cardiac arrest at 29)   I had my first cardiac arrest after it was open labled. (The arrest, was not a heart attack, with blocked coronary arteries, but due to rythum dysfunction due to  the stretched myocardium of the DMC and maybe the experamental medication.)   Since I have been on Vasotec, and Coreg, for most of my life now.  Yes; in time my EF did rise to 53 but I would say through the stresses of life, it has fallen again for me.  See the note from CFHeart.  We are scanning me in class all the time and my measured EF is 24 on the 2D parasternal long and M-Mode, but the visual one "with Contrast" done at the clinic is estimated at 45-50. (Their 2D measurements were the same as what we were getting in class on me.  I used to be thin but through time I have gained wt.  Working on that.
You are getting stents, meaning there are blockages that they need to keep opening.   I just have thin stretched dialated cardiac walls. At one point I was told that the inner lineing of my heart was a scared mess. Up until now, my coronary arteries have been clear and good.    Yes I get stressed out at times, being trained in the medical field, "I know too much". I am also a Registered Respiratory Therapist.   My situation now is compensated and stable.  My heart is beating, and moving blood in the right direction.  I have a small mitral regurg. that is normal for a DMC and a pulmonary regurg, that is normal as well.
I do not know if your measurements are 2D or visualized.   I am sure they know what they are doing.  Vaso tech or enelipril and Coreg have done good for me.  one is an Ace inhibitor and the other is a beta blocker.  You may already be on these.

[realladyb]

I will be 53 on January 4th. I too would be doing well without my cardiac issues. Did you not have a transplant because your EF elevated with use of the experimental drugs? I had a massive heart attack at 40 with a 100% blockage and 3 others above 80%. I don't have high blood pressure or any problems with my cholesterol though I was TOTALLY stressed out. I received 4 stents. One month later, they all closed and they went back in a restented the 4 and added 1. I now have 9 total and a defibulator/pacer. Four years ago I went through all of the necessary testing to determine that I would be a good candidate for a heart transplant. Just as I was expecting to go on the National Transplant listing my EF rose to 40%. Over time up until recently, I was doing ok then suddenly my EF dropped again. Once again I was determined a good candidate for transplant and am now on the National listing waiting for a heart. I am now on a dobutamine drip at the lowest dose. I am otherwise outgoing and healthy. What were these experimental drugs and are they still helping?

[sm347]

Thank you.    This was rather technical.  Yes I can understand the the answer.  :)  I am actualy doing quite well with sats at 98 at 1200  ft.  alt. (Midwestern state)

[CCFHeartMD21]

Interesting question. Visual EF is generally a approximation by the reader taking into account various views including parasternal long/short axis and apical 4/2chamber. Using only the parasternal long measurements to approximate EF is often not very accurate as it only takes into account the movement of the base of 2 walls. Measuring EFwith 2D echo is generally done with volume measurements from the apical 4 and 2 chamber views if there is good myocardial definition. I hope this answers your question.