Pacemaker and EF

[sammacel]

Age:71 Male; BP 120/80: From Operative Report of August, 2008:  Impression: Occluded vein graft (done 1990) right coronary artery.  Occluded mid right coronary artery with distal filling via homo-collaterals from left circumflex.  Normal ventricular function.

I have had a fatigue problem for a few years, my resting pulse has always been in the 50's until about 18 months ago when it dropped into the 30's which resulted in a pacemaker and daily 25mg Atenolol.
My pulse now runs in the 70's and my blood pressure is still good but no improvement in fatigue. I told the cardiologist that fatigue had not improved but he just said continue with the Atenolol. I also take Lipitor 20 mg, aspirin 81mg, Ambien 10mg, Xanax 0.25mg.  

Just had a treadmill stress test at my GP's office which was scheduled as a result of a possible TIA (sudden memory loss and confusion for a minute).  At rest my Ejection Fraction was only 40% (was around 60% about 3 years ago).  The EF increased to over 50% when my pulse rate was high and the pacemaker no longer controlling things.
My carotid arteries checked fine if that has any bearing.

My GP told me to cut the Atenolol in half and gave me an RX for Enalapril Maleate 5mg daily.  He said hopefully the Enalapril would dilate the output artery(my words?) and increase EF and blood flow thus reducing fatigue.

Does this sound reasonable and do you recommend other actions?  Would changing the settings on the pacemaker make any difference?  Is there anything new in the way of clearing old occluded arteries?

Thanks, Sam

[kenkeith]

I am somewhat confused based on the information on your post. The ejection fraction (EF) is the amount of blood pumped into circulation with each heartbeat.  I haven't ever heard of an increase of the EF when pulse rate increases.  Cardiac output (CO) is increased and that metric is the total amount of blood pumped into circulation based on heart rate for one minute.  A pacemaker would control the heart rate.

QUOTE: "My GP told me to cut the Atenolol in half and gave me an RX for Enalapril Maleate 5mg daily.  He said hopefully the Enalapril would dilate the output artery(my words?) and increase EF and blood flow thus reducing fatigue".

The quote makes some sense.  EF is closely related to the heart's ability to contract forcefully and the more forceful the stronger the contractility and and amount of blood pumped with each heartbeat.  If there is high resistance usually due to some constriction of vessels, the heart's increased workload can cause the heart to lose contractility force over a period of time.  This is because the left ventricle enlarges and the increased in size can/will cause weaker contractions.  The medication that dilates vessels decreases the heart's workload and the LV can return to normal size and increase EF.

If cardiac output is too low there can be symptoms of fatique.  Medication can slow the progression of vessel occlusions, but it appears there isn't any remedy to clear the occlusions.