how to improve ejection fraction

[sandiprshah123]

I am at the age of 47 Years having diabetis, Cholestrol & Hypothyrodism.Before three months it has been diagnosed by the Cardiologist from my 2D Echo that my Ejection fraction is 32%. Our Cardiologist- one of the Best in Ahmedabad, INDIA- Dr. Tejas Patel has suggested Engiography. On 3-11-11, I have gone through Engiography by Mr. Tejas Patel ( Intervention Cardiologist ).The report is NORMAL Coronary arteries- LMCA, LAD, LCX & RCA. In report it has been mentioned that EF is 25 %.Severe LV Disfunction. Global Hypokinesia.
You are requested to suggest the best medical treatment/ excercise/ any other suggestion/ remedies to improve my EF.
Thanks in Advance. From SANDIP R. SHAH , AHMEDABAD, INDIA.

[sandiprshah123]

No, Sir. On 30/7/2011, when I felt un easyness & concerned my Diabetologist first, on observing multiple VPCs , She suggested TROPONIN-T & TROPONNIN-I TESTs. The same day both the tests were performed & the result was NEGATIVE.

Regards,
SANDIP R. SHAH

[ed34]

I'm afraid I'm at a loss here. Your Mitral valve is normal, yet the left atrium is enlarged and your blood pressure is normal. Something is causing the low EF. Have you had a heart attack recently? Do you suffer unstable angina?

[sandiprshah123]

The reports OF 2D ECHO TAKEN ON 1/8/2011 are as mentioned:-
MITRAL VALVE- NORMAL,
AORTIC VALVE- NORMAL,ROOT SIZE- 38 MM,
PULMONARY VALVE- NORMAL,
TRICUSPID VALVE- NORMAL,
LEFT VENTRICLE- LVID DIASTOLE- 65MM, LVID- SYSTOLE- 57 MM, EJECTION FRACTION-32%, FRACTION SHORTENING- 16 %.
LV CONTRACTILITY- REDUCED
LEFT ATRIUM- DIALETED, SIZE- 46MM,
RIGHT VENTTIRICLE- NORMAL.
RIGHT ATRIUM- NORMAL.
PERICARDIUM- NORMAL,
MASS- NIL
VEGETATION- NIL, IAS- INTACT, IVS- INTACT, LVPW- INTACT, IVS/LVPW: 11/10 MM.

PULSED,HPRF,CW & COLOUR DOPPLER PARAMETERS
MITRAL- PEAK VELOCITY- M/SEC:-  E- 0.95, A- 0.74.
AORTIC :- PEAK VELOCITY-M/SEC. :- 1.28
PULMON :- PEAK VELOCITY- M/SEC :- 1.0
OTHER- TR :- PEAK VELOCITY M/SEC :- 3.2
                     PEAK PR GRADIENT M/SEC :- 4.2.
FLOW ACROSS IAS- NIL
FLOW ACROSS IVS- NIL
FLOW S/O PDA- NIL.

PLEASE REPLY FURTHER ANY INVESTIGATIONS ARE REQUIRED ? WHAT CAN BE THE REASON OF LOW EJECTION FRACTION ? WHAT TO DO FOR IMPROVING IN ADDITION TO MEDICINES SUGGESTED BY OUR CARDIOLOGIST.

THANKS IN ADVANCE
SANDIP R. SHAH

[ed34]

So your blood pressure looks good, but there is no mention of the condition of your valves. There are a proportion of patients where the cause is unknown, but have they mentioned any valve problems or infection?

[sandiprshah123]

PLEASE FIND THE REPORT OF ECHO 2D DONE ON 1/08/2011.
EF-32 % ( LV- 65/57 MM ), RS - Cli NAD, CVS- HEART SOUND- N,
ECG- MULTIPLE VPC. BP- 124/70 MM Hg.

THE REPORT OF ANGIOGRAPHY DONE ON 3/11/2011
LMCA- NORMAL, LAD- NORMAL, LCX- NORMAL, RCA- NORMAL,
LV ENGIOGRAM- SEVERE LV DYSFUNCTIO ( EF-25 % )
DIAGNOSIS- NORMAL CORONARY ARTERIES, GLOBAL HYPOKINESIA.
RECOMMENDATION- MEDICAL MANAGEMENT.

ON 3/11/11, SODIUM, POTESIUM, s. CREATININE ALL - NORMAL VALUE RANGE.

[ed34]

25% is low, very low and I'm wondering what the cause is, because it obviously isn't through ischaemia. Until it's determined what the cause is, personally I would feel reluctant to perform any exercises in case it makes the situation worse. When heart function is that poor, they usually recommend the implant of an ICD because you are at a higher risk of developing arrhythmia or even the heart stopping altogether. Did the Ultrasound not pick up any abnormalities? such as valve leakages or enlarged ventricles? was the muscle wall the normal thickness? Was any scar tissue observed, indicating a heart attack in the past? Have blood tests revealed raised white cell counts, indicating an infection? What is your blood pressure like?