retired athlete with low ef

[ehutchins]

I have been a competitive marathon runner and have been told I have an "enlarged  or athletic " heart. I am 63 and recently had on EF of 40%. I have no symptoms, still run 3 miles a few days a week. My DR has put me on lisinopril 5 two times a day. I get light headed because my BP is low anyway. Is this EF reading correct or am I on meds I don't need to be? my resting HR was 43 when the test was taken, does that affect the results?

[kenkeith]

To provide continuity to my previous post, and comments on the following post that seems to be a misunderstanding if I read the remarks correctly:

QUOTE: I've seen EF;s as low as 15% and only your doc knows for sure what your test results are.

>>>>>An ejection fraction is computed by the doppler software associated with the echocardiogram (ultrasound).  The measurement is calculated by determining the volume of blood in the left ventricle at the beginning of the pumping phase (systolic) minus the beginning of  pumping phase (systolic) and divided by the systole volume times 100.  That is the ejection percentage and the doppler software does the calculations and it is an estimate with about a 5% margin of error. Anyone that reads the computer output can conclude the strength of contractions, doesn't requrie a doctor....below 50% is abnormal, and below 30% is the heart failure range.  NYHA class1 is heart failure without symptoms, etc. Anyone that can read knows the approximation of the EF from the written report generated from the doppler software. (Doppler color codes the blood flow into the left vetricle and how much blood out of the left ventricle...).

QUOTE: The EF is based upon the force of the bloodflow and O2 that is coming in and out of the heart and if your pulse rate is lower and a little more sluggish it would make sense to me.  

>>>>>>EF is not based on the force of the blood flow.  It is based on volume of blood pumped with each heartbeat.  The reason it is not based on force of blood flow is that  contractual functionality does not take into account Mitral valve regurgitation (back flow rather going into circulation) and/or aorta stenosis, etc. Either condition will reduce the volume output so output is the correct parameter to estimate the EF. Also, 02 does not directly relate to the EF percentage .  However, indirectily low 02 can cause hypoxia and that condition can impair heart wall movement and reduce EF.

"Pulse rate and EF":  Blood flow dynamics that includes PS and EF are compensatory mechanisms that counter balance each other normally.  If the EF is low, that would reduce the cardiac output (CO), and because of the low output the heart increases the heart rate (pulse).  If one understands the dynamics and coping mechanisms for low cardiac output it would make sense.  When there is a low CO the body system (recognized the same as losing blood) the kidneys increase volume, there is vascular contriction; increases blood pressure and volume of blood available to the vital organs, the heart pumps more blood (increase in blood flow) that will increase heart CO (stroke voume times heart rate.

[cindy707]

The great thing about having an EF at forty is that with lifestyle, dietary and med intervention your EF rate can improve.  I've seen EF;s as low as 15% and only your doc knows for sure what your test results are.  And yes it would make sense that if your pulse rate were that low and your EF was that low that it would be effected.  The EF is based upon the force of the bloodflow and O2 that is coming in and out of the heart and if your pulse rate is lower and a little more sluggish it would make sense to me.  As far as questioning the meds you are on..i think more importantly is that you are questioning the doc and that throws a yellow flag at me that you need to consider getting a second opinion...good luck to you with this...

[kenkeith]

There is some inconsistency in the report.  An athlete's heart pumps well because it has stronger contractions.  The resting heartbeat is below 60 (normal) at rest, but a 43 may be too low!? An athlete's heart is not pathological and returns to normal size with reduction of the hear's workload.

The inconsistency is your heart is not pumping adequately as 40% (50 to 70 EF is normal) almost always indicates weak contractions and not strong contractions from an athlete's heart.  Also, the ACE inhibitor (lisinopril) dilates the vascular system and reduces the heart's workload that can cause hypertrophy (pathological). Usually, lisinoprol treats high blood pressure, so it is not clear why you are on the medicaiton?

It is possible to have an athlete's heart enlargement and hypertrophic heart muscle.  A low heart rate can effect the results of the test.  It can effect an EKG and an echo, but the low HR should be factor in for a correct evaluation....also, all tests are not always accurate?!

Hope this helps, and thanks for the question.  Take care.