Defibrillator for a LVEF 40-45% ?

[millimel]

Pls help and enlighten me with your wisdom and experiences.
My husband's 2Decho result  LVEF 40-45%, Trace tricuspid and pulmonic regurgitation, E/A reversal, Right atrium is mildly dilated, an Atrial Septal Aneurysm is noted.
He just had a urgent  Cardiac bypass X1 after a Cardiac Arrest last June 2014. His monitor shows S.Rythm or S.Tachy during his cardiac rehab.
My question:
Does he need a diffibrilator with this result? I know his interv. cardiologist said he needs to have it if LVEF is below 50%. But how about if it improves as he heals.
Does this result a damage from  his cardiac event or a pre existing condition before the  cardiac arrest? He has a blocked LAD which they cannot declogged ended up doing CBAG , but he has collateral circulation that compensate blood supply. With my research Atrial Septal Aneurysm is congenital.
Does a 2decho shows a scar tissue or a heart muscle damage. Because I dont see it with the result.
What is the prognosis for this result, is it ok for him to be doing extensive exercise? He is a 45y/o, active, lean man. Cholesterol level used to be borderline high so he has been conscious with his food. I just don't understand why this happenned. Thanks.

[millimel]

Thanks jerry and itdood for sharing, yes we have an appt with EP cardiologist this week, to discuss abt implanted defibrillator and he should have answers to my questions abt the recent 2Decho result or so might be doing more test.  am just in the point where I want to read and be comforted with first hand experiences about this ordeal, though I know everybody is unique but I wish you all well.

[itdood]

p.p.s., my father is/was a very lean man, very athletic, and had no signs of ischemia.  His cholesterol at the time was 202.  No typical indicators.  He was a smoker though.

I quit when he had his MI.  I was a pack a day Marlboro man.  I quit when I was 20.  I obviously keep up with my heart health, my arteries are 100% open when last extensively tested when I was 42.  I'm 46 now.  The reason I'm here is due to electrical problems with my heart.  So my blood flow is good, and the muscle is good, but I get whacky rhytms for reasons no on can figure out and seem benign.

[itdood]

p.s., sorry, I just noted that I guess his age wrong.  Was/is he a smoker?

As an aside, my father had a massive MI when he was 42, on the LAD.  He almost died.  There was no intervention (no cath, no bypass, no stents) for some reason (back in 1988, but still very poor care). He received very poor care at Quakertown memorial hospital in Pennsylvania.  

This resulted in even further damage to his heart and eventual progression to a LVEF of 15%.  He was placed on a heart transplant list and was transplanted 5 months later.  This was back in 1988.  He's still here, working full time.  He's 69 now, just celebrated 26 years with the transplant.

Since your husband has prevented further damage to the heart hopefully the muscle can repair itself with the good blood flow.

[itdood]

Sounds like confusion to me.  I could be wrong, but I've not heard of LVEF as being the chief indicator for an implantable defibrillator (ICD).   People with perfectly normal LVEF's get them if they are prone to electrical problems with their heart.  A few electrical issues can result in the heart not beating right, so it doesn't move enough blood.  Some of the ones I can think of are pulse-less (asystole) ventricular tachycardia and/or course ventricular fibrillation.  

Your husband went into cardiac arrest.  It seems the root cause of this was restricted blood flow to the heart. Especially on the LAD!  They call heart attacks (blockages) on the LAD "widow makers", they are bad.   Oddly enough, the older you are when it happens the higher the survival rate. If it happens slow enough the heart has time to, as you mentioned" grow peripheral arteries, this is called "angiogenesis" or "nature's bypass".    If this happens in your 30s or 40 most people don't make it because they hadn't had time to grow branches.  So I'm guessing your husband is in his 60s+?

I would think that since your husband had a cardiac arrest he would be an automatic candidate for an ICD (I'm not an expert), no matter what his LVEF is.    Even if his LVEF improves and the blood suplly to the LAD is OK now, the process that lead to cardiac arrest may still exist. Also, an ICD will not do anything to improve LVEF.  The ICD is there to shock the muscle back into normal rhythm should it go into v-tach or progress into course v-fib.   Make sense?

[Jerry_NJ]

You mention cholesterol, the total should be held below 150 given his heart disease condition.  Didn't the cardiologist say anything about the target for cholesterol?  I take a generic Simvastatin, no side effects I am aware of and my total cholesterol is usually below 140 and that's with an overly high HDL, the good cholesterol.  

I am unaware of a low EF requiring a implanted defibrillator, but given the other problems it may well be advisable, indeed is as you say that is his doctor's recommendation.  If not that it could be a good idea to buy a home based (car - travel with him) emergency defibrillator and learn how to use it.

While I might seek a "second opinion", not from the web from from a specialist, I'd follow what the doctor(s) say.

Sorry to read of the problems as such a young age, my heart problems didn't affect my life, including running, until I was in my mid 60s.