Increase In EF - Cardiomyopathy

[Bally88]

Hi there.  In December last year my wife was in hospital receiving surgery for a cancer (VIN) and while there her heart rate fell through the floor.  An echocardiogram was done and showed an EF of 30-35%.  In March this year another echo had an EF of 50% (marked increase) however the third one done last week came in at 40% which shows a decline again.  The reason why escapes us.

My wife (Sally) is on Dilatrend and Adacand.  The ACE was producing a significant cough hence the change to Adacand (however the cough is now returning yet again.  

Do you have any thoughts on why the decrease in EF, is it normal and some prognosis thanks.  Really appreciate the assistance - and what a wonderful idea this site is!

Best wishes,

[Douglas Bogart, MD]

I can't really know why the EF decreased but were all the echos read by the same person.  There can be inter-observer variability which might account for the difference.  With no symptoms of heart failure, I assume, it should be fine for the surgery.

[Douglas Bogart, MD]

I don't know what Dilatrend is--it may be diltiazem.  You might ask the doctor about a beta blocker such as carvedilol--which has been shown to improve the left ventricular function.  The better the LV function the better the prognosis.

[davidvee]

A related discussion, Improving EF was started.

[Bally88]

Thank you Doctor for your time answering this.

The Carvedilol is in fact Dilatrend - probably marked differently here in Australia.  Sally has been on that now for some time.  May I ask two more questions?

Why would her EF have decreased?

With an EF of 40% is it possible for her to have an operation on her shoulder to remove bursitis (the operations may be in a month or two?)?

Thank you again for the wonderful service that you and the other doctors perform here - it is truly remarkable.

Best wishes,

Robert and Sally