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Blockage Of LAD Artery, EF Of 30, Significant CHF, Rapid Heart Rate. What Do You Think About EF Improving?
Question: My husband had 100% blockage of his LAD artery 6 weeks ago.He has survived with an EF of 30, significant CHF, and very rapid heart rate. it was as high as 147-128 in CCO, but with Coreg, he averages in the low hundreds. He is in cardiac rehab. 3 days per week and is feeling a little stronger. His doctor advised that he suffered a lot of damage and has lost about half of his heart muscle.He is very pale, cool to the touch at times and still has severe
bouts of fatigue. he still has moderate CHD in 4 arteries...3 circumflex arteries , two 25-50 % and one of them 50-75% , and 25-50 % in the RCA. He is following a low fat, low sodium,
no caffeine diet. He is a construction project manager and is determined to go back to work.
This is a man that was doing 200 push ups per day, played golf, had a cholesterol level of
105 upon admission to the ER, and perfect blood pressure. It is family genetics that has
apparently caught him, we were living in a false sense of security as his yearly physical was
always ended with an excellent report. His cardiologist advised that he should file for XXXXXXX
disability...and that he can always go back to work if he improved beyond expectations. I'm
not sure if he is just trying to keep his spirits up or if he really thinks he will recover to that
extent. What are your thoughts about the EF improving and his return to work?
bouts of fatigue. he still has moderate CHD in 4 arteries...3 circumflex arteries , two 25-50 % and one of them 50-75% , and 25-50 % in the RCA. He is following a low fat, low sodium,
no caffeine diet. He is a construction project manager and is determined to go back to work.
This is a man that was doing 200 push ups per day, played golf, had a cholesterol level of
105 upon admission to the ER, and perfect blood pressure. It is family genetics that has
apparently caught him, we were living in a false sense of security as his yearly physical was
always ended with an excellent report. His cardiologist advised that he should file for XXXXXXX
disability...and that he can always go back to work if he improved beyond expectations. I'm
not sure if he is just trying to keep his spirits up or if he really thinks he will recover to that
extent. What are your thoughts about the EF improving and his return to work?
Hi AAAAA
Thanks for posting your query.
As your husband has positive family history, you should take extra precaution.
Ejection fraction (EF) represents the volumetric fraction of blood pumped out of the cardiac cycle.
LAD is the main artery amongst the three arteries of heart. This artery supply major part of left ventricular and blockage of this artery will affect heart tremendously.
Damage has already involved a major part and his ejection fraction is very low.
Although time has to be given for self recovery along with medications.
Few medicines are available that can increase EF with time such as ACE inhibitors, ARB's, Eplerenone.
You should consult with physician and cardiologist and should go regular check up and detection of EF.
Regular check up will guide the status of EF whether improvement or deterioration.
What is his ECG status? Is it normal or have some arrhythmias also?
Presence of arrhythmias may affect EF and there is high probability of getting arrhythmias.
If his blood pressure is normal then you should go for low dose ACE inhibitors and beta- blocker.
Beta- blocker are the best as they will reduce the possibilities of getting arrhythmias and heart start working with low blood supply (as in your husband case) as these drugs will reduce the oxygen demand of heart.
If he is getting chest heaviness, breathless on lying condition, crepts on chest examination (by treating doctor) then you should go for Eplerenone. This drug is effective in Low EF cases with systolic dysfunction (if your husband 2 D echo suggest systolic dysfunction)
If his blood pressure is on lower side then you should wait for a time till his blood pressure gets its normal limits.
Put your query if you have.
Best regards,
With wishes of speedy recovery.
Dr. Mayank Bhargava
Thanks for posting your query.
As your husband has positive family history, you should take extra precaution.
Ejection fraction (EF) represents the volumetric fraction of blood pumped out of the cardiac cycle.
LAD is the main artery amongst the three arteries of heart. This artery supply major part of left ventricular and blockage of this artery will affect heart tremendously.
Damage has already involved a major part and his ejection fraction is very low.
Although time has to be given for self recovery along with medications.
Few medicines are available that can increase EF with time such as ACE inhibitors, ARB's, Eplerenone.
You should consult with physician and cardiologist and should go regular check up and detection of EF.
Regular check up will guide the status of EF whether improvement or deterioration.
What is his ECG status? Is it normal or have some arrhythmias also?
Presence of arrhythmias may affect EF and there is high probability of getting arrhythmias.
If his blood pressure is normal then you should go for low dose ACE inhibitors and beta- blocker.
Beta- blocker are the best as they will reduce the possibilities of getting arrhythmias and heart start working with low blood supply (as in your husband case) as these drugs will reduce the oxygen demand of heart.
If he is getting chest heaviness, breathless on lying condition, crepts on chest examination (by treating doctor) then you should go for Eplerenone. This drug is effective in Low EF cases with systolic dysfunction (if your husband 2 D echo suggest systolic dysfunction)
If his blood pressure is on lower side then you should wait for a time till his blood pressure gets its normal limits.
Put your query if you have.
Best regards,
With wishes of speedy recovery.
Dr. Mayank Bhargava
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. AAAAA
He is on Coreg, a Betablock, but his blood pressure is too low for an ace inhibitor. they have mentioned putting in a defibrulator in about a month, after his next echo, if the EF is still low.They have mentioned irregular arhymethias. back to the initial question, have you ever dealt with a patient with this amount of heart damage and low EF that was able to regain a higher EF and return to work? I am trying to prepare him for disability, but he is determined that he will go back to work. I am trying to be realistic and want to be sure that I can help prepare him for the proper outcome. I realize you can't possibly predict his final prognosis. He has severe damage to the entire left side of his heart and moderate disease in the remaining right side. I just want to be sure our expectations are realistic and help him adjust to his new normal.
He is on Coreg, a Betablock, but his blood pressure is too low for an ace inhibitor. they have mentioned putting in a defibrulator in about a month, after his next echo, if the EF is still low.They have mentioned irregular arhymethias. back to the initial question, have you ever dealt with a patient with this amount of heart damage and low EF that was able to regain a higher EF and return to work? I am trying to prepare him for disability, but he is determined that he will go back to work. I am trying to be realistic and want to be sure that I can help prepare him for the proper outcome. I realize you can't possibly predict his final prognosis. He has severe damage to the entire left side of his heart and moderate disease in the remaining right side. I just want to be sure our expectations are realistic and help him adjust to his new normal.
Hi XXXXXXX
I have seen patient with only 15-20 % EF and we can say your husband is on better side.
These patients are still surviving although not able to perform all routine activities such as climbing stairs, running, living at high altitude.
Its better to take carvedilol (coreg) and wait for improvement of blood pressure and heart functions.
Yes, he can perform his routine activities (not all).
Yes, no body at this moment of time can tell you how heart condition will improve in coming day.
Give time to heart and take bed rest for better recovery.
Sincerely,
Dr. Mayank Bhargava
I have seen patient with only 15-20 % EF and we can say your husband is on better side.
These patients are still surviving although not able to perform all routine activities such as climbing stairs, running, living at high altitude.
Its better to take carvedilol (coreg) and wait for improvement of blood pressure and heart functions.
Yes, he can perform his routine activities (not all).
Yes, no body at this moment of time can tell you how heart condition will improve in coming day.
Give time to heart and take bed rest for better recovery.
Sincerely,
Dr. Mayank Bhargava
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, Dr. Bhargava.
OK XXXXXXX
All the best,
Dr. Mayank Bhargava
All the best,
Dr. Mayank Bhargava
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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