Question: Patient is 66 years old, no prior health problems at all. Had Rheumatic feather when he was a child. Recently had a physical done and the ekg was abnormal with inverted twaves. Patient had an echocardiogram and the docs diagnosis was that the patient had an ejection fraction of less than 20%. What should the dr. advise the patient to do immediately? Please be specific

Thanks for the follow up Dr Mandal but I have a few more questions. How serious is an ejection fraction of less than 20%? Is it serious enough that the doctor should take immediate action and follow up with the patient? What would the angiography tell the doctor?

When the doctor called the patient to tell him that his diagnosis was that the patient had an ejection fraction of less than 20%, should the doctor have told the patient that he needed to have the Angiogram immediately? or should it have been left up to the patient to casually make an appointment when he had time. The reason for my question is really I need to know the seriousness of an ejection fraction of less than 20%. Is that diagnosis life threatening? Also, if the ejection fraction was caused by a blocked artery and the blockage is cleared, what is the general prognosis going forward? Thank you again for your time and expertise. Looking forward to hearing from you.

Doctor,

First please understand that I really appreciate your responses to my questions and I hope you dont mind that I am writing so much. I am try to figure out whether or not my father is getting the proper medical advice and whether or not the doctor should be doing more. I completely understand that an Angiography is a test and not a treatment. Here are the facts again about the patient. 66 year old Non Smoking very fit male who was never sick in his life except for Rheumatic fever when he was 11 years old. Yes he had the common cold once in a while but never sick nor did he ever take medication for anything. Pertinent NEGATIVES include chest pain, dyspnea, orthopnea, palpitations, paroxysmal nocturnal dyspnea and syncope. NO hypertension, diabetes or any family history of heart disease. All of this information was taken right off of his medical records. The patient went to have a routine physical done and during that physical the doctor saw that he had inverted lateral T waves on the EKG. Blood work was also done during the physical and the total cholesterol level was a 298 with the LDL levels at 229. After the physical and cholesterol was complete, the doctor performed an Echocardiagram and his diagnosis was (1.)"Severely Depressed left ventrical systolic function Global" Estimated Ejection Fraction <20%. (2.) Mild Abnormal left ventrical diastolic function: Impared relaxation. (3.)Normal estimated pumonary systolic pressue 25-30mm" (4.)Aortic Valve: Mild Aortic Sclerosis. (5.)Mitral Valve: Trace Mitral Regurgitation. (6.)Tricuspid Valve: Trace Tricuspid Regurgitation. (7.)Chamber Size: Dilated Left Ventrical & Mild Left Ventricular Hypertrophy. If the patient had this diagnosis what should have been done next. Is the diagnosis serious? if so what should the doctor advise next? Should the doctor tell the patient to come in immediately for further tests like an angiography to see if a blockage was causing the low ejection fraction or could the patient make an appointment at his convenience to have further work done? I am trying to figure out the seriousness of the diagnosis. Is it life threatening? If there are any question you have for me please by all means ask me? Thank you so much again for your time and expertise.

Doctor,

I am sorry if I was not clear in my previous questions but I think you need to know that my father passed away from a heart attack in January 2011 It was five months after the doctor gave my father the diagnosis of the ejection fraction of <20%. The reason I am asking these questions is because I want to know if the doctor practiced a reasonable standard of care? Yes my father did not have any symptoms but the EKG and the Echocardiagram clearly showed that there was a problem. Should the doctor have followed up with my father and stressed the importance of having the Angiography? After the doctor gave my father his diagnosis he never spoke to my father again and my father died five months later. I had an autopsy done on my father and the Pathologist found that my dad died of Atherosclerotic Cardiovascular Disease. Here is what the pathologist wrote in his report "The major findings in the report included: severe hardening of the arteries (atherosclerosis) involving two major arteries that supply blood to the heart muscle. Also, there was evidence of extensive prior heart muscle damage due to inadequate blood supply (ischemia) that had formed scar tissue". Given the facts that my father had Ejection Fraction of <20%, Rheumatic fever when he was a child and high cholesterol is it not reasonable to think that a Cardiologist would want to get the patient in for further tests as soon as possible? Should he not have followed up with my father diligently until he found out what was wrong?