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How To Improve Ejection Fraction?
Question: Hi, I am 44 old year male, non smoker. 3 months ago I was diagnosed with dilated cardiomyopathy and my EF is 30%. Prior to the diagnosis made by my cardiologist in charge, I suffered shortness of breath and fast heart rate (over 150bpm). These 2 symptoms are now gone as I am under medication.
Any possibility for the EF to improve somehow?
What is the life expectancy in this case?
Given the substantial akinetic/hypokinetic heart wall/mucles, what would be the prognosis?
And, what would be the recommendation for 'next action'?
Thanking you in advance.
Any possibility for the EF to improve somehow?
What is the life expectancy in this case?
Given the substantial akinetic/hypokinetic heart wall/mucles, what would be the prognosis?
And, what would be the recommendation for 'next action'?
Thanking you in advance.
Brief Answer:
please see below.
Detailed Answer:
Dear Sir
Since it is only 3 months, you should wait. As a number of cases revert back to normal. ~25% will be normal in 3 years. 50% may not survive this 3 year period and rest will be in between. This is data from old observational studies for a group of people and do not apply to individuals directly. The prognosis depends upon many factors and one of them is EF. Your symptomatic response to treatment is a good indicator.
Since hypokinesia means alive tissue, it may recover completely. Even akinetic appearing tissue sometime respond partly.
Definitely EF may improve. The drugs like beta-blockers (carvedilol, metoprolol and bisoprolol) have the potential to increase you EF. They are slow to act but can cause marked improvement.
You are not a candidate for biventricular pacing as yet which is also helpful in improving EF.
You must be on standard guideline based therapy which includes beta-blockers, ACE inhibitors, spironolactone and other drugs (if required). The other ones are diuretics and digitalis.
I hope secondary causes for DCMP have been ruled out like alcohol, thyroid disorder, abnormal iron , calcium & phophate levels.
Hope this provides some insight. Feel free to discuss further.
Sincerely
Sukhvinder
please see below.
Detailed Answer:
Dear Sir
Since it is only 3 months, you should wait. As a number of cases revert back to normal. ~25% will be normal in 3 years. 50% may not survive this 3 year period and rest will be in between. This is data from old observational studies for a group of people and do not apply to individuals directly. The prognosis depends upon many factors and one of them is EF. Your symptomatic response to treatment is a good indicator.
Since hypokinesia means alive tissue, it may recover completely. Even akinetic appearing tissue sometime respond partly.
Definitely EF may improve. The drugs like beta-blockers (carvedilol, metoprolol and bisoprolol) have the potential to increase you EF. They are slow to act but can cause marked improvement.
You are not a candidate for biventricular pacing as yet which is also helpful in improving EF.
You must be on standard guideline based therapy which includes beta-blockers, ACE inhibitors, spironolactone and other drugs (if required). The other ones are diuretics and digitalis.
I hope secondary causes for DCMP have been ruled out like alcohol, thyroid disorder, abnormal iron , calcium & phophate levels.
Hope this provides some insight. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear doc,
Thanks for your prompt response. I have some additional questions for you:
My doc asks me for further medical tests namely, CT angiogram and heart MRI, as he couldnt find something serious in my renal arteries and kidneys ultrasounds tests. Based on the results later, he said, it would be the basis for decision on whether I would need ICD implanted or just taking drugs for medication. Do you think it is necessary to proceed with these tests, as they are quite expensive. And is it true that EF 30% is a treshold for considering an ICD?
My other doc, suggests me to conduct a testosterone hormone therapy. He shared with that his patients are doing fine with the therapy. What is your opnion?
Lastly, since both docs could not identify the root cause of the problem, they suggested my case could be genetical. I have a grandma passed away long time ago due to swollen heart disease. So, do you think I need to do some precautions for my 13 yr boy?
Please advise and thanking you.
Regards,
Thanks for your prompt response. I have some additional questions for you:
My doc asks me for further medical tests namely, CT angiogram and heart MRI, as he couldnt find something serious in my renal arteries and kidneys ultrasounds tests. Based on the results later, he said, it would be the basis for decision on whether I would need ICD implanted or just taking drugs for medication. Do you think it is necessary to proceed with these tests, as they are quite expensive. And is it true that EF 30% is a treshold for considering an ICD?
My other doc, suggests me to conduct a testosterone hormone therapy. He shared with that his patients are doing fine with the therapy. What is your opnion?
Lastly, since both docs could not identify the root cause of the problem, they suggested my case could be genetical. I have a grandma passed away long time ago due to swollen heart disease. So, do you think I need to do some precautions for my 13 yr boy?
Please advise and thanking you.
Regards,
Brief Answer:
please see details.
Detailed Answer:
Dear Sir
The threshold for implantation of ICD is 35% in non-ischemic dilated cardiomyopathy (DCMP). The patient should not be in class I (asymptomatic) or class IV (nearly bed-ridden). Hence it is indicated in your case, if all reversible causes have been ruled out.
Your doctor may have thought of ruling out coronary artery disease as a cause of your dilated heart. So he advised coronary CT angiogram. This is a reasonable strategy.
Cardiac MRI may be done to rule out particular disorder especially infilterative diseases of heart. This is usually based on indicators of that disease. Do not prescribe in all my patients.
Testosterone therapy is not a standard treatment option and we are not proponent of same.
Genetics may be one cause for the DCMP but that requires testing for particular genes. I am sorry to say that I do not go in for such testing in my patients and has meager knowledge of same. If there is a strong and definite family history of DCMP, the same can be done. Do not have much to prevent it in generations unless a specific cause is established. However, any symptoms of heart disease or heart failure should not be ignored.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Sir
The threshold for implantation of ICD is 35% in non-ischemic dilated cardiomyopathy (DCMP). The patient should not be in class I (asymptomatic) or class IV (nearly bed-ridden). Hence it is indicated in your case, if all reversible causes have been ruled out.
Your doctor may have thought of ruling out coronary artery disease as a cause of your dilated heart. So he advised coronary CT angiogram. This is a reasonable strategy.
Cardiac MRI may be done to rule out particular disorder especially infilterative diseases of heart. This is usually based on indicators of that disease. Do not prescribe in all my patients.
Testosterone therapy is not a standard treatment option and we are not proponent of same.
Genetics may be one cause for the DCMP but that requires testing for particular genes. I am sorry to say that I do not go in for such testing in my patients and has meager knowledge of same. If there is a strong and definite family history of DCMP, the same can be done. Do not have much to prevent it in generations unless a specific cause is established. However, any symptoms of heart disease or heart failure should not be ignored.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doc,
Please correct me, based on NT-proBNP 1745pg/mL, I am classified in class II based on Mayoclinic. Also believe that the secondary causes ruled out based on the facts in the provided blood test (such as alcohol, thyroid etc. Please confirm on this matter. Is the ICD is required as my doc recommends? Any other alternatives?
On the additional recommended tests, are you saying that coronary CT angiogram is needed and not necessarily on the heart MRI?
The following is my current medication given, please comment for any confer you might have:
Trimetazidine 2 hcl 35mg 2xdaily
Spironolactone 50mg 1xdaily
Clopidogrel 75mg 1xdaily
Irbesartan 150mg 1xdaily
Bisoprolol hemifumaraten 5mg 1xdaily
Isosorbide mononitrate 60mg 1xdaily
L-carnitine fumarate 500mg coenzym Q10 100mg 1xdaily
Recently, I have been having blurred eyesight especially when reading books since taking the medications. Do you think it is related to the possible side effect of the drugs?
Thanking you.
Please correct me, based on NT-proBNP 1745pg/mL, I am classified in class II based on Mayoclinic. Also believe that the secondary causes ruled out based on the facts in the provided blood test (such as alcohol, thyroid etc. Please confirm on this matter. Is the ICD is required as my doc recommends? Any other alternatives?
On the additional recommended tests, are you saying that coronary CT angiogram is needed and not necessarily on the heart MRI?
The following is my current medication given, please comment for any confer you might have:
Trimetazidine 2 hcl 35mg 2xdaily
Spironolactone 50mg 1xdaily
Clopidogrel 75mg 1xdaily
Irbesartan 150mg 1xdaily
Bisoprolol hemifumaraten 5mg 1xdaily
Isosorbide mononitrate 60mg 1xdaily
L-carnitine fumarate 500mg coenzym Q10 100mg 1xdaily
Recently, I have been having blurred eyesight especially when reading books since taking the medications. Do you think it is related to the possible side effect of the drugs?
Thanking you.
Brief Answer:
please see below.
Detailed Answer:
Dear Sir
In non-ischemic dilated cardiomyopathy (not due to a reversible cause), which is there for a duration of more than 3 months, EF is 35% or less and patient is in class II-III, ICD is indicated to prevent arrhythmic death. These are guidelines, Best judge is your treating cardiologist.
CT coronary angiogram may be done if your physician wants to rule out ischemia as a cause of your trouble.
I do not understand , by the information provided by you, why clopidogrel is being given.
Blurred vision may be a side effect of many drugs including L carnitine. Please consult your eye specialist and act accordingly. Discuss your physician before you withdraw any drug.
Sincerely
Sukhvinder
please see below.
Detailed Answer:
Dear Sir
In non-ischemic dilated cardiomyopathy (not due to a reversible cause), which is there for a duration of more than 3 months, EF is 35% or less and patient is in class II-III, ICD is indicated to prevent arrhythmic death. These are guidelines, Best judge is your treating cardiologist.
CT coronary angiogram may be done if your physician wants to rule out ischemia as a cause of your trouble.
I do not understand , by the information provided by you, why clopidogrel is being given.
Blurred vision may be a side effect of many drugs including L carnitine. Please consult your eye specialist and act accordingly. Discuss your physician before you withdraw any drug.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doc,
Many thanks for your kind explanations, They are very clear to me and helpful.
However, based on the facts and my explanation given, how could I tell that my case in non-ischemic or not? Do you suggest the angiogram would be used for to determine this? Bottom line, if I was your patient, could you consider ICD as mandatory or not?
On the administered clopidogrel, what do see could go wrong if I continue taking it?
Thanking you
Many thanks for your kind explanations, They are very clear to me and helpful.
However, based on the facts and my explanation given, how could I tell that my case in non-ischemic or not? Do you suggest the angiogram would be used for to determine this? Bottom line, if I was your patient, could you consider ICD as mandatory or not?
On the administered clopidogrel, what do see could go wrong if I continue taking it?
Thanking you
Brief Answer:
please see below.
Detailed Answer:
Dear Sir
We do rule out ischemia as a cause of DCMP in all our patients except where it is not a clinical possibility. It may be done by conventional angiogram, CT angiogram or stress testing. So it is individual patient and his clinician who will decide.
Urgency for ICD will also depend upon the history suggestive of any arrhythmia, likelihood of reversal of CMP, presence of ventricular arrhythmia on holter monitoring etc. All these require clinical evaluation. Theoretically , I already told you the guidelines.We do consider ICD in all our DCMP patients who have EF less than 35%.
If a drug is not indicated, it should not be taken. My major concern with clopidogrel is its potential to cause major bleeding.
Sincerely
Sukhvinder
please see below.
Detailed Answer:
Dear Sir
We do rule out ischemia as a cause of DCMP in all our patients except where it is not a clinical possibility. It may be done by conventional angiogram, CT angiogram or stress testing. So it is individual patient and his clinician who will decide.
Urgency for ICD will also depend upon the history suggestive of any arrhythmia, likelihood of reversal of CMP, presence of ventricular arrhythmia on holter monitoring etc. All these require clinical evaluation. Theoretically , I already told you the guidelines.We do consider ICD in all our DCMP patients who have EF less than 35%.
If a drug is not indicated, it should not be taken. My major concern with clopidogrel is its potential to cause major bleeding.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear doc,
Noted on the ICD, thanks.
On the clopidogrel, it was prescribed by the my doc as he indicated that I need blood thinning. By the way, my blood tension is 140/90 under medication. I would consult the doc accordingly.
Regards,
Noted on the ICD, thanks.
On the clopidogrel, it was prescribed by the my doc as he indicated that I need blood thinning. By the way, my blood tension is 140/90 under medication. I would consult the doc accordingly.
Regards,
Brief Answer:
please see below.
Detailed Answer:
Dear Sir
Do discuss this as clopidogrel is not a generalized blood thinner and has specific indications.
Sincerely
Sukhvinder
please see below.
Detailed Answer:
Dear Sir
Do discuss this as clopidogrel is not a generalized blood thinner and has specific indications.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I will do. Many thanks Doc.
Brief Answer:
You are welcome
Detailed Answer:
You are welcome Sir.
Sincerely
Sukhvinder
You are welcome
Detailed Answer:
You are welcome Sir.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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