
Is Ejection Fraction Of 25% A Cause For Concern?

Below are his current medications:
Losartan (COZAAR) 50 mg Oral Tab (Taking) Take 1 tablet by mouth daily
Clopidogrel (PLAVIX) 75 mg Oral Tab (Taking)
Aspirin (ECOTRIN LOW STRENGTH) 81 mg Oral TBEC DR Tab (Taking)
Rivaroxaban (XARELTO) 20 mg Oral Tab (Taking)
Nitroglycerin (NITROSTAT/NITROTAB) 0.4 mg SL Subl Tab (Taking) as needed
Atorvastatin (LIPITOR) 40 mg Oral Tab (Taking)
Carvedilol (COREG) 25 mg Oral Tab (Taking)
After hospital d/c his EFG was @ 10% with some mild feet edema. Since then no edema, now his ejection fraction (EFG )) is 25%, he is in cardiac rehab and is exercising daily (was very active and exercised prior to the incident). My question to you is, does a patient with his history EFG remain the same or may it improve. For some reason his doctors have made us feel this will not get better.
Will this increase is mortality and possibility of another arrest?
What are the probability of him having another arrest? We were told that he is at risk to have another arrest in the next year, is this true? His ICD has been provided from XXXXXXX Scientific, he was givn the pacemaker and the defibrillator model. We are terrified and live in fear every day!!
His wt is stable, BP x3/day avg. 110/60-115/60 this has been his range. His BP was never been an issue. No hx of smoking or other medical conditions. No family hx of heart disease.
I want to make sure I am asking all the correct questions and obtain the best health care for him. I have asked his clinicians what can we do to improve his EFG and they have not really given be a clear answer. Some say it will improve, others say it really does not matter, some say it will improve if he exercises, other say the rx meds he takes will assist him. He suffers no shortness of breath and is feeling good other than the anxiety that he feels (both of us are terrified). We're attending support groups to become educated on how to live with the implant. His ICD has picked up some ventricular tachycardia which lasted less than 4-5 seconds, the ICD did not have to give him a treatment. We were told this is normal. Is this normal?
Labs: His most recent lab work: 5/28/2016
CHOLESTEROL 114 mg/dL
TRIGLYCERIDE 55 mg/dL
HDL 50 mg/dL >=40 mg/dL
LDL CALCULATED 53 mg/dL
CHOLESTEROL/HIGH DENSITY LIPOPROTEIN 2.3
CHOLESTEROL, NON-HDL 64 mg/dL
SODIUM 140 mEq/L 135 - 145 mEq/L
POTASSIUM 3.9 mEq/L 3.5 - 5.0 mEq/L
CHLORIDE 106 mEq/L 101 - 111 mEq/L
CO2 29 mEq/L
CREATININE 1.00 mg/dL <=1.30 mg/dL
GLOMERULAR FILTRATION RATE 86 mL/min/BSA
GLUCOSE, FASTING 99 mg/dL
ALTAST 31 U/L 27 U/L
HGBA1C% 5.8 % ( this has value has been constant for the past 5 yrs.)
Past Medical DX:
ANGINA (Noted 11/18/2004)
CAD OF NATIVE ARTERY (Noted 2/9/2005)
CAD, PRESENCE OF STENT (Noted 5/7/2008)
HTN (Noted 10/17/2007)
HX OF MI (Noted 2/9/2005)
HX OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (Noted 9/7/2005)
HYPERLIPIDEMIA (Noted 2/3/2005)
OSTEOARTHRITIS OF BILAT HIPS (Noted 12/31/2013)
OSTEOPENIA (Noted 10/27/2008)
PERIPHERAL VASCULAR DISEASE (Noted 11/5/2003)
PREDIABETES (Noted 11/20/2015)
VENTRICULAR FIBRILLATION (Noted 12/27/2015)
Thank you and I welcome your feedback and assessment. Hopefully I proved you with a good history of his health.
Following advice...
Detailed Answer:
Hi and thank you for as king!
I read your query and understood your concerns.
1. I would like to say that a patient at his age, with a low ejection fraction, with previous heart attack and stenting, has a lower probability to improve his EFG.
First of all his myocardial muscle may gradually recover from december event and this may contribute to an increase in EFG.
Secondly ICD and pacemaker especially resyncronisation therapy may increase EFG. Since you don't mention if he had done resyncronisation therapy you should ask his doctor.
Thirdly medical treatment especially Losartan over a long period contribute to a gradual improvement of EFG.
2. Unfortunately for him he has a high risk to have another cardiac arrest within the next 1 year. However you should be optimistic because he has an implanted defibrillator (ICD) which will assist him immediately and wouldn't let the thing precipitate. Please keep in mind that ICD is the best treatment strategy and he has with him the maximal protection against cardiac arrest.
3 Moreover unfortunately for him his disease has also a poor prognosis (i.e. high mortality rates especially if aren't treated correctly). However the survival rates improve with proper management (including health diet, medical treatment and assisted device or ICD/pacemaker).
4. It's normal that he will experience 4-5 seconds of ventricular tachycardia (it's called unstable ventricular tachycardia) which are self limited and doesn't require ICD activation.
Hope this will be of help!
Wish you health!
Dr. Shehu


Following advice
Detailed Answer:
Hi back,
In patient with low EFG there's a asynchronous beats between ventricles and atria. The goal of resyncronisation therapy is to synchronise the beats between atria and ventricles.
The resyncronisation therapy per se may
improve EFG + 10-15%.
Hope this will be of help!
Wish you health!
Dr. Shehu


Following advice...
Detailed Answer:
Hi back,
Resynchronisation therapy is performed on a cardiac catheterization laboratory. The doctors should synchronize ventricle and atria beats through dual chambers pacemaker.
Since your husband has an ICD and pacemaker inserted you should ask his doctor if he is suitable for resynchronization therapy. If he is suitable he should be admited to hospital.
Hope this will be of help!
Wish you health!
Dr. Shehu


One more question is this a risky procedure or similar to a heart catherization /stent procedure.
Thank you for your response.
Following advice
Detailed Answer:
Hi back,
The procedure is similar to heart catheterisation and ICD/pacemaker procedure.
Wish you and your family health!
Dr. Shehu

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