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Suggest Treatment To Improve Ejection Fraction
Question: My mother with heart failure. She had operate CRTD+ICD for 8 months now her EF is 20% from 10%. Is there any therapy to improve her EF to 30 or 40 ???!!
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
I understand your concern and would like to explain that as your mother is suffering from dilated cardiomyopathy and severe heart failure actually she has received an appropriate therapy by CRT-ICD implantation and an optimal drugs therapy (after reviewing the attached reports).
Improvements in LVEF has occurred after this combined therapy, and it is necessary to carefully follow up by repeated cardiac ultrasound for monitoring further potential reverse re-modelling and thus EF improvements.
What is concerning is her important mitral regurgitation which may impede a positive remodelling and EF increase.
Coming to this point I would say that her actual clinical status is the most important determinant of further steps on the management strategy.
A surgical correction of mitral regurgitation (which seems to be secondary to LV dilatation) would not be much preferred facing her decreased cardiac function and the increased surgical risks.
Probably a percutaneous edge-to-edge repair may be considered as a tentative to improve symptoms, but no evidence to improve survival exists.
Other options are mechanical circulatory support devices, which are considered in patients in end stage heart failure despite the optimal medical therapy, in order to improve symptoms, reduce hospitalizations and the risk of premature death.
These devices may be used as a bridge to heart transplantation or even as a destination therapy. But when considering such an option several variables should be taking into account (like comorbidities, overall functional status, peripheral arterial or cerebro-vascular diseases, acute infections, etc).
All the above alternative strategies will depend on the opportunity of the attending medical center for offering the assistance.
Hope to have been helpful to you!
In case of further uncertainties do not hesitate to contact me!
Best regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
I understand your concern and would like to explain that as your mother is suffering from dilated cardiomyopathy and severe heart failure actually she has received an appropriate therapy by CRT-ICD implantation and an optimal drugs therapy (after reviewing the attached reports).
Improvements in LVEF has occurred after this combined therapy, and it is necessary to carefully follow up by repeated cardiac ultrasound for monitoring further potential reverse re-modelling and thus EF improvements.
What is concerning is her important mitral regurgitation which may impede a positive remodelling and EF increase.
Coming to this point I would say that her actual clinical status is the most important determinant of further steps on the management strategy.
A surgical correction of mitral regurgitation (which seems to be secondary to LV dilatation) would not be much preferred facing her decreased cardiac function and the increased surgical risks.
Probably a percutaneous edge-to-edge repair may be considered as a tentative to improve symptoms, but no evidence to improve survival exists.
Other options are mechanical circulatory support devices, which are considered in patients in end stage heart failure despite the optimal medical therapy, in order to improve symptoms, reduce hospitalizations and the risk of premature death.
These devices may be used as a bridge to heart transplantation or even as a destination therapy. But when considering such an option several variables should be taking into account (like comorbidities, overall functional status, peripheral arterial or cerebro-vascular diseases, acute infections, etc).
All the above alternative strategies will depend on the opportunity of the attending medical center for offering the assistance.
Hope to have been helpful to you!
In case of further uncertainties do not hesitate to contact me!
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Iiril. Thank you so much for your excellent medical advise and fruiful explanation. My mother is trying to avoid suregry in any caurse. The reason her heart decrease symptoms worsted because she stopping taking her medication five years ago. Result first heart pain and other severe attack. We are paying now an altmost price and not trusting her judgement. The doctor who operate her suggested an EECP therapy as i explained before to improve her condition. Since she is stable now. However to increase her EF recommeneded also walking destine exercises. We as her family do not have much options as i seek for second opinion and many advise to take find solution. I thank you for all my heart for you advise .
Brief Answer:
My opinion:
Detailed Answer:
Hi again, xxxxxx!
I would like to explain that EECP therapy doesn't seem to be beneficial for your mother, as she actually has a very dilated left ventricle with irreversible remodelling changes, and no clear clinical symptomatology for refractory angina.
The most appropriate strategy for your mother would be circulatory support devices and possibly valvular and left ventricular myocardial reconstruction (but this latter may be achieved in very few specialized surgical centers).
Of course an optimal drugs therapy is a major therapeutic cornerstone of medical management.
Best wishes,
Dr. Iliri
My opinion:
Detailed Answer:
Hi again, xxxxxx!
I would like to explain that EECP therapy doesn't seem to be beneficial for your mother, as she actually has a very dilated left ventricle with irreversible remodelling changes, and no clear clinical symptomatology for refractory angina.
The most appropriate strategy for your mother would be circulatory support devices and possibly valvular and left ventricular myocardial reconstruction (but this latter may be achieved in very few specialized surgical centers).
Of course an optimal drugs therapy is a major therapeutic cornerstone of medical management.
Best wishes,
Dr. Iliri
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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