My husband was recently diagnosed with severe acute systolic biventricular failure with low ejection fraction. Probable cause from some type of viral myocarditis in the past. MRI was done 5 days after initial consult with cardiologist. Results: -no evidence of regadenoson-induced reversible perfusion abnormality, - no evidence of prior myocardial infarction, - Gated SPECT wall motion study at rest demonstrates severe global hypokinesis with EF = 17% and severely enlarged ESV = 208 cc. Gated SPECT wall motion study at 64 minutes post-stress demonstrates similar wall motion with EF = 20% and severely enlarged ESV = 220 cc, - Findings consistent with non-ischemic cardiomyopathy are noted, -the probability of a hemodynamically significant coronary artery stenosis is considered to be low. This negative study for reversible perfusion abnormality combined with a severely reduced post-stress EF and severely enlarged post-stress ESV predicts a high risk of cardiac mortality over the next 1-2 years. Clinical correlation is required.
Ultrasound was done 3 days later - Final interpretation: 1-Four chamber cardiac enlargement, 2-Severe global hypokinesis of the left ventricle with estimated EF = 15-20% with mild paradoxical septal wall motion as seen with left bundle branch block. 3-reduced forward stroke volume, 4- mild aortic sclerosis w/out stenosis with a tri-leaflet aortic valve, 5-doppler studies show mild mitral and tricuspid insufficiency and trivial aortic and pulmonary insufficiency. 6- estimated RV systolic pressure of 26mmHg, 7-reduced RV wall motion.
MRI & ultrasound was done 1 month ago. He was started on Furosemide, Carvedilol and Entresto. Losartan was discontinued.
He sees Dr every 2 weeks and meds are being increased. Appt last week showed marked improvement. Lost 13 lbs and edema decreased significantly. Initial test (don't know name of machine that records reading) indicated heart pumping only 2.9 quarts / minute. Last week reading showed improvement to 4.7 quarts/minute. Blood test shows kidney/renal functions normal. He has put my husband on sick leave from work for 6 months.
Prior to diagnosis, my husband had planned for a trip to Philippines in December. We mentioned this to Dr on 1st visit, he was highly against this trip. Last week we mentioned again because my husband is determined to go. Dr was not in favor, but stated that it is my husbands decision. He advised my husband to record wt, blood pressure & heart rate everyday and stay on no salt diet. He provided copies of clinical reports which my husband needs to carry with him at all times.
Of course I am very concerned for my husband, but he is determined to go to the Philippines because he has family business that needs to be taken care of. I ask him everyday how he is feeling. He says he feels fine - no shortness of breath, his appetite has improved, he does not get tired doing normal daily activities. He is very good at taking his meds everyday and tries to watch his diet.
On first consult, Dr had advised him that he is at high risk for sudden cardiac death. During visit last week, Dr did say that there is marked improvement over first consult. I read through the reports that the Dr gave him.
Questions: Since he has showed improvement over a period of 1 month, would this reduce the 'high risk' factor for sudden cardiac death? Does improvement from 2.9 qtrs/min to 4.7 qtrs/min indicate an improvement of EF fraction? If he continues to respond will to meds treatment, does it improve the 'high risk factor of cardiac mortality over the next 1-2 years' which was reported in the MRI? Entresto is a recently approved Rx, will this improve prognosis for longer life expectancy? Do I need to worry about any complications on the flight to/from the Philippines? He will be traveling alone.