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abray1115, Physician
Category: Cardiology
Satisfied Customers: 10341
Experience:  Primary care with particular interest in cardiology problems and prevention. Work closely with cardiologist colleagues.
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I have recovered from heart failure after a heart attack.

Customer Question

I have recovered from heart failure after a heart attack. Have been follow carefully for last year but now I am not scheduled for holter and echo for another year. The anxiety is driving me mad, as it's been two months since my last echo and since my heart
attack I'd been having echoes every 2 months. My last two echoes were different: 4 months ago EF was 55-60 and two months ago it was 65-70. Is that just how it can vary or was it still going up? Is it safe to say it is still normal with no other factors entering
in? If it can sway 10 points in 2 months couldn't it go down in the same manner and put me in the category of low EF? I feel ok but felt OK with lowered EF so I'm highly anxious. My cardio says the heart is far more stable than I think but that's so hard to
trust given I've been in heart failure. Am I worrying for no reason? Thank you. Oh and while still on statin and aspirin, my lisinopril was discontinued 6 months ago and carvedilol lowered from 9.375 bid to 3.125 over last few months. Also, I keep feeling
my pulse, believing I can tell the heart strength. Is that impossible? I'm a teacher of young children and have a young child so I'm terrified of getting sick again. Thank you so much.
Submitted: 1 year ago.
Category: Cardiology
Expert:  abray1115 replied 1 year ago.


There would not be a need to measure an echocardiogram so frequently as you seem to think.Do you know what may have caused your heart failure episode ? Heart attack? Other cause such as arrhythmia ?? EF of 50 to 65 is more normal. You can get issues with too high of my ejection fraction as poossiblw too. ( it is not a value that goes to 100 percent by the way!! It does not work that way!!) It is the fraction of blood in the left ventricle that is ejected with each pumping contraction of the ventricle.

If too low say 40 percent then this is most common type and would suggest systolic dysfunction Too low of blood volume is pumped each best. Cardiac output of blood decreases and heart failure ensues. Now too high of EF may cause diastolic dysfunction and a type called high output failure . The heart ventricle may not have enough time to fill with blood to pump out in next contraction. This along with too high of pulse rate may cause diastolic type heart failure.

Your latter numbers look more potentially consistent with diastolic dysfuction.

If you had a heart attack event and systeolic dysfunction to begin with and then recovered to 2nd echo then that would make most sense. ..

Your blood pressure and pulse rate and echo results and history all factor in for your cardiologist.

There is not usually reason for frequent echo studies though .That is rarely needed....

I hope that this information is helpful Let me know if you have further questions or concerns.I will be happy to get back with you If my answers have been helpful and to your satisfaction then please remember to leave positive feedback Thank you and Best Regards,

Anthony Bray MD

Expert:  abray1115 replied 1 year ago.

PS I read back that you had a heart attack as cause so this makes sense as to the improvement of echo and no need for frequent monitoring. You do what you can to prevent future heart attacks!!

Best Regards!

Anthony Bray MD

Customer: replied 1 year ago.
Thank you so much Dr Bray. After my heart attack, my EF was just 25-30, but then I had an ablation for PVCs after six months and EF recovered to 55-60 a month after ablation. Had been holding steady at 45 for several months before ablation.I know all my recent echoes are normal but do you think the 65-70 most recently signifies actual continued improvement or just a normal variation from the 55-60 several weeks before?I guess my problem is that I have felt fine for the most part, at EF 25-30, 45, and now 65-70. Is EF really not so variable as long as there is no event such as heart attack or arrhythmia? Heart attack was mysterious as I am a slim premenopausal woman with no risk factors or family history, no drinking or drugs. There are thoughts that I had possibly had a peripartum cardiomyopathy which weakened my heart.Is is very unlikely for there to be changes in just two months? I'm anxious to be going so long before next set of tests.Thank you.
Expert:  abray1115 replied 1 year ago.

Hello again!

10 points difference may be only intra-observation variation although usually we expect more consistency than that.Your heart attack sounds rate at your age and lack of risk factors but such does indeed occur. Now in your case you probably had some heart muscle cells that does but a group of heart muscle tar was injured or stunned but not irreversibly damaged.

The stunned myocardium theory fits very well with your history and results .

So as long as you do not have another event ( heart attack) then there is no reason now to expect further significant change in your echo results.

The emphasis is to control risk factors. Daily low dose aspirin, lower cholesterol, watch blood pressure. These would be the main factors for you!!

Your echo is fine and no reason to worry. It fits as I said with injury and stunned heart muscle that has normalized again in function

There is no need for frequent exmchocardiograms for you!!

Keep check periodically on your blood pressure.

I hope that this is helpful for you.Let me know if you have further questions or concerns.Best regards,

Anthony Bray MD