Decreased EF

I need some advice, or reassurance I suppose. Six months ago I was having a large amount of PVCs, more than normal, to the point that I couldn't stand it any more and went in. They did an echo and found that my ejection fraction was decreased at 46. They figured it was due to the fact that I was having so many PVCs at the time but wanted to do a 6 month check just to make sure things resolved. Well, the PVCs got better after a few days for the most part, still have them but not nearly as many as I was having during that episode. I went in for my 6 month echo and they found that my EF is still decreased at 46. So, it hasn't gotten worse, but hasn't gotten any better. The nurse called me and said she would talk to the NP and the doctor and call me back, but at the time I have my battery change surgery (sometime in the next few months) there will be some big decisions to make. What does that mean?? Of course here I am running over every worst case scenerio there is but I'm scared! She sounded optimistic that they could fix this, but I have no idea how.

Has anyone else had their EF decrease out of the blue after having their pacemaker for a long time? Thank you ahead of time.

12 Comments

decisions

by Tracey_E - 2013-04-30 02:04:45

46 is on the low side but I don't think it's anywhere close to low enough to warrant a CRT therapy, which I suspect is what she's talking about. It's a 3-lead pm that synchronizes the left and right ventricles which can help with EF by making the heart more efficient. But unless you have debilitating symptoms, I think you need to be under 25% for most insurance to cover it.

My EF is still the same as it was when i got my first pm in 1994, but I figure one of these days it will drop. When it drops low enough that I can't stand it anymore, I'll add the 3rd lead. I hope things remain the same as long as possible, but I don't lose sleep over it either. There are some negative long term effects of pacing, but I figure it's a small price to pay for all the years I've had of feeling great. If I'd been born the same year as my mom, I probably wouldn't have seen my 30th birthday so it's all good.

How do you feel overall?? If you feel good, then I wouldn't worry about it just yet. Just continue to take care of yourself and keep on keeping on.

Thanks

by Chels - 2013-04-30 03:04:55

I'm turning 28 in June, I feel fine, which is why I was surprised at this news. I have always wondered if I would have a shorter life expectancy than most. Now it's just kind of hit me like a wall. I hope that this doesn't mean that's the case. I have a dual lead pacemaker right now, so I'm not sure what their plan is. Maybe nothing?

EF

by SMITTY - 2013-04-30 06:04:50


Hello Chels,

I can see while I was doing my hunt and peck routine Cabg Patch answered your message, but I have so much time invested in this I'm going to post it any way. If I contradict anything Patch has said, he is Right.

Tracey gave you some good advice and she the IMPOROTANT question, HOW DO YOU FEEL? If you feel OK and you have an increasing get SOB with your physical activity, that is my tip-off that my EF is going down. I have been getting EF numbers for 10years and had been told what to watch for. My current EF is somewhere between 39% and 44%. Frankly I can't tell the difference in 39 and 44. Another thing I will offer is don't put absolute faith in the numbers you are given. That is the reason I said that what Tracey asked about how you feel is much more important.

During the last several years I have had reported to me an EF of mid-30s to 70%. That's right 70%. When the dr told me that number (just last year) of 70% I told the good dr there was an error, he quickly told me he didn't believe it either and did it over and still got 70%. Since I felt no different I just dropped the subject.

Now I am going to guess you don't know how Drs determine EFs, so I'll tell you. If I'm insulting your intelligence, please accept my apology right now and you can stop reading.

EF is supposed to be a measure of the amount of blood the heart pumps with each beat. Somebody, somewhere, came up with the number of 200cc as being maximum amount of blood the heart will pump each beat. Notice I said "will pump" and not "can pump" each beat. Since they don't have a flow meter (yet) they can't measure the actual blood flow so they decided the next best thing was to measure the size of the heart before and after a beat. When you get an echogram what they are doing is getting pictures from which the dr can measure the size of your heart before and after a beat.

To make that 200cc mean something they knew the heart didn't empty itself of blood each beat so from experience, or guessing or something (I don't know) they selected the percentages of 50% to 70% as being a normal EF. Now let's look at those numbers. If average is a low 50% and high is 70% (some Drs will squeeze the range dong a little and say use a low 40% and high of 60, or a low of 50% and high of 70%) so you have to ask the range your dr uses.

I think the actual , if you are feeling all right, or they are talking about implanting a by-vent PM, or the three lead PM to help improve your EFR, are more important as conversation pieces than anything. But let's take a look at your 46%. That says your heart is pumping about 92cc(s) per beat. Multiply that number by heart rate to see how much blood your heart is pumping at the various BPM rates.

And with that I'm going to stop. I hope some of this helps a little. If you have a question you think I may answer, please ask.

Good luck,

Smitty


feeling fine

by Tracey_E - 2013-04-30 09:04:40

If you are feeling good, then I would not worry AT ALL about this. My guess is the dr is going to suggest more of the same, no changes. If he brings up changes, I would want a really super amazing fantastic reason to make a change before considering it. But I don't think it's an issue, your number is barely below normal and you feel good which means leave well enough alone.

My dr told me my life expectancy is the same as anyone else. I have congenital complete heart block, btw. Does he know that for a fact? Nope, because I'm the first generation to be paced long term so we are the guinea pigs, so to speak.

Are there risks to being paced long term? Yep. Will they shorten my life? Who knows, but I don't think so. There are also risks to the food we eat and crossing the street. I'm hyper diligent about diet and exercise, have been all my life, I figure that balances out any negative odds from the pm. I've spent too many hours on cardiology floors in the hospital and cardiologist's waiting room to ever let myself get a heart problem I could have prevented by exercising and eating well, not to mention I've had more heart tests than most people twice my age so I don't just think my heart is healthy, I know it is. So, this gives me an advantage. What it comes down to is we don't have a crystal ball so all we can do is take the best care of ourselves that we can and hope for the best.

EF Effects On Longgevity

by SMITTY - 2013-04-30 11:04:29

Tracey brings up an interesting subject about the effects of low EF having on longevity. I heard about my having congestive heart failure in 1980 and was told at that time it meant my heart was unable to pump as much blood as one my size should be pumping. The numbers I was given, if in fact I even got any numbers, I don't remember.

However, I do recall being told I would have to slow down as I would find myself running out breath quicker as the years went by. I also remember my wife asking about the effects it may have on my longevity and the reply she got was that would depend on how well I took care of myself. I had a quadruple bypass two years later(1982)and I had already been told by one dr. that I could expect at least another five years, if I took care of my heart.

I guess I did something right along the way because I'll be 84 the 15th of May I don't feel any nearer the end than I did in when I learned I had heart disease in 1982.
So, my advice to you is don't even think in terms of low EF and longevity. Live life one day at a time, taking care to live sensibly.

I'm convinced that in spite of what the Drs and nurses tell us only God knows how long we will be on top of terra firma.

Smitty

heart failure

by Tracey_E - 2013-05-01 01:05:05

No one knows, but I can tell you I've been paced since I was your age and I'm 46 now. There are a few other members who have been paced 30 or even 40+ years and none of us are in heart failure or even close to it. Think how far technology has come in the last 40 years, and imagine the cures they may have another 40 years from now. It's a waste of energy to worry about what might happen, I concentrate on the things in my control. While you can't do anything to increase EF, you can strengthen the muscle, keep the arteries clear and keep your bp in check.

Smitty, I like the way you count :o)

Thank you!

by Chels - 2013-05-01 10:05:27

I'm really grateful for all of these responses, really helps me put things in perspective. I have made the decision that even if they do suggest intervention, I will not do it at this point. I am going to start a regular exercise routine and low sodium diet and hope that I can maintain the level I'm at (or maybe even improve). The nurse told me there is absolutely nothing I can do to improve my EF on my own, which may be true but that doesn't mean I'm not going to try. My main concern is- will it gradually continue to get worse and I will eventually have heart failure? I'm sure no one can answer that but that is my only fear. If I can continue to live healthy and happy with a low EF that is just fine with me. She said my heart doesn't have damage, it's strictly from pacing. We'll see what the doctor says when he returns next week.

To the OP

by fishfighter - 2013-05-02 06:05:51

With a EF of 46, go on living.

2 1/2 years ago I start with heart trouble. I was a very fit person and didn't take any meds at 52 years old. Had great BP and heart rate.

Within six months, my ef dropped to 35. They put in a CRT-D. Still, I was feeling bad after many adjustments and a ton of meds. I was going into CHF. I had put on an extra 20 lbs.

At that point, I saw a new doctor. This doctor was a transplant Doc and was friends of a family member. Test, test and more test. By this time, my EF dropped down to 25. It stayed there for about 6 months. Still feeling bad most days, they did more testing and drug changes.

At that point, my EF was below 20. They put me on a dobutamine drip 24/7 which help my ef to stay at 20. 16 months and 5 hickman lines and fighter infections 4 times, they removed my hickman. Another EF test and I am now below 12. I lost a lot of weight and I am now at 155 lbs. I was listed for a heart transplant, but as of last week, they delisted me due to the fact the CHF is eating away my body. They even told me I have about 6 months to live.

Know what? I get up every day, Thank God for another one. Tell my family I love them. They get my butt up and do everything I set out to do that day.

What I'm getting at is listen to what your body is telling you. If you feel good, do what you can. Don't let the little things drag you down!

Why...

by donr - 2013-05-04 11:05:01

...did you get the PM at age 6? That can have some bearing on how you are performing today.

Are you on any meds for the PVC's in conjunction w/ the PM? Given meds, that could explain some of the effects you are having. Some of them turn you into a zombie.

I'll agree that a boatload of PVC's can make you seriously SOB. BTDT!!!!! Big time. I was running 33% PVC rate & had all I could do to function some times w/o being SOB. You said a "LOT" of PVC's. What was that lot?

Don

Ifelt fine, but had cancer...

by donr - 2013-05-06 03:05:00

...the analogy is the same. I really did have prostate cancer & felt fine - but it was there & had to be treated - before I started feeling un-fine. So now I've been good since 9 April 2004. Life has changed, that's fer sure, but I am still alive & writing to you about PVC's.

Yes numbers of PVC's per day is a relative number - but look how they affect some people. Just a few make them turn into bowls of quivering Jello!

Everyone has them, even people w/ normally functioning hearts. They can do strange things to people - strange things that are very uncomfortable to some. I run at about 2500 per day. Some folks would gasp in horror at that. But that's "only" a little over 1 per minute. I do not even recognize their existence unless I have a run of them.

I drive my cardio nuts asking "Why" about things like a change in something like PVC's that is not dangerous, my thought being that if it changed once, it can change again & become dangerous.

You say your heart is perfect - well, it really isn't. It has a complete electrical block - easily taken care of by a PM - AND is is now desynchronizing. Desynchronizing can also be taken care of by a PM w/ three leads to synchronize the two halves of the ventricles.

Considering your young age, why would they not strike early rather than wait till you were symptomatic? Once the damage is done, it cannot be undone.

Don

What I am afraid of...

by Chels - 2013-05-06 04:05:08

Don, I know it is probably irrational, but I am afraid that if they take that step now, is it possible that it will lose it's effectiveness? A lot of this stems from me having a lot of questions and no clear answers, and maybe no one who can give them to me.

When I look at my pacemaker, okay, it has been 22 years that I have been paced and things are starting to have problems now. It makes me think that, maybe if I wait as long as possible to get the CRD, I will get as much use out of it as possible before it starts having problems? Almost like, I don't to waste it's longevity before I really need it? I know that's probably crazy thinking, but it's how my brain is working right now.

Don-

by Chels - 2013-05-06 10:05:15

A lot is more relative to me, I suppose. I was only having between 800-1000/day but for me that was a lot more than normal. I know some people have 10,000.

I am not on any medications. I have a congenital complete AV block, hence the pacemaker at age 6. I have a dual lead pacer now, have had that since age 18.

Since the original post, I have obtained my echo reports to interpret them myself since the nurse is worthless. Since six months ago I have an increase in desynchrinization, that seems to be the only problem. So, I'm not sure if they will even do anything since at this point it's not debilitating. Health wise, my heart is perfect, it's all becuase of pacing from what I can tell. I'm not sure if they will think about a CRD since I'm not even in failure or anything. I don't think I would want that right now either since I feel fine. Not sure if they will change any settings on the PM. I should hear from the doctor this week now.

You know you're wired when...

You know the difference between hardware and software.

Member Quotes

I am just now 40 but have had these blackouts all my life. I am thrilled with the pacer and would do it all over again.