Ejection Fraction

I have a Cardiologist that wants to do a cardiac catheterization and is talking about I probably need a stent put in because I didn't pass my chemical stress test.  I have let him know before that I am highly allergic to the radioactive dye, and I almost pass out.  But he won't tell me what my ejection fraction is with my echocardiogram.  He said they don't go by that.  He won't even do a CT Scan to see if there is a blockage first.  Are there other ways to have ejection fractions done besides a chemical stress test?


9 Comments

LVEF and caths

by AgentX86 - 2019-07-21 13:56:27

The LVEF has very little to do with blockages. Stress tests are intended to see how much work the heart can do, which means seeing if oxygen can get to the heart muscle. Pictures are taken to see where the oxygen is being used. If they don't like what they see, then a cath is perfectly normal. They need to see exactly where they are before they even know if they can be stented. When I has my cath, the cardiologist told me that one couldn't be stented because it was blocked at a branch and another would risk my kidney. So, off to the CABG patch.

tests

by Tracey_E - 2019-07-21 16:00:19

Ejection fraction shows how hard the heart is pumping. Stress test shows circulation. If they're talking stent, that means blocked arteries which is circulation and has nothing to do with how efficiently the heart pumps. I don't understand why they won't tell you EF from the echo, but I can see why they'd still want the cath. 

I am allergic to iodine also, but have had tests done with iodine successfully. They loaded the iv up with something to counter it. I was groggy and loopy for hours, but no allergic reaction. 

Online portal to your records?

by Hoser - 2019-07-22 09:21:12

These days, many hospital systems have patient portals that will contain all of your medical test/appointment/reminder information on it.

The results of every test performed on me are available to me online through this portal. Something you may want to check on.

Stress test- what is after that

by Selwyn - 2019-07-23 06:49:28

A stress test induces a fast heart rate, and then the doctors look for signs in the heart muscle that it is being starved of circulation.  The ejection fraction is not relevant to this test.

You can have a CT angiogram ( as you state)  rather than a cardiac catheterisation, to try to see what your coronary arteries are up to, though the gold-standard test is a catheterisation as there is a lack of sensitivity and specificity with CT angiograms. There is a small risk to your health in having a cardiac catheterisation. ( I have had 4 without incident).

Should you have a significant narrowing ( and usually symptoms of angina) then you are likely to get a coronary artery stent at the time of the catheterisation. Stenting relieves symptoms but does not prolong life expectancy. You can be awake at the time. It is a painless procedure. 

As stated  by others, your ejection fraction does not tell you whether you have angina or coronary artery disease. There are different contrast media available for those with severe allergy. Tracy's account of receiving something to stop allergy is relevant. I had a friend who was allergic to prawns ( urticaria), and the only way he could enjoy what he loved to eat - namely prawns was to take an anti-histamine before the meal!

 

Ejection Fraction

by Ellen - 2019-07-23 09:46:35

Thank-you for your information. It's greatly appreciated!  The cardiologist is telling me that my ejection fraction is lower-he never once has mentioned circulation.  This is so confusing to me.  He makes me feel like he just wants to make money.  They are also saying that my afib is making my heart weaker.  I have had Afib since 2003 and an Electrophysiologist at Johns Hopkins said I can't have an ablation.  I have a CRT-pacemaker.  I was always told people can live just fine with Afib as long as they take blood thinner.

LVEF - can vary a lot

by crustyg - 2019-07-23 10:30:26


All of the above is good info.  The LV EF isn't a very good marker of how healthy your heart muscle is because heart is unusual muscle.  Up to the Starling point, heart muscle automatically contracts harder the more it's stretched.  And since EF is (when performed by echo) area of LV at end of diastole (when filled) compared to area of LV at end of systole (when emptied by contraction), expressed as a percentage {((EDA-ESA)/EDA)*100}, filling is as important as emptying.

EF is heavily controlled by ventricular filling - a normal heart has the atria contract first, filling and stretching each ventricle which then contracts strongly expelling the blood and leaving a small amount behind.  Atria that flutter or fibrillate don't fill the ventricles well, so they don't contract very hard => lowered EF.

Before my first ablation for Aflutter my EF was abnormally low (should be 55% or better in normals) while it had been 70% a few years back.  Post ablation with a vaguely normal rhythm it climbed to 68%.  Heart muscle hadn't changed, but heart activation had.

The point of cardiac re-synchronisation therapy for patients with heart failure is to optimise their heart muscle pumping by ensuring that the two phases of filling and contraction are as good as can be managed.  So actively managing heart operation is known to be effective at improving the heart's function as a pump.  But if your heart muscle is short of healthy, oxygen-rich blood due to furred up coronary arteries, then that needs to be investigated/addressed.

So don't worry too much about your EF.  It's a number.  It has its uses, but there are other things to consider.

However, if you've lost faith/trust in your cardiac doc, time to move on.  No treatment in Medicine works well if the patient doesn't trust in their medical advisor(s).

crustyg

by Ellen - 2019-07-23 13:01:53

Thanks for the information.  I've never been told this before.  I hate that we have to do so much homework to find these things out.  All the cardiologists I've been to rarely even want to answer any questions or take the time to explain.  They act like an assembly line.  I can't have an ablation, and I've tried the cardiac synchronization, but it didn't work, except for burns from the metal tabs they forgot to take off of me.  I am going to try and find another cardiologist but they are hard to find around here.  I may have to do some traveling of 250 miles one way to George Washington University Hospital in D.C.  They are great.  

Angina?

by Selwyn - 2019-07-24 06:55:03

If you have an abnormal stress test, I think I would be wanting to tackle that problem as a priority.

I can see that you have communication problems with your cardiologist. Perhaps they have access to a specialist nurse you can talk things through with?  Sometimes going with written questions or sending an e-mail/letter may help get answers. 

If you have symptoms of angina ( chest pains on excertion) the investigations are more urgent.

I trust you are anticoagulated. The more modern factor Xa anticoagulants are I think now the treatment of choice, if possible, though they are more expensive to buy, you don't need regular blood tests, and the overall outcomes are better. 

Your heart rate should be resonable, even though you have AF. Personally, I have never heard of not being able to have an AF ablation ( I have had 2 for AF, and one for flutter) if that is indicated ( ie. medication is not suitable for the heart). Sometimes, with long standing AF the outcome may not be worth while. 

Your priority should be to get your suspected coronary disease sorted. 

Should you wish to change your cardiologist that may be a secondary consideration. 

ejection fraction

by pogerm1 - 2019-11-20 15:07:08

There was an article in the news that drugs are more helpful than stents.

You know you're wired when...

“Batteries not included” takes on a new meaning.

Member Quotes

Stay positive and remember that your device is your new best friend.