poor ejection fraction

Hi all....(just checking in as hadn't posted for a while)....any thoughts on poor ejection fraction 30-35% but feeling very good and not too many exercise limitations.My cardiologist (Dr Death I call her) says she cant explain that someone with such poor EJ can do what I do.Surf, hike, ski tour,snowshoe, play bagpipes, work.Low to normal blood pressure, I have a CRT pacemaker.Any thoughts, reccomendations appreciated? chrs Dave


Low ejection fraction

by Gemita - 2020-03-21 09:45:15

Dave, well if your cardiologist cannot explain it I would say you have found the perfect recipe for your heart health.  You are definitely keeping your heart muscle healthy from all those activities especially the bagpipes I would imagine and this would require a lot of “breath control”.  Are you on any medication ?  Clearly your CRT is also helping to keep you symptom free.  Well done.

Have you actually been diagnosed with heart failure ?  I see there is a condition where left ventricle ejection fraction is reduced (<40%) but where there are no signs and symptoms of heart failure.  This condition is frequently referred to as "asymptomatic LV dysfunction" (ALVD).  Hopefully others can give you more information since I cannot find any "uptodate" research papers to post.

Speaking with my husband’s cardiologist recently, I recall he mentioned that some patients with a low ejection fraction may not have or show symptoms of heart failure.  That is not to say that they will not develop heart failure symptoms in the future but there is every chance with appropriate treatment, medication (beta blockers, ACE inhibitors, ARBs for example) and lifestyle changes, this can be delayed.  You would seem to be in this category and I hope it lasts for a long long time Dave.

I have found and pasted a link below to copy and paste into your browser in case this is of interest.


Stay well

Thoughts? Recommendatoins?

by AgentX86 - 2020-03-21 11:58:06

My thoughts: "Wow, that's impressive. You're beating the house at their own table".  My recommendation: "Keep doing what you're doing!".

Nice summation, Gemita.

poor ejection fraction

by blowhard - 2020-03-22 05:24:33

Hi you two...awesome repsonse thankyou very much....yes thats exactley what she said its not normal to be able to be that busy.However I do push hard and the bagpipes are the one that seems to be the hardest lung wise.The only drug I am on is flecinaide for the PVC s which is quite effective.I am wonderig if you both know if an older echo equipment can give different results to a newer modern one.I have had echos with very different EF from two different hospitals...one said 35-40-% the other 30-35%...? I will check that link you mentioned thankyou Dave


ejection fraction

by Gemita - 2020-03-22 06:30:58

Hello Dave,

Can newer equipment give different results to older equipment ?  I would hope newer equipment will be more effective in detecting small changes in EF.   I believe however that different imaging techniques:   MRI, CT, Echocardiography for example may all produce slightly different values and it would also depend on the skill of the technician carrying out the investigation.   Other factors too can result in changes to EF, like for instance uncontrolled hypertension, worsening heart disease, diabetes and even arrhythmias which may prevent our heart from pumping effectively.  I see you are on Flecainide for your PVCs.  

My EF often fluctuates several percentage points from one year to another depending on my general health, the skill of the technician carrying out my echocardiogram and any treatment that I am on or changes to my medication.  

Dave, I was told Flecainide is contraindicated in patients with heart disease (congestive heart failure, coronary artery disease and reduced ejection fraction) and may in fact be dangerous.  I would speak to your doctors since I was advised Flecainide can slightly reduce ejection fraction.  I was on Flecainide for two years for Atrial Fibrillation and other arrhythmias.  I had to stop it when I developed worsening arrhythmias, including Atrial Flutter.

But don't forget "how you feel" is just as important as those EF numbers.  You are feeling good and that is what really matters.  Just have a word with your cardiologist though to make sure Flecainide is right for you

Impaired left ventricle ( LV) function without symptoms.

by Selwyn - 2020-03-22 08:34:56

Hi Dave,

You should read the guidelines:


You should not be taking Flecainide as you have structural heart disease ( I was in a similar position and have had to stop this drug as there is a risk of sudden death).

It is worth discussing whether a three lead pacemaker to re-synchronise your heart is worth while at this  stage to try to avoid the muscle change associated with LV impairment. Prevention is better than cure. You do not mention the cause of your impaired LV. I would want to know this if I were you! ( I did ask my cardiologist to investigate me for my LV remodelling  and ended up finding all sorts of undiagnosed pathology).

poor ejection fraction

by blowhard - 2020-03-22 19:30:46

Thnks for that info....I do have two cardiologists I am seeing, both disagreeing with certain aspects of my condition.When I say condition it is more a braycardia condition with occassional PVC's, and LBBB shown by ECG, and certainly impaired pumping function.I have had the CRT tweeked a few times to allow my exercise tolerances which are demanding.Before the CRT I was suffering a bit under exercise and with the CRT insert that was a game changer, although the EF numbers and,heart shape on latest echo are the ones that have me receiving mixed messages.The fleccanaid doage is small 100mg/day and I have been tolerating this well with zero phsyical side effects I know of.I am certainly alot fitter and stronger than many of my peers which is also a little confusing considering I am supposed to be impaired!! So thnkyou all for what you have been saying, all your information is valuable and helps with the jigsaw of unknowns.chrs Dave



by Bionic Beat - 2020-03-23 18:58:03

I'd just keep on keeping on if I were you! 


You are doing a great job at living and enjoying yourself.  Well done.


35% is not terribly low as normal is around 50%.   Many compare the EF with 100%, not so.


As I said, well done!  Enjoy!



"I do have two cardiologists"

by AgentX86 - 2020-03-23 22:36:02

Why oh why do you have two cardiologists?  Given two people, you'll never get an answer.  It takes either one, or three.  ;-)

You need an electrophysiologist to sort this all out.  Ps are specialists in the electrical systems of the heart.  Cardiologists do plumbing.  I have on of each but they communicate well and stay out of each others way.

poor ejection fraction

by blowhard - 2020-03-24 05:41:31

Yes I think you are correct, my 2nd Cardiologist is also an electrophysiologist...I went to see him as he supervised the pacemaker insertion...I also have another one who has tweeked the CRT pacemaker twice now.It may be time for another visit to the first guy.It is very interesting communicating with these people as none of them are driven sports junkies like me.I have to really explain carefully the demands of the activity, the outcomes, and the recovery process after a hard few days.Usually I am pretty careful to rest up but occassionaly I overstep the mark.Learning as always.Well we are in lockdown for 4 weeks now so cant go anywhere.Thnks for the last two comments, awesome! Dave



he did adjust a few settings here and there

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