Ejection Fraction post surgery

[Paleowoman]

Prior to my aortic valve replacement (seven months ago), my ejection fraction was 79%. It had always been around that level the previous seven years since it was being recorded at regular echos . Now, post surgery, it is 67%. My cardiologist is happy with that, he says 67% is good - had echo on Tuesday. I'm wondering though if the drop in ejection fraction is what's making me feel less fit with less stamina and endurance since surgery. I'm not on beta blockers or such like.

I always feel like I'm spoiling things for those who felt 'better' after surgery when I say I feel less good. I'm trying to find an explanation.

Cardiologist also said there was some kind of slight area of 'damage' to my heart muscle which he said is very common from surgery but that it wouldn't cause how I'm feeling. He's going to do repeat echo in six months but said to come back any time to see him.

 

[epstns]

Anne, I can't say for sure, but I doubt that your EF is low enough to cause much of an issue. I would be more inclined to chalk it up to variation between echo's, as your tissue density, internal positioning, internal interference with "view" etc., have probably changed due to surgery.

In my case, it was probably closer to a full year before I felt fully "normal" again after surgery.

Feeling "less good" is better than feeling "bad."

 

[Duffey]

I had a high EF before replacement, somewhere in the mid-70's. I was told by the cardiologist that a high EF sometimes signals the heart is struggling with the valve issue (having to over compensate) and a lower EF is actually a better predictor of heart health. My EF is now about 64.

 

[Paleowoman]

Hi Steve, I know the lower EF in itself isn't considered low, but I'm wondering if it's because I'm used to having a higher EJ that I feel different ? All the previous echos were 77% or 79% even with different machines and different technicians, and now the two echos since surgery have been 67% on different machines and different technicians but same result. Maybe different tissue density is the reason like you say.

Hi Duffey - what your cardiologist says makes sense in some respects and I had considered that previously, but the echo before surgery showed that my heart muscle was strong, the technician commented that he could see from it that I did weight lifting ('athletic heart' another consultant told me) so my heart was considered strong so I can't think it can have been struggling (pressure gradient on referral for surgery was 68 mm/Hg and EJ 79%, valve area 0.9 cm2).

My pressure gradient when I first started to record my echos seven and a half years ago was 35 mm/Hg with EF of 77%, and now my pressure gradient is 33 mm/Hg with the 67% EF. When I asked my cardiologist why the pressure gradient is as high with the new valve as when I had moderate stenosis, he said it's something to do with it being a small size and with the ring making the valve area small. Just found a previous post from Larry (Mentu) done in 2010 about post surgery pressure gradients: http://www.valvereplacement.org/foru...ue-valve?36503 Seems mine is about the same as Larry's and Johan's....not sure I understand it though !

 

[Duffey]

Anne, here's a thread from way back when. In one of the replies, it's mentioned that an EF above 75 can indicate cardiac hypertrophy (heart enlargement or thickening) or other problems.
That was what I meant to say in my previous reply to you but it wasn't very precise.



http://www.valvereplacement.org/forums/forum/heart-talk/8411-ejection-fraction

By the way, I am member Mary in the replies.

 

[river-wear]

Hi Anne, I'm sorry you're frustrated with the pace of your recovery. I've read about your incredible weight-lifting feats (in my mind, anyway) and know you were very fit before surgery. This may not apply to you, but I'm wondering if you've been most focused on weight training during your recovery? Maybe it could be that you just need more cardio workouts first?

A normal EF is considered to be 55-70% as indicated by Duffey (and spelled out on the heart.org site). Above 70% can indicate hypertrophic cardiomyopathy (not that it necessarily applied to you): http://www.heart.org/HEARTORG/Condi...trophic-Cardiomyopathy_UCM_444317_Article.jsp

However, that could relate to the comment about an athletic heart as well. If you google the term, you'll see that it isn't necessarily all good. At one point, my husband was running a lot of marathons and developed a murmur due to an enlarged heart due to training. (It went away when he stopped working out as hard and later switched to cycling.)

What I'm trying to say is that your heart is probably healthier now than before - well, not "probably" since your valve is functioning properly now. I'm sure you'll get back to where you want to be. Work hard, but be kind to yourself. Try to be patient - at least until you see your cardiologist in six months.

 

[Paleowoman]

Hi Duffey/Mary ! Interesting thread, and itsn't it great that all those older threads are still there for us to read. I didn't have hypertrophic cardiomyopathy or left ventricular hypertrophy either, they were obviously looking for that. Funny thing was that I got "mild left ventricular hypertrophy" about two months after surgery ! That has all gone now.

 

[Paleowoman]

Hi Michele - I will try to be patient, it is frustrating though ! I've been doing a mixture of weight training and cardio since I started doing cardiac rehab, just under five months now. It's an interval training which combines the two and I keep an eye on my heart rate with a monitor. I shall persevere. That is kind of shocking that your husband got a heart murmur due to an enlarged heart due to training !

 

[river-wear]

Yeah, that murmur kind of freaked us out for awhile. The doctor said because the heart enlarged, the valve couldn't close properly any more. They did an echo for a better look. Still seems odd to me, but here we are years later and his doctor doesn't hear a murmur anymore.

Good luck with rehab. Interval training should be particularly effective in building your stamina.

P.S. I didn't see Mary's second post when I posted above...