Ejection Fraction question

[Paleowoman]

Despite my pressure gradient going up to a mean level of 60 mm/Hg (getting referral to surgeon based on that), my ejection fraction is 77%, an increase of 1% on my ejection fraction of 76% back in 2007 when I was last given the ejection fraction number. Can anyone tell me is this ejection fraction good or bad ?

 

[Midpack]

Ejection Fraction question

As far as i know, EF can be estimated by various techniques. And it is not something constant. As a matter of fact, EF can vary with each heartbeat. 76% or 77% does not make any difference. 1% is completely irrelevant.

In order to be referred for surgery, EF is just one of the key parameters to consider. Less than 60%, with severe mitral regurgitation, may be considered for surgery (even if asymptomatic). I dont know if it is the same for aortic stenosis...

Anyway, your EF seems good.

Good luck!

 

[clay_from_nj]

I do know from experience that here in the US, below 40% will keep you from getting a commercial driver's medical card.

 

[Eva]

Despite my pressure gradient going up to a mean level of 60 mm/Hg (getting referral to surgeon based on that), my ejection fraction is 77%, an increase of 1% on my ejection fraction of 76% back in 2007 when I was last given the ejection fraction number. Can anyone tell me is this ejection fraction good or bad ?

Hi Anne,

Here are some information about high EF.

1- Quoted from: http://www.cpmc.org/services/heart/tx/ejectionfraction.html

"An EF of 55 to 75 percent is considered normal. A higher than normal ejection fraction could indicate the presence of certain heart conditions, such as hypertrophic cardiomyopathy. "

please don't get scared by the last two words! In brief, it mean LV enlargement which is common. The good news are that in almost all patients (I'm one of those) the LV size returned to normal size after surgery.

2- Another quote from the top para on page from

http://eurheartj.oxfordjournals.org/content/31/3/281.full.pdf

"..... patients with severe AS and LV concentric remodelling often tend to have relatively higher EF’s than normal (e.g. .70%) to compensate higher values for the insufficiency in ventricular filling."


3- Quoted from American heart association: http://www.heart.org/HEARTORG/Condi...rt-Failure-Measurement_UCM_306339_Article.jsp

"EF higher than 75 percent may indicate a heart condition like hypertrophic cardiomyopathy."

Good luck and keep us informed. 

 

[Midpack]

Ejection Fraction question

As a matter of fact, before reading Eva answer, i was unaware that a high ejection fraction can be indeed a negative thing. We allways learn something new!
Anyway, if 55-75 is normal, 77 cannot be that bad! I would call it upper normal. EF Measurement, as i said, is not so accurate. The same day, another technician with different equipment can measure it at 73, for instance.

In my experience dealing with cardiologists, they dont pay much attention to single values SLIGHTY out of normal range. They look at the full picture.

 

[Eva]

As a matter of fact, before reading Eva answer, i was unaware that a high ejection fraction can be indeed a negative thing. We allways learn something new!
Anyway, if 55-75 is normal, 77 cannot be that bad! I would call it upper normal. EF Measurement, as i said, is not so accurate. The same day, another technician with different equipment can measure it at 73, for instance.

In my experience dealing with cardiologists, they dont pay much attention to single values SLIGHTY out of normal range. They look at the full picture.

I totally agree that measurements differ from one technician to another. This is why the symptoms and the full picture is what the surgeon weighs!

 

[Paleowoman]

Oh dear - I'm actually not happy with my cardiologist now. He wrote to the surgeon to refer me, just a brief two liner, and hasn't sent him any details about me, just said my pressure gradient is 60 mm/Hg and I have BAV. He hasn't included anything about all my other medical conditions. I aksed the cardiologist if it was okay for me to do my weight lifting and he said "yes it's okay to do your low level of weight lifting" - well I don't do a "low level" ! I lift extremely heavy weights (eg 125kg on the leg press, that's 275 pounds) - and everywhere I read that that is contraindicated when you have severe aortic stenosis. I emailed my cardiologist again to clarify the situation but he hasn't replied ! I also want to see a different cardiac surgeon, one whom my endocrinologist (who is a much better doctor than my cardiologist) recommended, but my cardiologist is dragging his feet, he told me that he always refers his patients to one particular surgeon, always, no matter what.

What is a stressful situation for anyone being referred for surgery has become mega stressful now for me becasue of my cardologist.

This is probably posted in the wrong section, but the ejection fraction thing highlighted this

 

[Eva]

Anne,

I got stressed the same way as you are now with my cardio who told me I needed surgery within 3 months and would not return my calls after I recovered from his shocking news and had some questions on mind. (I fired him though it was the wrong time to fire a cardiologist).

Are you entitled in the UK to get copies of your echocardiographs CD and of the reports?! Ask for the last one or last two, at least.

I would not do any strenuous exercise or extreme lifting (no matter what he thinks). In my opinion, this is your heart and you do not need to exert it unnecessarily at this time...heavy lifting can wait for now and strenuous exercise may speed up you need for surgery. You need to time to check out other surgeons in addition to the one he recommended.

Check the surgeon he recommended on the internet (he could be good!), and check him out when you meet with him. But definitely I would see more than one surgeon.

Stay calm and take deep breaths and take walks. You are OK, but start searching.

Keep us informed.

 

[Paleowoman]

Hi Eva,

Thanks for your message ! I didn't know there might be CDs of the echos - I will ask about that. I get copies of the reports the cardio sends my GP, but they don't give all the details like valve size etc. I shall ask my cardio about this next time I see him. I am also doing more investigations of the various surgeons and have seen one who seems to have done a lot of AVR surgery who I like the look of. I took 1/2 mg lorazepam yesterday evening and that helped clear my mind so it wasn't quite so overwhelmed with anxiety and I was able to get a good night's sleep. The night before I had not dropped off till 5am. I don't like taking the lorazepam though because sometimes I get side effects the next day, like memory lapses, but I will definitely have to take it occasionally from now on (doc originally gave it to me because of the stress of the heart problem, but I've only used about five times in the past two years).

I'm lucky in that, because of my husband's work, we have private health insurance which means that, although I see my GP on the NHS, and get all my medications on the NHS, everything else, consultants, tests, surgery when it comes, is all done 'privately'. The consultants I see and consultant surgeons are the same ones who operate in the NHS but they do private work too. This kind of means that I am, in a way, in a more similar position to you in the US, except that there are no co-pays and my insurance company pays the whole bill.

I contacted the Society for Cardiothoracic Surgery today and they say that my cardiologist can't stop giving me a choice - obviously I should see the relevant surgeons and then discuss it all. I rang the hospital where I will have surgery today and they said it's a good idea to see a couple of surgeons ! And they will show me and my husband around the cardiac unit any time ! The hospital is St Anthony's : http://www.stanthonys.org.uk/our-services/specialised-services/cardiac-services and the surgeons come from St George's which is a very large London teaching hospital.

I'm not doing anymore weight lifting - I can wait till I'm recovered from surgery !

 

[Rachel]

Paleogirl

I'm glad to hear that you've stopped lifting!!!!

A note about tests...I also had to "fire" my first cardiologist - had an echo and CT under that guy and when I went to retrieve my records to transfer to a new cardiologist – the new doctor couldn't read them because they used a "different protocol" whatever that is....long story short - had the tests done all over again.....but it was worth it in the end!

Trying to stay on topic here.....this also relates to the fact that measurements can vary from different facilities.

 

[Eva]

Hi Anne,

Great job!

As Rachel said, even if the surgeon or new cardio could read the CD, they will still prefer they do their own testing! It is worth it.

As for Ativan and as long as you are not abusing it, I won't worry about using in such difficult stressful times. It is very helpful. It helped me a lot before and after my surgery. Have you tried quarter of a mg?

Keep us informed and I'm happy for you being proactive and responsible.

You shall make the right choice.

 

[Paleowoman]

Will definitely try a quarter of a mg of the lorazepam Eva - thanks for the suggestion !

 

[kimcdougc]

I interviewed (3) surgeons before my AVR surgery. Did my homework and decided to use the last one I interviewed. I fired my cardiologists right after my follow up visit with him after surgery. Got a new one and I am very please with him and his staff. You need a Dr. who will answer your calls and give you all the information you need. My EF rate after surgery is 65. Dr. says normal! Good luck with all of your decisions.