EF question

Hi,
I'm new to this site and was hoping someone could help with some information on a question I have.
I have SCA about two years ago, after the event I had a ICD implanted. A few months after the implant my EF was about 20% so my doctors replaced my ICD with a CRT-D. After 4 months my EF was 40%-45%. My doctors were very happy and so was I. It's now been about a year since the CRT-D was implanted and a recent echo shows the EF declining a bit. Between the echo's at 4 months and the recent one, I have had some adjustments made because the device was causing my stomach muscels to spasm sometimes. So the voltage and timing was changed. Could these adjustments lead to a decrease in my EF????? To make worse my EP doc, who I really liked has left the hospital, so now I see a new one next week.
Thanks
Two Lives
Tony

2 Comments

EF Numbers

by SMITTY - 2011-11-03 06:11:07

Hello Two lives,

Welcome to the Pacemaker Club.

I'll comment on your questions about EF as it is a subject I have spent some time thinking about during the last couple of years. Let me start with what I understand about how EF is determined. I hope I'm not insulting your intelligence with this, but I wanted to include it so that we both are reading form the same page.

I know of four different test procedures by which they can get a visual of our heart chambers before and after it pumps blood. The EF is determined from the before and after size of the left ventricle. From the difference in its sizes they can estimate how much blood is being pumped each beat.

To go a little further, a "normal heart" contains about 200CC blood ready to be pumped. An average EF ranges from 50% to 70% which says if you have an EF of 60% about 120CC of blood is pumped each beat, or the size of the heart chamber is about 40% when compared to the 100% before the contraction. Of course it is not that simple, but for me that is all I need to know.

Although I have had EF determined by at least four different procedures, an echo is the most frequently used test I have for my EF. I had my first echo for EF in the early '90s. I ever gave the numbers I was quoted until a about 6 or 8 years ago. That was a few years after I got my first PM and after the Drs started prescribing different medicines to "improve" my ejection fraction.

I have seen my numbers range from a low of the mid 30s to a high of 70%. Right now the number I user for my EF is 45%, plus or minus 5%. After seeing my numbers range all over the map and learning how my EF are determined I no longer put much significance in a few points change. There are two reasons for that. First the echograms have been done on different machines from time to time. And I can tell you for certain the ones used today are many time easier to read than the first ones I saw. Second, the percentage reported is the Drs measurements and interpretation of their size before and after the heart beat. And that in itself leaves room for discussion.

My conclusion is I'm more interested in how I feel, the EF trend over a long period of time and what the Dr has to say about the changes than a few points change from the last test.

Good luck,

Smitty

Go with the flow

by nofib - 2011-11-07 09:11:36

The EF is a meaningless term offered to patients as a placebo. What is important is the stroke volume - the output in milliliters of the left ventricle. However, doctors cannot at this time determine this number; so they give you what they know, the EF. What volume is the EF a fraction of? They don't know.

More than 40% of heart failure patients die with a "preserved ejection fraction" (>/= 50%).

What is important is how you feel, as the other commenters noted. So don't worry about the cardiologists' little games. But if you want a modicum of honesty from your cardio; ask him/her what your stroke volume is, in milliliters.

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