ejection factor

[flanaganspoint]

Six and a half weeks post op. Been walking a mile and a half in about 26 minutes most days, no chest pain, a bit short of breath but not enough to stop walking. Had an echo done last week and saw my cardio Dr today. He informed me my ejection factor was down to 25, having been 40 prior ro AVR and triple bypass on May 7. He started me on ramipril and altace due to swelling in the leg they took the vein out of for the by pass. This is a result of a long drive and hours and hours spent in a classroom over the weekend.
Anyone else have issues with ejection factor or diffficulty breathing after thier operation? Thnks!!

Terry
Heart Attacks x2 in 2001 TIA x4 2001
AVR, triple by pass St Francis Roslyn NY 5/7/2012

 

[Bill B]

Just FYI, it's "ejection fraction". It's the fraction (expressed as percentage) of blood volume that the filled left ventricle chamber pumps out with each beat. So, in your case, 25 means that when the ventricle fills to a certain volume, it pumps out 1/4th of that amount when it contracts. That lower percentage is probably contributing to you being a bit short of breath during your walk. I too had a rather substantial drop in ejection fraction after surgery compared to before, although I started higher than you but fell about the same percentage. Mine recovered gradually over the first year. With just AVR for stenosis and/or regurgitation, ejection fraction really should go up, although there is very little information on this in the immediate post-op period, and you had a lot going on with the triple bypass and your history of heart attacks. The good news is you have no chest pain and are able to exercise. Hopefully you will improve from here, like I did. The general information is that EF is improved post-AVR at 1 year.

BTW, ramipril and altace are the same drug, so I assume the second drug is something else.

 

[hook]

Here is how it was explained to me, as my docs said my EF may go down after surgery. When leaking valves allow blood to back-flow, this is often still seen during the EF measurments as blood flow. When the valve is replaced the flow can only go in one direction, thus reducing the number. Mine was about 20 after surgery, and has gone up to the 30s. I can lead a normal life in the 30s once in shape. Everyone is different, but you can teach your body to compensate in a good way.

 

[scott.eitman]

Wow, you guys are making me feel great. Fist, because I concentrate on EF and not gradients. Second, because I was disappointed that after getting a mechanical that my EF did not go up drastically. I assumed that a mechanical would work better than anything, especially now that I feel the doors slam shut. I went from 50%+/- to 50%+/-.

Thanks for sharing this.

 

[rvrkumar]

Lets put things in perspective. I was told that healthy heart will have an ef of 60-65%. I was concernrd after 3 month post-op check when the ef went below 40%. It was estimated as 45% pre-op when valve was severely leaking.

But, latest echo done two weeks ago ( 9 months post-op) showed the ef as 50%. Doc is happy is haapy to see the improvement, but cautioned again that these measurements from Echo are subject +/- 5% error. But, we both were happy to see the improvement and he agreed to reduce the metoporol dosage from 100mg a day to 50mg a day.

 

[flanaganspoint]

Thanks for the responses. Bill B, you're right on the meds. I have a habit of letting my wife take care of that for me. I should make an effort to be more familiar with what I am taking. I have scheduled a low level stress test for next week so I can start cardiac rehab. I need to drop a few pounds and keep my walking going ona daily basis.
In the mean time I am spending the day putting together an "Infrered, Gas & Charcoal Cooking System" ( father days gift) I know the instruction manuals for these things are written by tech manual terrorists, who want to see how easy it is to drive the average homeowner off the deep edge. I'll just breath deep and take my time.......

 

[ramjet]

Hello all,

Ejection fraction is affected by a number of things, the ability of the heart to pump or eject blood, the ability of the valves to prevent blood backflow (regurgitation), blood pressure, previous heart attacks, medications, age etc. So you can't just focus on ejection fraction, as I am sure you will know. Also, some hearts take a little while to "remodel" or reshape once a new valve is inserted, and hence EF may take a little while to improve, it depends on how much ventricular enlagement has occurred (if any) and so on. Thats why pressure gradient, blood velocity, Ejection fraction, Left Ventricular End Diastolic Volume (LVEDV), etc etc are all important in combination when assessing your current state and your post op health. An EF of below 30% is quite low for most people, but you need to factor in age, weight/size, symptoms, etc etc, so it is a bit difficult to make direct comparisions or comments without all the facts...but I hope that helps a little bit. Some patients get "SAM" after a new valve is inserted, "Systolic Anterior Motion" where the heart, not be used to a good valve, moves awkwardly until the presssure and muscles and things settle down, and while this is happening another valve may start to lek a bit, of ejection fractions can go a bit haywire etc etc, but remember, everyone is an individual with regards to state of valves, heart muscle, medications, other conditions, general fitness and health, so it can all get a bit complicaed sometimes..take care