How to Raise Ejection Fraction?

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Homeskillet

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So I just had my annual echocardiogram—and it came back with a reduced ejection fraction (EF) of 40%, down from 50% last year 😡!

I have been lifting weights pretty heavily for the last year though, and am also off of my beta blocker carvedilol at my cardiologists recommendation since my EF was at a decent range and the beta blocker was wiping me out.

I do take 2.5 mg of lisinopril though, but, for some reason my EF is dropping once again. Of course, my initial thoughts were, “Here we go once again!”

Without going into detail the last 2 years have been EASILY the most stressful of my entire life (i’m 51). We’re talking on-going acute-clinical stress, which I highly suspect is a contributing factor (I realize there’s mixed consensus among cardiologists). But, who lives a stress free life?

I see my cardio in about 6 weeks, but here’s my game plan in the meantime (I am asking for any input, experience or advice to this brief list):

1. Up my lisinopril from 2.5mg to 5mg.

2. Restart my beta blocker carvedilol

3. Look into natural supplements such as advertised on this cardiologist’s website: https://www.drsinatra.com/treating-low-ejection-fraction

**Again, if y’all have any experience or input I would greatly appreciate your time. This is ALWAYS the very first place I come to for studied input! Thank you much in advance.
 

tom in MO

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I wouldn't change my lisinopril or carvedilol dosages w/o talking to my cardiologist.

Since you are on warfarin, I wouldn't take those supplements w/o talking to my cardiologist. That's what he told me. When I had my AVR, he (and my primary care physician) told me most supplements have the primary effect of increasing the wealth of the seller :) The best thing is a balance diet with exercise.

Your profile shows you are a pastor. For stress, I recommend prayer aka meditation. Saying the rosary helps me. Rote prayer can be very calming.

For stress and exercise, I also recommend walking 2-4 times a day, preferably behind a dog. They can relieve stress too :) You can also pray while you walk thus doing two things at once to relieve stress.

Moderate use of recreational drugs such as alcohol has been known to help stress as well, but don't tell the nurse at the coumadin clinic :)
 

Eva

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I totally agree with Tom in MO ... be careful about supplements you see advertised. Check with your cardio or their interaction with your medication.

From my own personal experience, I very much regret having stopped my beta blocker (Metoprolol) in 2014 for your same reason...feeling sluggish.
My cardiologist advised me not to stop it while another cardio (in a different city) agreed to stop it. Of course I chose to stop. Little bit at a time, over time, on and off, my pulse starting going higher and higher, yet not dangerous!! My blood pressure started elevating occasionally!

Last March I admitted myself to the emergency. My pulse was 135 continuously for 8 hrs. Thanks to my Fitbit! Echo taken after 30 hrs of high pulse showed heart enlargement and EF 47%!!!

Now, I’m back on Metoprolol and double the previous dosage. I’m also awaiting Electrophysiologist’s decision when I see him next time whether I’ll need ablation or stay on medication.
Meanwhile, I’m learning now how to beat the fatigue it causes me.

So, in conclusion, check with your cardio or a new cardio and get back on beta blocker. Some are able to get off it, some (like me and maybe you) need it!

Good luck and keep us posted.
 

Homeskillet

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Thank you both. My cardio office called today and said that my lower Ejection Fraction *COULD* be due to my stopping the carvedilol, which, they said, was not what they intended me to do. They instructed me to restart the beta blocker, which I did today.

Spent several hours researching how to raise my EF last night, and did order some staple supplements — which I will tell my new cardio about when I see him next month.

Regarding prayer, I have never lacked in that area & spend daily devotion time doing so, but, again, without going into much detail, suffice it to say we assumed a nightmare situation when we took over as pastor of this church (there had been decades of, well, let’s just say problems and just leave it at that)....which we did not know until after we got here.

Thank you for your input! Very valuable.
 

Eva

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gerrychuck

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One thing that needs to be addressed is the inherent variability in EF as measured by echo. Studies have shown a 6% variability with retesting by the same sonographer, and more like 10% between different sonographers. Echo is a test that is highly operator dependent, while tests like the MUGA scan are not, and therefore only to around 2% variarion. So...you may or may not have experienced an actual drop in EF this year. Case in point: last year I had an echo which was right at my usual 51% in November. When read by the cardiologist, however, he changed it to 40%. I had another done 2 months later when I saw a different cardiologist regarding my need for a pacemaker. 50%. This November, 44%. Here's the kicker; MUGA scan in March; 39%. Keep in mind that ACE inhibitors and beta blockers improve EF by decreasing arterial resistance and making it easier for the heart to expel its contents. Stopping a beta blocker can definitely change things. In my case, I observed that my blood pressure had gradually crept up to "normal" levels of about 120/80, while they had been more like 105-110/65-70 previously. I had been on very low doses of metoprolol and ramipril, which was originally all I could tolerate, but I think my system accomodated over time. I am now on increased dosages of both and my bp is back where it had been previously, and I imagine my EF is back to where it had been as well. I guess I'll find that out when I get my next echo in November. Assuming the echo is somewhere close to accurate of course! As an aside, the one linked article recommended abstaining from alcohol; that is not the current thinking according to what I have read. Alcohol has much the same effect in relaxing blood vessel walls as ACE inhibitors do, so in moderation it can actually help in improving EF. No one recommends starting to drink for health benedits, but continuing in moderation is not a bad thing for your heart.

On a different note, my father was a minister and he really suffered from the stress of the job as well. It is very real and can be profound. I wish you well.
 

Homeskillet

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Thank you much gerrychuck. Really good points. I am seeing my cardio in about it 6 weeks and will ask for a MUGA (assuming I can have one w. my pacer wires in (I cannot have an MRI w. pacer wires😡!). Bad thing is, I could actually be sitting at an EF of 30% - and not even know it. Honestly, I don’t know why they wait a whole year to do echoes anyway. For repeat OHS patients 6 mos. would seem long enough (my surgeon even suggested that time frame).

I have also noticed my BP & heart rate rising over the last 2 months. Also shorter of breath upon exertion, which is all very likely tied to my EF reduction (although I have been taking 2.5mg of lisinopril daily for this whole time).

Regardless, I started my beta blockers again and will likely never go off of it again!

Thank you again!
 

gerrychuck

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MUGA is no problem with the pacemaker. I have a pacemaker too, and it never came up when I had the scan.

Yes, you may have an EF of 30, but it is equally likely that it is 50 just like it was last year. All the best.
 

AZ Don

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FYI, about a year after my BAV sparing aortic aneurysm repair, I had moderate regurgitation at the aortic valve and my ejection fraction dropped to 40. Cardio explained the inaccuracies in the echo mentioned earlier so I had two MUGA scans 6m apart that came in at 45 and 46. I was told at the time that EF doesn't improve and I assumed subsequent echo's showing 50-55 were due to the margin of error. That is until I saw a different Cardio, who clarified that my echo clearly showed an EF in the mid 50's. He believes that it improved because of the (still anecdotal) beneficial effects of Losartan (25mg/day) on a Bicuspid valve, although my regurgitation is still moderate - and in his view, virtually unchanged from the year after surgery. I also take Metoprolol but cut back from 25mg twice daily to 12.5mg twice daily a couple years ago, because it still slows my heart and why take more than necessary. Nothing else really changed. After OHS I was back to exercising asap but it was at least a year before I was exercising like I used to.

Reading the 'How Can I Improve my Low Ejection Fraction' article (thanks for posting) I think it is as likely that it was exercise that caused my EF to improve as the Losartan, but there is really no way to know so I will continue with both.
 

Homeskillet

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Thank you much men. After reading these posts I am going to request a MUGA to get to the nitty gritty on this.

Really good info. AZ Don! Not sure if AZ stands for Arizona, but I lived in Surprise, AZ for a while. In fact, my first OHS was done at Banner in Phoenix.

I freely acknowledge my obsessive behavior regarding weight lifting. It’s just something I have done virtually all of my life and really difficult to tear away from. In the last few months I have started back to moving some pretty serious weight—and it is ALWAYS in the back of my mind that I’m probably not helping my heart very much by doing this heavy weight😯.

A renowned surgeon in Portland, OR (at OHSU) told me that the heavy weights is likely what caused my first (tissue) valve to fail so soon. He also pointed out that that is very likely why Arnold Schwarzenegger had his heart problems. He said flatly, “We are not made to move that kind of weight and it’s very hard on the heart!” I will definitely be toning things down.

I have restarted my beta’s and also taking the supplements on the site I linked earlier. Will know more in 6 weeks.
 

tom in MO

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Betas have side effects that I didn't like. I brought it up with my cardio and he weaned me off them to make sure I didn't really need them anymore after surgery.

If you lift "serious weight", you can switch to a machine and do it fast, kind of like a cardio workout :)
 

carolinemc

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May 31, 2010
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kansas city, mo
So I just had my annual echocardiogram—and it came back with a reduced ejection fraction (EF) of 40%, down from 50% last year 😡!

I have been lifting weights pretty heavily for the last year though, and am also off of my beta blocker carvedilol at my cardiologists recommendation since my EF was at a decent range and the beta blocker was wiping me out.

I do take 2.5 mg of lisinopril though, but, for some reason my EF is dropping once again. Of course, my initial thoughts were, “Here we go once again!”

Without going into detail the last 2 years have been EASILY the most stressful of my entire life (i’m 51). We’re talking on-going acute-clinical stress, which I highly suspect is a contributing factor (I realize there’s mixed consensus among cardiologists). But, who lives a stress free life?

I see my cardio in about 6 weeks, but here’s my game plan in the meantime (I am asking for any input, experience or advice to this brief list):

1. Up my lisinopril from 2.5mg to 5mg.

2. Restart my beta blocker carvedilol

3. Look into natural supplements such as advertised on this cardiologist’s website: https://www.drsinatra.com/treating-low-ejection-fraction

**Again, if y’all have any experience or input I would greatly appreciate your time. This is ALWAYS the very first place I come to for studied input! Thank you much in advance.
Just go by the best advice in this room. Always consult your cardio before making any adjustments on any medication. You are in good hands and the best advisers in the world here.
 

Protimenow

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FWIW - I also didn't like the effects of metoprolol. The cardio, for some reason, had me taking FOUR TIMES the dose I probably needed. He switched me to Bisoprolol, which seemed to have fewer side effects. Also - my body apparently needs half the dose of the stuff he prescribes me. I take 2.5 mg Bisoprolol (1/2 of a 5 mg), and, I think, 2.5 mg Benazapril (again, 1/2 the dose prescribed). He wanted me to take 800 mg of Magnesium - a dose that I CANNOT tolerate without serious digestive issues -- I'm okay with 200 mg of Trader Joe's magnesium, (which has magnesium in three different forms). I might up the dose of the Trader Joe magnesium, if I remember to.

You might ask your cardio about switching to Bisoprolol to see if you have fewer side effects.
 

ddwheeler

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I live in Dallas, Georgia, in the United States. W
I've been taking a low-dosage prescription of metoprolol... 25 mg ... for the past few years. My cardiologist prescribed it just to slow my heart rate. My aortic valve leakage is mild/moderate. But I also have a slight aneurysm at the base of the aorta. So, the idea was to slow down my heart rate, lowering my blood pressure (it wasn't high but it was borderline... ie 130s over 80s type of readings). I also exercise, lift weights, but I was told to definitely not lift heavy, so as to not put such a strain on my heart. But, I was emphatically encouraged to continue working out (I use nothing heavy.... 25 lb. dumbbells and a Total Gym for a variety of exercises). They were adamant concerning keeping in good shape, especially if/when the time should come that I would need to undergo surgery, rather than go into surgery out of shape, flabby, fatty torso, etc.
 

carolinemc

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Messages
632
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kansas city, mo
FWIW - I also didn't like the effects of metoprolol. The cardio, for some reason, had me taking FOUR TIMES the dose I probably needed. He switched me to Bisoprolol, which seemed to have fewer side effects. Also - my body apparently needs half the dose of the stuff he prescribes me. I take 2.5 mg Bisoprolol (1/2 of a 5 mg), and, I think, 2.5 mg Benazapril (again, 1/2 the dose prescribed). He wanted me to take 800 mg of Magnesium - a dose that I CANNOT tolerate without serious digestive issues -- I'm okay with 200 mg of Trader Joe's magnesium, (which has magnesium in three different forms). I might up the dose of the Trader Joe magnesium, if I remember to.

You might ask your cardio about switching to Bisoprolol to see if you have fewer side effects.
And I hope you had discussed with the doctor about you taking the lower dosage. Communication helps between Doctor and patient. Always be careful on change dosage of any medication and discuss it with your doctor.
 

Keithl

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Apr 20, 2019
Messages
180
I've been taking a low-dosage prescription of metoprolol... 25 mg ... for the past few years. My cardiologist prescribed it just to slow my heart rate. My aortic valve leakage is mild/moderate. But I also have a slight aneurysm at the base of the aorta. So, the idea was to slow down my heart rate, lowering my blood pressure (it wasn't high but it was borderline... ie 130s over 80s type of readings). I also exercise, lift weights, but I was told to definitely not lift heavy, so as to not put such a strain on my heart. But, I was emphatically encouraged to continue working out (I use nothing heavy.... 25 lb. dumbbells and a Total Gym for a variety of exercises). They were adamant concerning keeping in good shape, especially if/when the time should come that I would need to undergo surgery, rather than go into surgery out of shape, flabby, fatty torso, etc.
You might want to discuss an ARB like Losartan with the cardiologist there is some evidence that slows down the growth of an aneurysm. I was on 25mg for years once they diagnosed it in 2007 and finally needed it fixed this year.
 
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