Normal ef function befor AVR now severely low ef function after AVR

[katielady72]

As the title states, I had normal ef function around 60 - 65% ef function before my AVR, I was lucky. Now a year and a few months later, I just had my first yearly follow up echo and it showed severely low ef function at 35% and I am not in systolic heart failure. I have a normally low blood pressure of around 110/65 but my heart rate is usually sitting around 95 - 105 all the time. In july of this year my cardio said it was just low resting tachycardia and he wasn't worried because my ekg looked ok other than my lbbb (left bundle branch block) and my valve sounds good. he decided not to do an echo then and said to wait for my yearly check up.Needless to say when he got the results he was more than shocked and very worried. I am now on the lowest dose of an ACE inhibitor and beta blocker he could give me but with my already low blood pressure I can't even function, all I want to do is sleep and I nearly fall over with dizziness. Has anyone else heard of low ef % after AVR with normal ef % before? I am baffled, confused, upset, angry and very, very very scared...thanks for reading

 

[honeybunny]

Did your cardio give you any reasons for this or recommend additional testing of f any kind? FWIW, my BP has always been low, running around what yours is. And my heart rate has always been high, even before surgery, with a resting rate of 100 or higher. My cardiac rehab nurses finally realized that was normal for me. I've been on a beta blocker since surgery last September. I don't know what my efficiency % is but will try to find out. I had an echo a month ago (I'm enrolled in a research study) and was told everything is just fine. What does your doctor plan for follow up?

 

[T in YVR]

I was at 60% and dropped to 50% and occasionally 55% after AVR. I stayed there for about 18-24 months (usually 55%). I just had an echo and was back up to 60%. There are different ways to test your EF - one is a visual estimation; and one is more quantitative (modified Simpson method). There are others. This link, while a bit scientific, might help - https://www.radcliffecardiology.com...on-fraction-techniques-and-potential-pitfalls

My Cardiologist told me that the beta blockers help your EF. I have been on Metoprolol (~30mg daily) and Coversyl (4mg daily) since my surgery 2.5 years ago. Was hoping to get off of them but no luck (due to my LV size which was as high as 66mm pre surgery but was down to 56 mm (near top of normal range) last month. My resting HR is around 58-65 beat/min and I have low-normal blood pressure. If I was you I would get a 2nd echo (maybe at a different place??) and request a more scientific measurement (depending on how they did it the first time).

Tony

 

[katielady72]

my cardo, my pcp and all my other dr's are at a complete loss as to why this has happened because before surgery, and just after my ef % was at 60 - 65% with my blood pressure on the low side and a resting heart rate in the upper 70's to low 80's, then out of the blue my heart rate sky rocketed and stayed there, once jumping into the 200's and I swelled so much I had a hump on top of my foot that looked like the hump on quasi moto's back. I couldn't wear shoes for a long while, and the whole time I kept asking everyone if this needs looking at and they said not to worry because everything sounded ok with my valve, and because I had no history of any other cardiac disease they weren't concerned. Now they are. There is no reason for this, I have not had a heart attack, I have not had any infection, I do not have CAD, it is just a total mystery. my echo took an extra long time to do because the tech saw something strange and went and asked my cardio if she should do a contrast study so I consented and the only other difference found other than the ef % was slight regurgitation in my tricuspid valve which I never had trouble with before. I'm so frustrated I could scream. I see my cardo on Thurs but I plan to ask him to take me off the meds because they have dropped my blood pressure down to 80/50-60 and I am waking up dizzy in the night. I am on the lowest dose as it is.

 

[T in YVR]

Sorry you are having such troubles. I would be stressed too. I would not worry about the low/mild regurg on the tricuspid very much. Loads of people have this (including me). My cardiologist said alot of people can have this and it stays like that forever. Get another echo. Strange to have such low BP with a high heart rate....pacemaker needed? I hope they can figure it out for you. Hang in there.

 

[tsanjose]

my EF was 65% before mitral valve repair surgery 4 months ago. my 2 week and 3 month post echo showed it decreased too at 52% and 56% at my 3 month. my BP is also significantly lower now at 110/75 vs 125/75ish before surgery. i remember immediately following post op it was very low at 90's/60ish and a resting HR of 100. i got lightheaded all the time. my cardio said for me there's a lot of trauma done to my heart with the surgery and it will take some time to settle. i hear up to a year or more in some cases. at 4 months i feel a lot better but i do wonder if my EF will go back to my pre-op reading.

 

[honeybunny]

Sending cyber hugs your way. Please update us after your appointment. We care.

 

[katielady72]

sorry for the delay. my cardio believes it was cardiomyopathy caused by a viral infection I caught in the first 6 months after my surgery and the only one I got was the noro virus. My sister asked me to babysit her 18 yr old daughter as she got food poisoning the night before so I went and sat with her the next day. Well it wasn't food poisoning. When I got home, after about 3 hours I was very, very sick. It seems my symptoms began after that if I recall correctly, the swelling, the very high rapid heart rate, palpitations, and shortness of breath. they all came on slowly one at a time and none of us (me, or my medical professionals) thought it was low ef % or heart failure because of my normal numbers going into surgery. He also told me it should have rectified itself before now, however since I have a LBBB + the low ef% it may never get better and I normally have very low bp anyways and I was unable to handle the beta blocker so he took me off so I have to wait 2 months before I can have a certain device implanted so I don't have to rely on medication that makes me so sleepy and dizzy I cannot function. The reason behind waiting 2 more months is that my insurance wont pay for it until I have had 3 months of medication therapy. Thanks for caring

 

[honeybunny]

Sorry that a good deed led to all this but glad to hear there is a resolution in sight. Getting your BP back up is a good idea. I wish you didn't have to wait two months but I understand the insurance issues. What will the implant entail?

 

[katielady72]

I believe he called it an RCD device or something to that effect. It apparently works similar to a pacemaker but not exactly. i will know more soon hopefully.