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Atrial Fibrillation and Heart Failure
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I_Love_Beach_Music posted:
My 43-year husband had a heart attack at the end of December. He had a 100% blockage in the LAD, he had just started cholesterol medication 2 weeks earlier. His cholesterol was just was just over the level to be considered high. He is 5'11" weighing about 235.
We lead a busy life, like any other parents of two children, with full time jobs. His choice exercise was riding his bike at 4 a.m. about 12 miles and between 12-15 mph. In the last 6 months or so he was not as consistent as he would have like or should have been.
His enzymes at their highest level were 97, which as I understand is a "middle of the road" heart attack. He was in the Cardiac Care Unit for 7 days because of atrial-fibrillation and because his ejection fraction was 25-30%. (I believe his AF is a flutter not a quiver — flutter being the better type to have, I think.)
He had a cardio inversion day 5 post heart attack, normal sinus rhythm only lasted about 5 days. He was discharged with a heart monitor / defibrillator. At no time has he been able to identify that he was in AF.
The doctor has asked that he not return to work until May. I believe his intends to try the cardio inversion again in mid-April.
His mother died 3 years ago from complications of diabetes, but had a history of atrial-fibrillation and was cardio inverted twice.
I have the upmost respect for the cardiologist, but have a few questions. I understand the combination of the two complications can be lethal and the doctor is hoping for improvement over time.
In your experience, what is the percentage of patients that improve from an extremely low ejection fraction, to an ejection fraction of 40% or more?
He is walking on the treadmill 15-30 minutes at a time at approximately 2.8 mph, which did cause an "alarm from the defibrillator" which he was able to delay and then stop the shock as per the instructions.
We live near two large teaching / university hospitals, I've thought about requesting a second opinion, but we are apprehensive about doing so.
What is your experience in reference to partial or complete recovery for someone with the two complications. I understand that you've not examined and are basing an opinion on information I giving — just wanted an thoughts from another professional.
Anytime and consideration you give would be greatly appreciated.
Reply
 
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James Beckerman, MD, FACC responded:
It's very difficult to predict recovery for any particular patient - although I think it's a very good sign that he is able to exercise as well as he is doing - many people with even higher ejection fractions cannot do so.

As hard as it may be, I try to encourage people to stay on their meds, live a healthy lifestyle (as your husband is doing) - and get a follow-up echocardiogram within a few months of the initial heart attack. I am frequently happy to see improvement even over that period of time.

Take care and best to your husband.
 
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CAT9LIVES responded:
Hello; I know what you are going through. I too had AFIB. and a cardio inversion. I had the TET prior and boom the very next day after leaving the hospital my AFIB was back. So... went to my Cardiologist and this time had a halter and he confirmed I had Permanent AFIB. I had been doing my research and had come up with Cardiac Cryoablation. Thankfully my cardiologist referred me to a Rhythm Specialist (Dr. Wilbur Zu - you can google name or go to www.stopafib.org). March 13th I went in for full electro study and Cardiac cryoablation (only missed about 4 days of work). After cryoablation I still had a track in the top chamber of my heart that they didn't find while doing the study. They tried to "flip it with medicine" before I was released from the hospital. Back to the my cardiologist another heart halter. I still had AFIB... Back to Dr. Zu another cardio inversion... Same thing After 6 weeks when my heart had healed from the procedure in June I was scheduled for another Cardiac ablation but not cryoablation... Today I have the "flutter". I was in AFIB after my 1 week visit from the hospital and then was told to go to the hospital the next day for another cardiac inversion. I showed up and was in normal sinus rhythm and after all the admitting was just sent home. . The flutter is liveable and I am told that most patients it just fades away in 4 - 6 months. I can feel mine when I lay down..I never knew I had heart trouble till I was on a operating table last November and went into AFIB. I don't have high blood pressure, high cholesterol, any blockages or sugar diabetes.. My advice.. considering his Mother's health issues ask for a referral to a Cardiac Rhythm Specialist from your Cardiologist and do your research and find the best treatment for your husband.

My husband had his 1st hear attack at age 54. He has had hypertention since he was 36 and then Type II diabetes at age 40 then the high colestorl started to appear. After he stabalized from his heart attack he had a heart catharazation and it was discovered he top branch blockage.and 2-3 others as well. To date he has had 7 stents. February 2008 a pacemaker / defibrillator implanted. Then September 2010 his batteries needed changing so they just swapped out the device. They had to tweak his pacemaker rhythm but today is unbelievable. He was given 5 - 7 years to live and this is now our 11th year since his 1st heart attack. Our sharing is that today we both go to the same Cardiologist just different problems.

Hope these words give you encouragement. I use to lay awake at night thinking how unfair it was. I was only in my early 50's all our plans ... actually it was a reality check for us and our priorities. What really mattered was we had each other and every day are give another 24 hours together. I spent so much time worrying in those years I am sure it was a contributing factor in my Cardiac AFIB as Stress is number 1 cause. Now I us the Just for Today.. and will it matter in 10 years and its been working. I have calmness I haven't felt in years. Take care of yourself as the "Caretaker" has the burden that isn't easy. Internet research has been my lifeline... for my Laser Spine Surgery... which really saved my life and also my Cardiac Cryoablation. I would go to a good Rhythm Specialist as the procedure has only been allowed in the USA in 2010. God bless you... CAT
 
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suemurray responded:
am a female 60 years old in march of this year. I was diagnosis with COPD, A-fib, CHF & severe sleep apnea with the last 6 years. I worked all my live, was a single mother & am permentately disabled. I do have Medicare health care but because i am considered low income in my state of California I also get Medi/cal which actually means I have Medcaid... the choice of Dr.'s I can see is very small especially cause I live in Tulare county in central California. So my medical care has really not been that good!!!! Tulare county is the 2nd poorest county in Calif. i just got a computer & internet so I could my son, his wife & my 2 grandaughters, ages 4&5....His wife is still in the Navy and they just got thier new duty station in Japan...so I can Skype now with them which is very wonderful, cause I don't drive & am basically homebound,,,,they have owned a home in South Carolina for the last 2 years....I haven't seen my son or my youngest granddaughter since she was 11 days old. I have just been told I have an anxiety disorder...duh...I have COPD, & all the above which is just read your letter & info on COPD, A-fib, CHF and so on & so forth...it tells me my conditions can cause depression & anxiety,,, but they treat me like there is somethimg wrong with me????? Yes I am a anxious person, but with my conditions & age (60) depression & anxiety go hand & hand with my conditions espesically because I was raped in the middle of the night by a man my daughter & son-n-law allowed to live in thier home' the guy was my age & I also lived with them at the time.. the guy was an alcohalic & came home from the bar drunck & came in & raped me while I was sleeping' I was barely able to get my sleep apnea mask of my face & when i awoke & he was already on top of me. Ah, I think that has increased my anxiety'too!!!! At the time i got professional help...the it was a mental health counsoler & he said I was really handleing ut well cause I told him' "No I didn't want to get raped but at the same time i was glad it happened to me cause he could have done it to my 10 year old gradnddaughter!!!!!!!! Then about a year later when I got up in the middle of the night to use the restroom..I couldn"t go back to sleep, I began to feel ansy & squirmy & could not stop my mind not just cause of the rape (although that was a very big part of it) but my anxiety would go thru the roof.....now I know that, given my medical conditions combined with the rape,I was a classic Post Traumatic Stress disorder survivor!!! I didn"t know that not only my medical conditions already made me feel depressed & anxious until after the rape...now 3 years later I am still dealing with anxiety over my medical condition & lack of good medical care for those conditions & the rape & the triggers I have been dealing with, except until just about 6 months ago I found out what triggers are !??!!?? So now I was just told I have a lesion on my liver via a recent Cat Scan & he is referring me to U.C.L.A. me to medical center.....oh boy!! except if there is a bad problem with my liver given my other medical conditions U.C.L.A. is the best place I could go & be treated!!!!! So every cloud does have a silver lining{-} (LOL) Now with my new computer, I can stay connected to family & friend so much easier.... Sooooo I am a happy girl, (who said I was 60?) (LOL) I also plan on staying around for atleast another 40/50 years, so said I can't....Only my Heavenly Father knows & he's not talking right now...Thank you Father!
 
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SueMe responded:
Hi, I have been thinking about you and your husband since I read this the other day. From my own experiences (extensive since a 2004 car accident), I wouldn't hesitate to see a Cardiac Rhythm specialist. I'm wondering if you or anyone else out there can help me with a question about my mom. She's 85, has A-fib (flutter, I believe?), has a stent, and now has congestive heart failure, thickening of the heart wall, a stretched heart, etc. She was just hospitalized again and told she has an ejection fraction of 20%, which probably won't improve and is being managed with meds. Can anyone help me understand how serious this is (we were told "normal" is 65%) and a rough idea of prognosis?? Her 68 year-old nephew has A-fib, had a heart attack in December, and received a pacemaker and defibrillator, neither of which have been offered as options for my mother. We are guessing this is because of her age and the risk factor of more invasive procedures? It seems like those who are younger are treated with those options if meds don't work or their conditions are serious enough. Is that right? Any help appreciated! Meanwhile, I hold you all in my thoughts and prayers.
 
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cardiostarusa1 replied to SueMe's response:
Hi:

Prognosis is a variable, especially since everyone is unique, with each and every case/situation being different.

Noteworthy, looking back, for quite some time, there was a generalized 5 year statistic lifespan/life expectancy prognosis that we kept hearing about (which came from the Framingham Heart Study).

This is now considered as being no longer applicable, as thanks to modern medicine, marvelous medical technology, and the doctors who know how to use it, many patients with heart failure/congestive heart failure are living/surviving much longer than ever before.

As applicable, in some cases, along with a doctor recommended/authorized exercise regimen (unless contraindicated), left ventricular ejection fraction (LVEF) can be increased, sometimes substantially, by customizing/tweaking prescription drug-therapy (e.g., Coreg, which showed, back in its clinical trial days, that it could boost LVEF in some individuals) and supplemental (complimentary or integrative medicine) therapy, as deemed applicable.

Just one example of complimentary medicine is the use of the supplement Coenzyme Q10 (CoQ10 or ubiquinone, a vitamin-like substance) for heart failure (though currently not scientifically proven, some doctors may advise the patient to give it a try) which may/can (i.e., along with doctor directed prescription drug-therapy, and with the doctor knowing about any supplements being taken) help to improve LVEF in some, with other supplements sometimes added to the mix.

Additionally, as reported, as applicable to the patient, if/when the LVEF improves substantially or even recovers, and the heart appears to function near-normal or normally, other problems (unseen, that is, at a cellular or molecular level) often exist, or possible problems may/can occur anytime down the road, putting one at an increased risk.

Understanding Your Ejection Fraction

http://my.clevelandclinic.org/heart/disorders/heartfailure/ejectionfraction.aspx

**To get a decent estimate of LVEF, a MUGA scan is reported as being the most accurate of the non-invasive methods.

Pertinent excerpt from an article on About.com by Richard N. Fogoros, M.D.

When is the MUGA scan more useful than other heart tests?

The advantages of the MUGA scan over other techniques (such as the echocardiogram) for measuring the LVEF are twofold
. First, the MUGA ejection fraction is highly accurate, probably more accurate than that obtained by any other technique. Second, The MUGA ejection fraction is highly reproducible. That is, if the LVEF measurement is repeated several times, nearly the same answer is always obtained. (With other tests, variations in the measured LVEF are much greater.)
.
Best of luck to your mom down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)

-

-

Be well-informed

WebMD/Cleveland Clinic

Living with Heart Failure

http://www.webmd.com/heart-disease/heart-failure/living-with-heart-failure


Heart Failure Society of America

Heart Failure Stages

(Class I-IV)

http://www.abouthf.org/questions_stages.htm

Heart Failure Center

Stages of Heart Failure

http://www.heartfailurecenter.com/hfcheartfailurestages.shtm

Classifications of Heart Failure

http://www.heartfailurecenter.com/hfcheartfailureclassifications.shtm

LEARN ABOUT the Heart



WebMD

The Heart: (Human Anatomy) Pictures, Definition, Location in the Body and Heart Problems

http://www.webmd.com/heart/picture-of-the-heart



How the Heart Pumps

Animated Tutorial

http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/heartpump-tutorial.html


-

Quote!

"Be a questioning patient. TALK to your DOCTOR and ASK QUESTIONS. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"


- Charles Inlander, People's Medical Society

.

WebMD/WebMD forums DOES NOT provide medical advice, diagnosis, or treatment.

WebMD DOES NOT endorse any specific product, service or treatment.
 
avatar
cardiostarusa1 replied to SueMe's response:
Hi:

Prognosis is a variable, especially since everyone is unique, with each and every case/situation being different.

Noteworthy, looking back, for quite some time, there was a generalized 5 year statistic lifespan/life expectancy prognosis that we kept hearing about (which came from the Framingham Heart Study).

This is now considered as being no longer applicable, as thanks to modern medicine, marvelous medical technology, and the doctors who know how to use it, many patients with heart failure/congestive heart failure are living/surviving much longer than ever before.

As applicable, in some cases, along with a doctor recommended/authorized exercise regimen (unless contraindicated), left ventricular ejection fraction (LVEF) can be increased, sometimes substantially, by customizing/tweaking prescription drug-therapy (e.g., Coreg, which showed, back in its clinical trial days, that it could boost LVEF in some individuals) and supplemental (complimentary or integrative medicine) therapy, as deemed applicable.

Just one example of complimentary medicine is the use of the supplement Coenzyme Q10 (CoQ10 or ubiquinone, a vitamin-like substance) for heart failure (though currently not scientifically proven, some doctors may advise the patient to give it a try) which may/can (i.e., along with doctor directed prescription drug-therapy, and with the doctor knowing about any supplements being taken) help to improve LVEF in some, with other supplements sometimes added to the mix.

Additionally, as reported, as applicable to the patient, if/when the LVEF improves substantially or even recovers, and the heart appears to function near-normal or normally, other problems (unseen, that is, at a cellular or molecular level) often exist, or possible problems may/can occur anytime down the road, putting one at an increased risk.

Understanding Your Ejection Fraction

http://my.clevelandclinic.org/heart/disorders/heartfailure/ejectionfraction.aspx

**To get a decent estimate of LVEF, a MUGA scan is reported as being the most accurate of the non-invasive methods.

Pertinent excerpt from an article on About.com by Richard N. Fogoros, M.D.

When is the MUGA scan more useful than other heart tests?

The advantages of the MUGA scan over other techniques (such as the echocardiogram) for measuring the LVEF are twofold
. First, the MUGA ejection fraction is highly accurate, probably more accurate than that obtained by any other technique. Second, The MUGA ejection fraction is highly reproducible. That is, if the LVEF measurement is repeated several times, nearly the same answer is always obtained. (With other tests, variations in the measured LVEF are much greater.)
.
Best of luck to your mom down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)

-

-

Be well-informed

WebMD/Cleveland Clinic

Living with Heart Failure

http://www.webmd.com/heart-disease/heart-failure/living-with-heart-failure


Heart Failure Society of America

Heart Failure Stages

(Class I-IV)

http://www.abouthf.org/questions_stages.htm

Heart Failure Center

Stages of Heart Failure

http://www.heartfailurecenter.com/hfcheartfailurestages.shtm

Classifications of Heart Failure

http://www.heartfailurecenter.com/hfcheartfailureclassifications.shtm

LEARN ABOUT the Heart



WebMD

The Heart: (Human Anatomy) Pictures, Definition, Location in the Body and Heart Problems

http://www.webmd.com/heart/picture-of-the-heart



How the Heart Pumps

Animated Tutorial

http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/heartpump-tutorial.html


-

Quote!

"Be a questioning patient. TALK to your DOCTOR and ASK QUESTIONS. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"


- Charles Inlander, People's Medical Society

.

WebMD/WebMD forums DOES NOT provide medical advice, diagnosis, or treatment.

WebMD DOES NOT endorse any specific product, service or treatment.


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