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Low EF from chemo
An_253832 posted:
My daughter was diagnosed at 13 months with AML and had a bone marrow transplant at age 2. One of the chemo drugs she received had the side effect of weakening the heart muscle. She has been a healthy normal child since the day she left the hospital after her BMT. Years later we found out her left ventricle was functioning at a "low normal". the cardiologist did not put her on any meds because she wasn't having any symptoms. She was an extremely active athlete, competitive gymnast in the gym 4 hrs/day 6days/wk. for years with never an issue. This continued for years, the dr saying no meds because she had no issues with exertion. NOW she is 18 a freshman in college on a track scholarship and she starting having problems. Now her EF is at 20%. She feels totally fine on a daily basis, just gets out of breath during exertion. All blood work is perfect, everything else is great except for her EF. We are now seeing a new Dr and she is saying our old dr. should have put my daughter on meds when her EF went from 57% to 35% then it dropped to 29% and still no meds. Just wondering what your thoughts were. As of right now, we are extremely upset that our daughter wasn't started on meds years ago. She is on meds now and a heart monitor for 3 weeks for the dr to gather info. Please give me your thoughts.
cardiostarusa1 responded:

......"and she is saying our old dr. should have put my daughter on meds when her EF went from 57% to 35% then it dropped to 29% and still no meds."

That would be the general consensus for sure, even though some individuals who have a low (moderate) or a really low (severe) left ventricular ejection fraction (LVEF) feel fine and function well.

Also, in some cases, side effects/adverse reactions from this or that type of prescription drug may/can be worse than the condition it is treating, and sometimes even cause an "iatrogenic" condition to occur, which simply means that the condition would have not occurred if the patient had not taken a certain drug or had a certain procedure performed. An "iatrogenic" condition may/can sometimes be permanent or reversible.

"Now her EF is at 20%"

As applicable to the patient, in some cases, along with a doctor recommended/authorized exercise regimen (unless contraindicated), 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.

ust 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

**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 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 daughter down the road of life. May she live long and prosper.

Take care,


WebMD member (since 8/99)



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