EF, bypass, left branch blocks ????

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dizzyintx
New Member


Date Joined Jun 2006
Total Posts : 16
   Posted 7/14/2006 11:40 AM (GMT -7)   
I need to have a better understanding of what's going on before I go to the cardiologist next week. I feel like I go to him and don't even know the right questions to ask because I know so little. I still feel so tired and he just pats me on the head and says that I'm fine.
 
1. Does a CABG help your EF?
 
2. Is there any other way to tell your EF, besides a Cath or a MUGA scan? He hates MUGA and refuses to do a Cath this soon after my bypass.
 
3. I also have a left ventricle branch block(what ever that is) I have been reading about a 2 sided pacemaker. Is this what I should be fighting for? Anyone know anything about it?
 
I know before the bypass my EF was at 23%, yet I felt good. Why am I so tired  now? He has never told me I have heart failure, but from everything I have read I do.
 
4. What would you ask? 

Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 7/15/2006 9:28 PM (GMT -7)   
Dizzy, I am so sorry to not have repied to this post earlier. I did not see it. I am not saying that I can help you, but I surely would like to try. My feel good hurts tonight :), but I will get to work on trying to help you tomorrow.

G-d Bless you,

Rj

dizzyintx
New Member


Date Joined Jun 2006
Total Posts : 16
   Posted 7/16/2006 2:38 PM (GMT -7)   

Take care of yourself and don't worry about me. I hope you get to feeling better real soon!

God bless you too!

Dizzy


Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 7/17/2006 1:15 AM (GMT -7)   
A successful CABG sure should increase your EF. It revitalizes the heart muscle by greatly increasing the blood supply to your heart muscle that formerly had myocardium (heart muscle) that was deprived of adequate blood flow. An EF of 23 is not good Dizzy. SSDI requires an EF of 30 or less to qualify for heart failure. If your EF is truly 23, you have some degree of heart failure. It can certainly improve dramatically after CABG, if your heart was not significantly damaged from lack of coronary blood flow to the heart (prior to the CABG). Your EF should be at least 45. Normal for my age is around 55. Mine is 45.

You should have been through rehab, and should now be exercising under the direction of your doc of course. This can help "rebuild" your heart. Sometimes damaged heart muscle can be hibernating due to CAD, but can be restored to normal after revascularization (CABG). It other words, the heart muscle never died but was damaged and goes into hibernation.

If you are experiencing arrhythmias that are dangerous, like V-tach, I would talk to the doc about a pacemaker or ICD.

You may have not been taking so many heart medications prior to your CABG. Beta blockers and other heart meds can cause fatigue. If your resting BP is good or low, and your heart rate is good or on the low side, you may talk to the doc about reducing some of your meds or try a different med(S). I take my beta blocker at night, and my cardio knows it. It helps with the associated fatigue. Talk to the doc about which one of your heart meds that could be causing your fatigue or weakness.

Do you retain fluids? DO you watch the salt in your diet? Most people with heart failure take the newest beta blocker called Coreg. It is supposed to be better than the other beta blockers. I still take Atenolol.
Normal Bundle Branch Function

The heart's electrical activity normally starts in the sinoatrial node of the upper right atrium (the heart's built-in "pacemaker"), and travels to the atrioventricular node. From the AV node the electrical impulse travels down the Bundle of His, and divides into two branch bundles, one for each ventricle.

The function of the bundles is to speed the electrical impulse and distribute it in a pattern which makes later heart muscle contraction forceful and coordinated. As electrical impulses travel down these bundles, they spread over the associated ventricle to the muscle fibers, stimulating the fibers to contract in a rhythmic manner, squeezing blood out of the ventricles and into the arterial circulation.

Because the left ventricle is larger, the left bundle divides into an anterior left bundle and a posterior left bundle, the former controlling the front wall of the left ventricle, and the latter controlling the back wall of the left ventricle.

Bundle Branch Blocks

When bundles are injured, as in a myocardial infarction, or because of underlying heart disease, a bundle or a branch of a bundle may cease normal function. The result is an altered pathway for electrical heart activity. Since an electrical impulse can no longer use the bundle to travel, it may move instead through muscle fibers in a way that both slows the electrical movement and changes the direction of the impulses. As a result, the ability of the ventricles to effectively pump blood is impaired, and cardiac output — the amount of blood the ventricles can pump into the arterial circulation — is reduced.

Many people with bundle branch blocks may still be quite active, and may have nothing more remarkable than an abnormal appearance to their EKG. However, when bundle blocks are complex and diffuse in the bundle systems, or associated with additional and significant ventricular muscle damage, they may be a sign of serious underlying heart disease. In more severe cases, a pacemaker may be required to re-establish better heart muscle function.

An echocardiagram calculates an EF, but... :

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.) These advantages - along with its noninvasive nature - make the MUGA scan ideal for detecting subtle changes in a patient's cardiac function over time.

Good luck at your appointment. Make notes and take them with you :)

Rj

dizzyintx
New Member


Date Joined Jun 2006
Total Posts : 16
   Posted 7/17/2006 12:59 PM (GMT -7)   

Thank you so much for your research Aldo. You have given me a lot to think about and ask at my appt. I used to have a MUGA scans before every 3rd treatment of chemo(not for cancer, for MS) now my cardio thinks there useless. GRRR They did not send me to cardiac rehab because of the MS. GRRRR

I am on lasix, lisinopril, and Toprol xl.

I hope you are feeling better.

Thanks again,

Kim


Post Edited (dizzyintx) : 7/17/2006 2:04:03 PM (GMT-6)


Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 7/18/2006 12:18 AM (GMT -7)   
So glad to have helped a little bit Kim. Sorry about the huge font.....I cut and pasted info to wordpad....You didn't mention you couldn't see well! Your medicines are pretty well standard for treatment, not that I am an expert at all.

Do you take Lasix daily, and do you know that you should be taking 10-20 meq of potassium with each 40 mg of Lasix? Maybe not that much of potassium, but Lasix depletes potassium quickly. BUT Lisinopril increases potassium....but not like Lasix depletes it. You need your blood electrolytes checked often to see what your serum potassium is. Talk to you doc before taking K. The high doses you need are prescription only.

To much potassium or K, causes hyPERkalemia, and too little of K causes hyPOkalemia. I think both of these conditions can cause fatigue. Hypokalemia also causes muscle cramps usually in the calves. K affects the rhythm of your heart, and either condition can lead to very serious consequences.

Hypokalemia
An abnormally low level of potassium (K+) is called hypokalemia. The adrenal gland makes a hormone (aldosterone) that signals the kidneys to excrete or conserve potassium, based on the body's needs. In hypokalemia, the adrenal gland retains the hormone and the kidneys conserve potassium when more is needed.

Causes
The most common cause of potassium depletion is diuretic medication that increases urination. Diuretics are prescribed for medical conditions and are used in weight-loss programs. Other causes include:

Diarrhea
Dietary deficiency
Excessive sweating
Magnesium deficiency (causes overexcretion of fluid)

Signs and Symptoms

Symptoms of deficiency include cardiac arrhythmia, muscle pain, general discomfort or irritability, weakness, and paralysis.

Diagnosis

Diagnosis may require urinalysis and blood tests to determine the amount of potassium being excreted by the kidneys.

Treatment

Treatment involves potassium supplements, proper diet, and intravenous (IV) solution. The best way to maintain an adequate potassium level is to eat foods such as sweet potatoes, bananas, avocados, spinach, and oranges. Patients taking diuretic medication are also given potassium supplements. Potassium is given slowly to avoid hyperkalemia.

Hyperkalemia

An abnormally high level of potassium is called hyperkalemia. Potassium is released into the blood when cells are damaged.

Causes
Conditions that cause hyperkalemia include:

Burn
Chemotherapy
Hemolysis (red blood cell destruction caused by infection or burn)
Rhabdomyolysis (destruction of skeletal muscle; associated with acute tubule necrosis, or ATN)
Strenuous exercise (rarely)
Urinary excretion of potassium can be impaired by the following:
Acute renal failure (ARF)
Chronic renal failure (CRF)
Impaired aldosterone release or production
Medications that decrease potassium excretion:
Amiloride (diuretic)
Bactrim® (antibiotic)
Cyclosporine (immunosuppressive)

Signs and Symptoms

Hyperkalemia affects the heart and causes electrocardiogram (EKG) changes, ventricular fibrillation, and cardiac arrest. Other symptoms include tingling in the extremities, weakness, and numbness.

Treatment

Treatment of low-grade hyperkalemia may involve diuretics and calcium given intravenously to promote potassium excretion. Insulin is given with glucose to help cell absorption of potassium, and albuterol may be added to increase absorption. Drugs that bind to potassium, such as Kayexalate®, force potassium into the intestine to be excreted.

Some drugs used to treat electrolyte imbalance may be unsafe for pregnant women and should not be taken without consulting a physician.
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