Aa
Aa
A
A
A
Close
Avatar universal

Acurracy of LVEF from an Echocardiogram

Hi,
I am a 57 year old male.  2-years ago had a spell of Myocarditis that was mistaken for a heart attack, hence placed in intensive care for 4-days with lots of tests.  The myocarditis left me with a LVEF of <25 it recovered to 40% within 6-weeks taking coreg & analipril.  1-year later had a bout of AFIB had low EF <25 with bad breathing problems, had an electro-cardioversion that brought me back to normal sinus rythem, normal breathing and again EF back up to 40% in 1-month continued on with Coreg and Digoxin for 9-months, came off the coreg and continued taking the Digitek only.  
Felt great for that whole year, never had high blood pressure throughout this whole episode but 3-months after stopping the coreg my breathing became bad again, this happened after a chest infection and a horrible bout of hives (urticaria) that lasted three months. (digitek was recalled during this time too.  
Went back to a new cardiologist in April (moved to new State in this last year), did an echo May 5th that showed EF of <25.  New Dr put me on Metoprolol, lisinoprol and an aspirin, blood pressure was very low after taking these (90/60) had to stop the lisinopril because I was too dizzy & lightheaded, felt better after a week but breathing was still an intermittent issue.  Placed me on a halter, showed paroximal afib and slight arrythmia. Dr said given the low LVEF and the arrythmia that I might be a candidate for a ICD fibrilator and pacemaker. Sent me to a electro cardio specialist and they decided to wait a month or two to see if there is any improvement in my EF since I recovered so well the year before.
Here is the crux of the matter.  Went back for another echo last week (10-weeks between echo's).   Was feeling really good in myself and my BP has been averaging (105/70).  The echo tech said that my EF looked like it improved to about 38 to 40%.  When I left the clinic I was feeling even better with this news on the EF improvement.    Had a follow up appointment with the cardiologist 2 days later.  The cardio said my EF was around 20% and that I am definitely a candidate for sudden cardiac death.  Well of course I was floored by this news especially since I have been feeling so good.  I asked the doctor to double check the echo report (did not betray the tech in case he got in trouble).  I had many questions but the cardio just referred me back to the Electro cardio specialist to discuss the ICD again.  My problem is that I have no confidence in the last echo reading since the tech said 40% and the doc is saying estimated 20%.  I know techs are not supposed to say anything, however, I have always respected their knowledge too.  
Question #1:  Since techs read the scans live and do it all day, would you think their oppinion or reading at 40% was good?  
Question #2:  Does the doctor reading the echo report do calculations or does estimate mean it is visual, could it be a mistake at 20%.  Do the doctors ask the techs for input on this?
THere is obviously a huge difference between 20 and 40% when it comes to LVEF.  The other thing is that my breathing is almost back to normal and I feel great except the doc said I might have one foo in the grave because of sudden cardiac death.  I am a bit confused, I have never had any chest pains, arteries are clean.  I have copies of both my echo's should I get another echo or can someone else calculate the ones I have. The numbers (i.e Diastolic 5.6 cm) on the report look close to the normal range numbers on the 2nd column.  Also, 2-years ago when the echo said  40.
Any comments or help on this would be appreciated.
Thanks
The Major
4 Responses
Sort by: Helpful Oldest Newest
172023 tn?1334672284
The Metoprolol can also contribute to SOB and fatigue in some cases.

Lisinopril at that dose shouldn't really cause you to feel any different at all, really.

I'd get another echo and another opinion.
Helpful - 0
88793 tn?1290227177
When I have my stress test done.  The doctor (head of the department) was not happy with my picture.  He dosed me with a lot of strong coffee to make my heart looks better.  Asked me to walk around the hospital before the second day scan.  When I went back to my cardio, I prepared to hear for the bad..... but a great suprised!   My cardio said, "all good.  The rest were artefact!"  Few months later, I got a heart attack (bad chest pain).  The ER diagnosed anxiety.  

Run an echo few months later.  It showed MI, severe hypokinese.... but my LVEF was 59%.  Angiogram performed.  There were no blocked artery.  All arteries are opened wide.   Dr said, he made a mistake on my echo.  It was no MI!  

Mistake could be a typo, the doctor or the tech.  All possible.  Go for how you feel.
Helpful - 0
Avatar universal
Thank you so much for the reply, comments and the advice.  Your comments and advice seem like good sound common sense.

I am going for a second opinion this week and I am going to ask if I can go back on the coreg instead of the Metoprolol.  As far as the lisinopril, I was only on 2.5mg per day and the cardiologist would prefer I take it, I am going to go back on it starting today, I am sure it will feel better once i get used to it.  The dose of coreg that I took was 6.25 mg twice a day.  The metoproloI I am taking is a one a day 25mg. I agree with what you said, I am confident that the afib can be controlled specially since it is only a very occasional flutter lately.  Apart from that I am feeling quite well too.  There is no dought that I still have a weakened LV heart function left over from the myocarditis, however, like you, I think that it is too early for the ICD.
Again, thanks for the reply.
The Major
Helpful - 0
Avatar universal
Well, first of all, your doctor should never have taken you off the Coreg.  It has been proven that one needs to stay on it forever, and POSSIBLY a slightly lower dose may suffice.  I know what you are saying about the EF varying between what the tech says and what the actual physician reading it says. But remember, the tech is just that, a tech.  I had one the last echo who confided in me that she was actually a student tech, which left me with zero confidence.  Anyway, I would ask for a MUGA scan.  Next to a cath, it is supposed to be the most accurate for estimating EF.  It CAN  be way off an echo.  Also remember, that one doctor reading an echo can say one thing and another 10 minutes later something else.  It is a +/- 10 %.  I would certainly hope that the physicians do not ask for input from the techs.  What they do is measure the left ventricular diastolic dimension and the systolic and the EF is derived from that.

As for the Lisinipril, keep trying.  My bp has always been low....90's systolic and I started on a dose of 5 mg./day of the drug, and had to be lowered to 2.5 mg. which is a baby dose.  The target dose for that drug is 20 mg./day.  BUT, I was still on the drug.  I am just super sensitive to cardiac drugs.  After several years I have been able to raise it to 10 mg./day, and still run 90's mostly and sometimes high 80's.  It is important to be on some kind of ACE or an ARB.  Your doctor should also know that!  Also, what dose of Coreg did you eventually hit?  The target dose is 25 mg. twice a day.  Until you are maxed out on these drugs, you should not be getting an ICD, IMO.  Those are the guidelines from the heart association.!  I didn't make any of this up.

Ok, lastly, intermittent afib can cause shortness of   breath and fatigue.  You lose the *atrial kick*.  Your cardiac output is thus reduced.  Your doctors need to get that under control as well before they rush into an ICD, IMO.  There are a number of drugs out there that may get rid of the AF.  Soooo, I would ask for a MUGA scan if I were you.  Hope this helps!
Helpful - 0
Have an Answer?

You are reading content posted in the Heart Disease Community

Top Heart Disease Answerers
159619 tn?1707018272
Salt Lake City, UT
11548417 tn?1506080564
Netherlands
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Is a low-fat diet really that heart healthy after all? James D. Nicolantonio, PharmD, urges us to reconsider decades-long dietary guidelines.
Can depression and anxiety cause heart disease? Get the facts in this Missouri Medicine report.
Fish oil, folic acid, vitamin C. Find out if these supplements are heart-healthy or overhyped.
Learn what happens before, during and after a heart attack occurs.
What are the pros and cons of taking fish oil for heart health? Find out in this article from Missouri Medicine.
How to lower your heart attack risk.