Need advice for Dad - EF 10-15% - LAD 100% occlusion

[tiskets]

Dad recently discovered heart trouble during routine EKG.  He is 71 and prior to this had never been to doctor.  To make a long story short, he has left bundle branch block and one side of heart enlarged (due to long term high bp) as well as a damaged heart due to silent heart attack.  Dad had heart cath revealing a 100% occluded LAD that couldn't be stented and a 70% blockage in the RCA that was stented.  His EF at the time of stent was/is 10-15% (is this heart failure?).  He was placed on meds for high bp, high cholesterol and meds to increase EF.  I am concerned about where to go from here, and if there is something more we need to be doing.  Cardiologist who performed heart cath did not give much info or prognosis.  Please advise.  Any feedback would be greatly appreciated.  With all this, never any symptoms.

[Lisaz729]

If your dad's EF remains below 35%, then the cardiologist/EP will most likely discuss the placement of a Bi V ICD or bi-ventricular defibrillator since he has a left bundle branch block. He has a conduction delay in the electrical circuit of the heart which attributes to the heart failure.  Having a BiV ICD implanted will help the ventricles beat in sync and may improve his overall EF.  The ICD also acts as an "airbag in a car" for emergencies.  If your dad develops an arrhythmia, the device can either "pace" him out of it or "shock" him out of it. His low EF puts him at higher risk for developing arrythmias such as atrial fibrillation, ventricular tachycardia, or ventricular fibrillation.  So having a Bi-v ICD can be very beneficial.
Hope this helps.

[dax0007]

WIsh you guys the best!!

[ed34]

Thank you so much for letting me know. As he is developing collaterals, I wouldn't be surprised to see his EF increase substantially, but it does take time. Even after 90 days it may not have reached its potential but a pattern will be seen. Fingers crossed for you :)

[tiskets]

Thought I would give you an update.  Dad had follow up appointment.  He is very encouraged by the fact that he has developed collateral arteries and says the meds have truly helped him to feel better and regain his appetite.  We were told not to focus so much on the low EF but moreso on the way Dad feels and that he does not show any physical signs of heart failure.  Dr plans to do another ECG in 90 days to see if his EF has increased.  If not, he may consider a defibrillator.  Based on your replies and our research, we feel comfortable with this outlook and have decided for now not to seek a second opinion.

[ed34]

oh, and Please keep us informed. I will be thinking of him and I really hope it all goes well.

[ed34]

exertion like gardening is great, it's just all about pace. Do a little bit each day and take his time with it. The fresh air and the task taking his mind off things is actually quite theraputic. As long as he doesn't push a mower up slopes of anything. Even using a wheelbarrow is fine, as long as it isn't over loaded and too heavy. I admire his dedication. If his complexion has improved and he has a healthier appetite, then these are obviously good signs.

[tiskets]

Thanks again for your help.  Dad and I will return on Wednesday to the cardiologist in Tuscaloosa, Alabama.  Feel as though we owe him the courtesy of returning for this follow up from the heart cath/stent.  We have several questions for him.  After this, we plan to make an appointment at UAB in Birmingham, Alabama for a second opinion just to be on the safe side and "ease his daughter's mind".  Dad has always been a very active man, and I am concerned he may overwork - wife is very sickly, has a garden to tend, teaches piano, etc...  Must add since the stent/meds a little over a week ago, Dad's color has improved as well as his appetite.  Prior to learning of the heart condition, he was pale and had lost about 40 lbs. but never any shortness of breath or chest pain.  I am very thankful to God that Dad is still here.  Thank you again!

[ed34]

Please, if you have any more questions then don't hesitate to ask. We have a lot of experiences shared between us and are always willing to share and help. One thing I am not sure about is which country you are in. I would like to just say that in the UK patients with very low EF had a LVAD (left ventricle assist device) fitted as a stop gap while waiting for a transplant. It was realised that with this device doing much of the work, hearts were actually starting to get stronger. In many cases, patients no longer required a transplant, had the device removed and were discharged from hospital. Perhaps it might be an idea to mention this to the professionals at the hospital and ask if they think it would be beneficial. They may want to wait 3-6 months first and then do an echo, to see if the EF has improved through medication.

[tiskets]

Thank you so much for your reply.  It is very helpful to someone who isn't educated in these matters of the heart.  

[ed34]

Hi
   Just to say I'm really sorry to hear about your DAD and I know it must be tough. An EF of 10-15% is very low and is classed as heart failure. There has obviously been significant damage to the left side of his heart, which pumps oxygenated blood to all areas of the body. I would have been surprised if stenting would have actually helped with the LAD because the blood has been shut off for a significant amount of time. As they couldn't get the catheter through the blockage, it would have been calcified, meaning it has been there some time now. Medication is really the only path to take, to give the heart the easiest possible job, which does mean keeping blood pressure in the lower normal range. With medication and limiting exertion, his heart EF could increase but nobody knows by how much, everyone gets different results. To be honest with you, your Father is in the realm of stem cell research now, and this is the only option but it's still experimental.