Understanding Echo report

[angdoren]

First of all, at 52 my husband had his arotic valve replaced with a St Judes and had his right caorted cleaned following a stroke and heart attack. 2 weeks post surgery he had a VTAC episode and we almost lost him.  A month post off he started deveoping alot of fluid and now lives in CHF.  The meds for his heart have damaged his kidneys.  We are now 2 years post op and he is still with me.  However, I still wake up every day worried.  He is very unaware of his symptons, he can not feel anything as far as pain, blood pressure to high. When BP is low he gets all the normal symptoms.
Here is my question - from the last Echo his EF has improved slightly 28% - has been as low as 11%.  The rest of it I do not know how to translate.  
Moderate left ventricular enlargement, left ventricular hpertrophy and severe left ventricular dysfunction with EF 28% regional abnormalities as noted.  Moderate left atrial enlargement, moderate dilation of the ascending sorts, E:A wave reversal consistent with diastolic relaxation abnormality.
He takes Coreg, Lisinopril, Norvac and Amiodorone and Lasix cosistently since surgery not to mention 16 other daily meds now.  
Nobody really talks about what to expect long term, occassionally we hear if you want to be around a few months from now you need to do this.  They feel it is critical he gets a debribulator and he is now considering.  His BP goes from 190/120 to 86/54 his pulse has gotten as low as 32 within the last few days here.  I know the cold weather is very hard on him and well we are coming up on winter very soon.  I have become a nurse by necessity and have no idea where we are with him from a few months to 20 years - how bad is his heart?? He is out of breath walking from chair to kitchen.  Always feels bloated and full.  He has not smoked in the 2 years now and does not touch a salt shaker.  Well anyway any insight as to the results?

[kenkeith]

The heart's filling phase is impaired due to rigidity and thickening of the heart's wall (diastolic relaxation abnormality).

An EF below 30% is in the heart's failure range meaning the heart's left side is receiving more blood/oxygen from the lungs than the heart is able to pump into circulation.  The blood backs up into the lungs causing leakage of fluids into the lung tissues (congestion).  Medication should be focused on reducing fluids, increasing the strength of contractions, and reducing the afterload i.e dilate vessels, etc.  If the afterload is reduced, a heart with a low EF may be able to meet the demand (reduce demand by less exertion), etc.

Cold weather adds an extra burden on the heart as the system demand will increase in an attempt to supply more blood to the peripherals to warm.  A weak heart may not be able to meet that burden and provide blood to the vital areas.

A defib will pass an electric current through the heart muscle when appropriate to resume rhythm control to the sinus node (normal pacemaker). Defib may be necessary (32 bpm is too low and irregular beats could develop as well). Sorry to hear of your husband's medical condition.