low ejection fraction but no symptoms

[marywantstoknow]

My husband was diagnosed with low ejection fraction 35-40, but has no symptoms. He is 67 years old, runs 6 miles a day and has blood pressure of around 110/70 to 118/80.

He was discovered to have LVEF during an echocardiogram performed to determine whether he had a bicuspid valve (which he does not) because it runs in the family.  Cardiologists have since put him on BP meds to address what they are calling heart failure, even though he doesn't feel like he has heart failure. He's considered himself to be in good health (maybe slightly overweight until recently) but now we're wondering. Can you have a weak heart and absolutely no symptoms?

[marywantstoknow]

It is so encouraging that medication can actually result in the EF going up again. I don't think that was clearly explained to us.

My husband is reluctant to go any higher with the ramipril dosage because his blood pressure is now around 106/70.  They're recommending 5 mg per day up from 2.5 which is where he started a couple of months ago. He feels 5 mg per day makes him woozy, but I suspect it's his imagination. He's always been averse to taking prescription drugs.

[tacolino]

Hi there. You are best guided by his doctor. But generally yes the EF can sometimes go up, depending on the cause of the reduced EF. He should take the meds as prescribed and yes they all have side effects. Ramapril 5mg is not a very large dose, so it should settle. Woosy and fuzzy foggy head seem very common with these medicines. Also improvements in EF are a gradual process if they happen. It takes months rather than days to see any change. So stick to the docs orders! Go for further  testing too. Has he had an Angiogram? Its an invasive test and expensive too. But should be considered in the medium term.

[Ger57]

I agree with Tacolino.
Ramipril is an ACE inhibitor. Studies have demonstrated the benefits of ACE inhibitors for people with lower EF (for patients with as well as for patients without symptoms).

If till now only an echo was made, it seems advisable to do further testing to find the cause of the low EF.

Yes, the term "heart failure" sounds unsettling That is however the term cardiologists use when EF is below 40%.
Keep in mind that EF can go up again, although mainly in those cases where there was clear cause (i.e. high BP).

One possible side effect of the ramipril could be a very low BP.

Take care.

[marywantstoknow]

That's what we're wondering. The doctors said the ramipril is not just for blood pressure but is also for his weak heart to see if it improves the EF. They've sent him for additional tests and even recommended a higher dose of ramipril despite the fact that his oxygen level was 114 when he did the bicycle test. The doctor kept talking about him being in a state of heart failure which is very unsettling.

[tacolino]

Hi there. I know and understand how people become full of fear and concern when the term Heart Failure is used. It seems the Ace inhibitor is prescribed to try and improve the EF. It is prescribed for high BP, but also for heart failure sometimes. It may be worthwhile having further testing and a follow up Echo in 3 months would be a good idea. Symptoms of low EF vary from person to person. Generally it seems symptoms only present with an EF of 30% or less. Although people with less than 30% can get on normally too!. I had an EF of 15% caused by very high BP, but that was controlled and after some time its back up to 40%. So meds can improve it.

[Ger57]

Your husband has a low EF but that does not necessarily mean he has symptoms.
Apparently, for his daily activities (including the running), the total amount of blood pumped is still enough to meet his body's needs.
I would not call his heart weak but rather call it a strong heart.

Why did they put him on BP meds when his BP is already "ideal"?