Dr Fett or Ladies

[Janelle]

Hey everyone-I am currently sick and when I went to see my pcp he told me that my Enalapril dosage should be higher. I am currently taking 2.5 mg/day and I am almost 4mos post dx w/ an ef of 24%. I haven't talked to my cardiologist regarding this matter b/c wanted feedback first so I can be prepared.

Also, my cardiologist has suggested an ICD if I don't improve. If I am not at the magic 30-35% mark at 6mos out should I push to wait to see if I improve more over a longer period or just go with it? My original cardiologist kept lowering my Coreg b/c of my bp for the first 2 months and I believe this inhibited my progress.

Any feedback or suggestions are definitely welcome. Thanks for the help in advance!

[JAMESFETT]

The Enalapril is a very good ACE-inhibitor to use. The Coreg is a very good beta-blocker to use. You'll need to work out the appropriate dosage with your doctor, but the use of both is important. Rate of recovery is different with each person, and there really is nothing magical about the 6-month stage because healing continues long after that if one is not yet above EF 50 at that point. Having said that I will say that I am concerned about your rate of improvement; you are in the group for which one should at least give consideration to right heart catheterization and endomyocardial biopsy, one biopsy to be handled with "quick freeze" and polymerase chain reaction testing for presence of viral particles. The other reason for biopsy is to be sure there is not another process going on in the heart muscle, such as giant cell myocarditis, for which the treatment is different. There is now anti-viral treatment available should one find virus in the heart muscle, and in dilated cardiomyopathy improvement in left ventricular EF has been seen with eradication of virus (when present). The biopsy SHOULD ONLY BE DONE BY SOMEONE WHO DOES A LOT OF ENDOMYOCARDIAL BIOPSIES in order to minimize complications. Two tests that may be helpful to know if there is an active process in your heart muscle are blood biomarkers, each test around $20 to $30, they are: high sensitivity C-Reactive Protein and B-type Natriuretic Peptide. It would be good to discuss these with your physicians, and if I can be of any help, please let me know. The trend is to more and more use implantable defibrillator for those with persisting EF less than 30 per cent.

James