Dr. Fett - some questions

[miachic]

Hi Dr. Fett! I went for my third trimester echo today. I'm 34.5 weeks. I have absolutely zero swelling (yay!) and I haven't been symptomatic that I can tell. I'm pretty tired but I think that has to do with being hot and in the third trimester mostly. ;) My weight gain is very slow and steady and I'm pretty much not having anything in the way of symptoms or anything like that.

My question is about recurrence. What classifies a recurrence exactly? He said today on my echo my heart is completely normal size, all my dimensions are completely normal and my heart is looking pretty good, no leakage and seems to be holding steady. He said he'd classify my EF at 45-50% but more likely 50%. I started this pregnancy and have been maintaining 50-55% so I was a little bummed that he gave me a "sort of" lower reading today. He said that he thinks everything is looking good and jokingly asked again when we're having our next.

So my question is, does a lowered EF make me in the "recurrence" group? Or are there more factors involved? Since we don't really know whether my EF is more towards 45 or more towards 50 it's hard to say at this point really but I'm just curious (and a little irked and frustrated with my body right now, hehehe).

Thanks in advance.

[tina_m]

I'm definitely interested in Dr. Fett's answer to your question also. I started my pregnancy at 57-58% and both my 2nd and 3rd trimester echos were about 10% lower and my cardiologist was completey unconcerned about it.

[kirstinherbs]

Just wanted to say that during my post ppcm pregnancy my ef dropped from 60-65% to 55% my cardiologist was a little concerned as my fs dropped to 29 but my echo straight after delivery was back to ef 65% and fs 37. When I asked my cardiologist about if after delivery he said it was insignificant - maybe because it didn't drop any further, not sure.

[JAMESFETT]

Your history of how things are going sounds very good. We use a definition of "relapse" as:

1)LV EF decrease of at least 10 points (example: 55 to 45)
2)Change of NYHA Heart Function Classification of going from NYHA I to NYHA II or higher.

You don't have 2) and you are not yet at 1); so for now you do not qualify for our definition of relapse.

With the change you have experienced, I think it is helpful to do a blood BNP and see if the level remains near baseline and/or below the " cut-off" for LV failure. Levels above the " cut-off" COULD be associated with LV impending or definite failure. Also to do a blood CRP and make sure the level is below 10 mg/liter. Levels above that in pregnancy COULD be associated with inflammatory process in the heart.

If those are both normal that would be reassuring, and then simply follow symptoms and repeat echo if symptoms or at term/postpartum.

Best wishes,

JD

[miachic]

Thanks Dr. Fett! That's very encouraging to me! I get my first internal next week and another ultrasound to check baby and will request my blood work next week and at 37 weeks. I think I'm going to request another echo either at 37 weeks or right after delivery.

I appreciate your response! :D