Dr Fett

[louisianasurvivor]

I finally decided to call my cardiologist office for a copy of the echo that he did on me. On September 12, 2005 I coded on the operating table at the start of my c-section and was diagnosed with PPCM having an EF of 19%. My second cardiologist did his first and only echo on September 27, 2005 and my EF was 55%. I know some women recover faster than others, but does this seem right.

Other questions that I don't understant on the report:

Left ventricle is of normal size and thickness with mild hypokinesis, however, EF is over 50%.

Doppler study shows trace MR.

Please explain what they mean. Thanks Brooke

[pistons22girl]

how do you get a copy of your echo? Do you just request it?

[louisianasurvivor]

I justed called my cardiologist's office and they faxed it over immediately. My next and last appointment with him is in January and I had been thinking about what my last EF was. I did not know it would be that easy, wish I would have done it sooner. Brooke

[JAMESFETT]

When they say, "Mild hypokinesia" it means that they think the contractions of the left ventricle are good, but don't seem quite normal, despite an EF of > 50 %. This is not an uncommon observation in a recovered PPCM patient, indicating that it does not seem quite normal, but it is nevertheless into the recovered range of EF. It is good news both for the EF and for the normal size of the left ventricle. The MR refers to mild mitral regurgitation, doesn't mean anything wrong, and again, quite common in recovered PPCM.

JD

[louisianasurvivor]

Thanks for the info Dr Fett. I had finally accepted my dx of PPCM and I am wondering yet again because of how fast my EF went back up. I am picking up my first two echos that were done while I was in the hospital tomorrow but two weeks after diagnosis my EF was 55%, with that being my last echo. My family and I really think that something may have happened with the spinal that I was given right before I coded. My question is have you had women recover that fast. I was told that my first echo was 19%. Thanks Brooke

[JAMESFETT]

Yes, once the process begins to correct itself, the improvement can occur in just a matter of hours. In the realm of evolution of disease, we are seeing recovery occur in a matter of hours, days, weeks, months or years. All of those are compatible with a diagnosis of PPCM.

JD

[angela]

I was just wondering I just found this website. I think I am going to like it. I have had PPCM for 8 years now and have a pacemaker. When I found out I had it was right when I was puching to have my son and my EF was 13% and over the years it had gotten better in 2006 it was 45% then last year it was 42 % and I went for my yearly echo and it went back down again to 14% I had another echo done this past Tuesday and my cardiologist said it was 20% now but also said it was the same as the last time how can it be if there is a 6 % change? They want to put in a Defibillator in and maybe a heart transplant if that doesn't work my question is how can it go from 42% last year to 14% so fast. Do you know or anyone know why it does that? I am 39 years old.


Thank you, Angela

[JAMESFETT]

Welcome, Angela. Thanks for sharing your story. That would be somewhat unusual to have experienced that type of change during this past year. Most importantly, it would indicate to me the need to thoroughly investigate, try to find out IF those numbers are accurate, and WHY? Undoubtedly, you have access to expert opinions and re-evaluation? I think the type of information that would help to sort that out include:

-blood tests to include kidney function, electrolytes, BNP and CRP, hemoglobin, cardiac troponin
-imaging to include cardiac magnetic resonance imaging with gadolinium enhancement
-cardiac catheterization to include consideration for coronary artery status, endomyocardial biopsy with exclusion of other types of cardiomyopathy, doing immunohistochemical staining and search for viral particles by PCR testing of fresh frozen biopsy tissue.

Best wishes to you, please let me know if you need additional information. Also surprising to see a bounce in EF from 42 to 14 to 20, since even the change from 14 to 20 is very significant; perhaps that reflects a change with changed treatment. I wonder what is your current treatment? The ICD is a good idea if you remain in the 20 or less range EF.

JD

[angela]

My treatment has been the same for 8 years now I take 25 mg coreg twice a day, 25mg spirnolactone, 250 mcg digitek, 40mg lasix, 20mg lisinolpril. That is the only treatment they have been giving me. Should be doing something else.

Angela

[JAMESFETT]

If your EF of 20 is correct, these are things to consider (discuss with your doctor) about your treatment, which overall is very good:

-be cautious on the digoxin dosage because of risk of toxicity, particularly if the serum potassium is on the low side. When we are more cautious on digoxin dosing we use 0.125 mg/day and keep the serum level on the low side.
-at some point anticoagulation with warfarin needs to be considered when there is low EF (<25-30 %) because of the risk of clot formation in the heart due to sluggish flow; pieces of clot can then break off (emboli) and cause problems in other areas of the body.
-it is appropriate to consider the ICD.

I notice you live fairly close to Los Angeles, where there is an outstanding authority on PPCM. Perhaps you have already consulted?

Uri Elkayam, MD, Cardiology
E-mail: elkayam@hsc.usc.edu
Section of Heart Failure
Division of Cardiology
USC School of Medicine
LAC/USC Medical Center
2025 Zonal Ave, Rm 7621
Los Angeles, CA 90033

The most important issue is to find out why your heart function has decreased so much in the past year. Once you can learn that, the treatment options become more clear.
JD

[angela]

Thank you for answering my questions and so fast sorry for all the questions but it is frustrating to know that I was doing so well and that all of a sudden I now am not. I was exercising and walking alot and have been doing that in the past 8-1 year could not exercising or walking have any effect on my heart function.

Angela

[JAMESFETT]

No, I don't think so. Your function is not down because you have decreased your walking and exercise. It is the other way around: Your heart function is decreased and therefore you don't tolerate as much walking and exercise. Get back function and your exercise will be able to go up.

JD