decreased ef

[kay840]

I had an echo done in December with an ef at 50%. I had been on coreg and lisinopril for a year. My cardio was okay with weaning off the meds. I just had my last echo done 2 days ago and my ef is 45-46%. I am assuming I need to go back on the medicine. What makes the ef go down? Is there still some kind of active process happening-viral, etc? If I didn't go back on the medication could it ever go back up?

[JAMESFETT]

The best explanation of decrease in LV EF when weaning off meds is that healing is incomplete. To avoid confusion it is often best to wean off the BB and ACE-I one at a time, followed by echo check. If the drop in EF occurs with first weaning off ACE-I, then best to return to previous dosage. If there is no drop with weaning off ACE-I, but there is a subsequent drop when weaning off B-B, then best to return to previous dosage of only the B-B. I always discontinue the ACE-I before the B-B, and retain the B-B as the last to go because it has additional benefits. Will there be a return to LV EF >50 % if one does not go back on one of the med? Unknown. It is possible that spontaneous improvement may occur, but the best chance is with the med. I have no qualms about continuinng the B-B for another year or two or longer, if necessary. I also find it better not to drop off the remaining medication (B-B) until the LV EF is > 50 %, since LV EF of 50 does not fit the definition of "recovered." If there has been a history of ventricular tachyarrhythmia and/or "sudden cardiac death" there may be an indication to continue B-B "for life."

JD