Enlarged heart/ Dr. Fett

[ChandaC]

Dr. Fett my EF is 35%-40% and my heart has shrunk, but not back to it's normal size. My Dr says I have some leakage from my heart expanding and then shrinking. What exactly does that mean? What happens to the extra skin and when will the leakage stop? And I hate to ask so many questions but once the heart expands what other problems can occur. Thanks in advance for your reply.

[JAMESFETT]

Chanda, the heart size in recovery of PPCM always lags behind the recovery of EF. When the heart enlarges with PPCM, it is first and foremost the left ventricle, and when the left ventricle gets larger so does the valve ring, mitral valve. That causes some back leakage, but it is not serious, and generally that lessens and disappears as healing occurs. The actual size of the left ventricle varies with the height and weight of an individual, and we consider in USA anything under 2.7 cm per meter squared body surface area to be within normal limits for size. (so you can't just go by the cm diameter, need to relate it to body surface area). In any case, your situation is not unusual, and as your EF improves, the size of heart will also decrease.

James

[Yvonne]

Dr. Fett,
Now it is one year after dx. My EF is improved (from 15% to 37%), but the size of my left ventricle is larger than at dx. The doctors are not worried about this because my other functions are allright. But I don't understand why my EF can improve while my heart enlarges. Has it something to do with meds?
Yesterday, my doctor changed my meds (because I have bradycardy during the nights), my digoxin will be lowered/ stopped and my carvedilol will be increased. Is it true that carvedilol is (of the two) most benefitial for increasing the heartsize or has it nothing to do with it? Do you expect a shrinking of the heart over time?
I know I don't have to worry about size as long as my functions are good, but I find it still difficult to believe it is not a first sign of deteroriation.

[JAMESFETT]

Usually as the EF increases, the left ventricular size decreases. The most likely explanation in your case is a variation in measurement--there is always a variation in one reading to another, even on the same day, in the range of 5 percent, sometimes more. I think the size will take care of itself as your EF increases. Carvedilol is excellent, because it improves heart output, calms an overactive immune system, and decreases undesirable remodeling of the ventricle. You are in good hands, and I expect continuing improvement, hopefully total recovery.

James