Heart & Cardiology/My heart

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Question
I have been diagnosed with an idiopathic cardiomyopathy. I ave an EF of 15 to 20 per cent, and atrial fibrillation that will not respond to treatment. I get SOB really easily, often with chest pains. My doctor has given me some meds but they are doing nothing much to help. I am taking 40 breaths a minute and my heart is beating 170 times a minute right now. My heart skips beats and the pulse can stop for a long time...

Answer
Hi, http://blog.myheart.net/2014/03/16/what-is-heart-failure-everything-you-need-to-

Your case sounds complex, and given the history of ischemic cardiomyopathy, atrial fibrillation and the presence of symptoms, you really should be under close specialist care. I would recommend that you are followed by a heart failure specialist in a heart failure clinic by someone who can pay close attention to the care you need.

A couple of things to mention.

You have a low ejection fraction of 15-20%, you should have had a full work up to rule out reversible causes of cardiomyopathy. Then once truly labelled idiopathic, there are several medications that are known to improve survival and increase quality of life. These are known as an ACE inhibitor and a beta blocker. Often other medications called Aldactone is added. In your case with the atrial fibrillation, digoxin may also be of use. You may require diuretics such as Lasix to relieve congestion and improve symptoms. These medications can be commenced and titrated to optimal doses in specialist clinics.

With your heart already weak it is important to control your heart rate in atrial fibrillation. Often the beta blocker and digoxin can do this, sometimes other medications can be added. 170 is just to fast, it will further stress the heart as well as worsen your symptoms. The irregular irregular beat of atrial fibrillation can make if feel like you have long pauses, this is unlikely to be actual long pauses. I would advise you have a heart monitor for a short while to assess atrial fibrillation control and better guide decision making.

Finally, i'm not sure how long you have had the cardiomyopathy for, however if it has been a while, and of you are already on the recommended medications and still only have an ejection fraction of 20% then you may be a candidate for a defibrillator, another treatment that has proven to be potentially life saving.

As you can see there is a lot to consider. However, heart failure really is one of the areas in cardiology where these treatments can make a big difference in terms of survival and quality of life.  In the setting of specialist heart failure clinics there are even more further advanced options available in the case of treatment refractory heart failure.

Hope that was helpful,  

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

Organizations
http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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