I Am 72 Yrs Old Had A Heart Attack He Had A EF Of 45 Before The Surgery Then 1.5 Months Later EF Was 49 To See Negative Results Positives After Bypass. I Am Also Having Lot Of Stress Because Of This Pls Advice What To Do Next?

Posted on Tue, 28 Aug 2018

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 28 Aug 2018 Answered on

Mon, 3 Apr 2023 Last reviewed on

Question : am 72 yrs old had a heart attack on September 26 then cabg×3 October 10 had a EF of 45 before the surgery then 1.5 months later EF was 49 doctors put me of nitroglycerin 2.5 on February 28 had an anxiety attack on 10 March then performed an echo which showed an EF of 51 from XXXXXXX onwards I some time feel intermittent breathlessness with excessive sweat on long walks which I did not felt earlier it went away on its own without need to rest .....I also feel a bit more tried and on late night and early morning felt little dizzy ....The frequency of these episodes has incresed further .....Now on echo on August my EF was again reduced to 45 I checked from two different places it came the same .....I am on carvidolol 6.25×2 ,deplatt 75, strovass 20 recently for 2 weeks had a high systolic pressure so having telmaH40 for it .....To see negative results positives after bypass. I am also having lot of stress because of this....... pls advice what to do next. Will my EF further detorite or it can again go to 51. Moreover the place of my Heart attack RWMAs which were akinetic on the Nov echo were hypokinetic on March echo but now again gone akinetic

Answered by Dr. Bhanu Partap (54 minutes later)

Brief Answer:
Please don’t be stressed or get anxious with this

Detailed Answer:
Hello Sir

First of all am happy to hear from you again and hope you are doing well.

I have gone through the details provided by you and I can totally understand your concern. But I would like to assure you that you are fine and please don’t be stressed or get anxious as stress and anxiety do have noticeably effect on our cardiac function.

Echocardiography is one of my fields of interest also and from my past experiences I can confidently tell you that 3-6% variations in ejection fraction is very common in different echo studies at different times by different operators so don’t get stressed because of that. However as you are telling some areas where akinetic before then became hypokinetic and then akinetic again, now let me clarify that akinetic from cardiac point of view in general language means dead area, now it’s not possible for a dead area to become alive again, so that might be a obeserver variation.

What important is how do you feel like as you are telling you feel chest discomfort with sweating and have started feeling lazy more often, this is important.

I would like to suggest you to kindly get the following tests done.

1. Complete blood count
2. Kidney function test with serum electrolyte
3. Fasting and PP blood sugar levels.

Also importantly I hope you are following healthy lifestyle routine and also start doing yoga/meditation daily as it will help you control your stress and anxiety levels.

Kind Regards
Dr Bhanu Partap

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhanu Partap (1 hour later)

I don't feel chest discomfort but intermittent breathlessness from XXXXXXX onwards before that I was fine I feel that while on long walks with excessive sweats and sometimes I never feel any thing on 4km walks which I used to do regularly after by bypass. On XXXXXXX I noticed this for the first time, it was then @2 times per week but now the episode happens 5 times per week .....On very recent test sugar fasting was 80 I never had blood sugar , kft was well normal , calcium and potassium normal sodium 134 and magnesium 2.6 chloride normal, on CBC-ESR 40, Hb 11.7 it used to be 12.5-12.7 before my surgery and PCV 32 which is less used to be 37-38 before my bypass Lft is also normal , total cholesterol 133 HDL 48 LDL 71. MOREOVER THE PERSON WHO DID MY ECHO WHERE EF 51 AND HYPOKINETIC ANTERO SEPTAL WALL, FOUND MY ECHO OF NOW WITH EF 45 AND AKINETIC ANTERO SEPTAL WALL. This guy was little concerned and told me to ask my Dr, but my Dr said to come after a year with another echo and didn't paid attention to this, therefore I decided to check it from another lab where a doctor did the echo he said the EF to be 44.5 or 45

Answered by Dr. Bhanu Partap (2 hours later)

Brief Answer:
Hello again

Detailed Answer:
Sir I understand your concern but from medical point of view an EF Of 45 % or 50 %is not gonna make an significant difference clinically. We just have to wait and see and instead of 1 year I would like you to repeat your echo after 6 months.

Also it advisable to limit your daily water intake to no more than 1.5 to 2 ltrs per day. And if your breathlessness worsens in corse Of time then probably an Angiography will be required to see the status of the grafts which has been deployed during CABG.

So just continue with your current prescription for now and maintain healthy lifestyle.

Hope this information will guide you properly

Kind Regards
Dr Bhanu Partap

Above answer was peer-reviewed by : Dr. Vaishalee Punj