I had anterior myocardial infarction five years back, and I was on medications until angiogram and angioplasty were done last year. My last month echo report states, mid anterior septum, anterior wall, and anterolateral wall thinned and hypokinetic. Apical septum, LV apex thinned, and akinetic. Dilated LV with moderate LV dysfunction. No LV clot, 2+ tricuspid regurgitation, moderate pulmonary artery hypertension, mild mitral regurgitation, impaired RV function (TAPSE 1.4cm), dilated right and left atrium, and EF is 40 %. Does the above indicate any bigger trouble?
These are changes due to AWMI (anterior wall myocardial infarction). You are having dysfunction of the heart, which is of moderate intensity. It is a significant dysfunction, but manageable. Normal functioning of the heart is more than 55 %, and yours is 40 %. Survival chances are very less with heart functioning less than 15 %, so you have sufficient reserve. Now, the priority is to prevent further damage to the heart, which can be by healthy lifestyle and medicine. You should visit a hospital if any recurrence of chest pain, chest heaviness, or sudden onset sweating, etc. You should have a healthy lifestyle as follows. Avoid fatty, oily, and high-calorie diet. Have low-salt diet and monitor blood pressure regularly. Blood pressure should not be persistently more than 140/90 mmHg. Do regular exercises like brisk walking or just walking according to your capacity for at least 30 minutes a day and five days a week. Consume a lot of green leafy vegetables, fruits, fish once or twice a week, and avoid meat. Avoid smoking and alcohol if any. Also, you need to be on medicines like Atorvastatin or Rosuvastatin, Aspirin, Clopidogrel, Ramipril, beta blockers like Metoprolol, Spironolactone, etc., which I guess you must be on. Also, your lungs need to be evaluated once, and you will need a chest x-ray and if necessary HRCT (high-resolution computed tomography), if not done earlier. Hope this helps you, and get back if you have any doubts.
Thanks a lot for taking the time to review my reports and advice. I have been following the lifestyle changes mentioned by you for the last 5 years since the AWMI occurred. Lifestyle changes regarding food, exercise, and medications. I missed mentioning that I had CKD diagnosed five years back. At that time, the creatinine was 1.7. The kidney disease progressed, and I had to go for AV fistula and then hemodialysis. I got the simultaneous kidney and pancreas transplant done last month. The echo report which I sent you last time was taken just before this surgery. I have few queries in mind which I request your opinion on. My EF was 50 % when I got discharged from the hospital five years back, but over time, it has degraded to 35 %. What could be the reason for the same? I had to go for angiogram and angioplasty purely because I had to get the clearance certificate from the cardiologist to undergo the transplant. But personally, I was not sure about the advantages of doing it because the heart muscle had already died in AWMI and clearing the block now after 4.5 years will not be of any help, right? I have attached the echo taken last year, and the EF was 35 % then and 40 % now. The right atrium, left atrium, and right ventricle was normal before the angioplasty, but now after a year, it is all dilated. How can this happen? Will the transplant help the heart to get better in any way? Should I go for bringing the AV fistula to normal so that the load on the heart is reduced? Thanks in advance for your support.
Firstly, there are two reasons for decreased ejection fraction. One is the presence of block, which is not complete but 95 %. Due to this, there is continuously decreased blood supply to the heart tissue and gradually heart tissue becomes less functioning but not dead. This non-functioning is called as hibernation of the heart. Due to this, both heart function goes down, and heart function may improve after opening the vessel, which was the basis for your angioplasty and improvement in function to some extent. Some tissue was already dead, and some part was hibernating, so angioplasty had probably lead to slight improvement in heart function. Another cause is once the heart is damaged, then vicious cycle begins, and some internal factors kept on damaging the heart, and to prevent this we keep the patients on beta blockers, ace inhibitors, and spironolactone, which slow down the damage process. The likely cause for dilated right heart is fistula only, so if there is no need, then it should be closed. It is possible that right side was dilated to a small extent at the time of angioplasty only, but it was overlooked since it was minimal and now it has progressed over a year to a noticeable extent. An echocardiogram is highly observer dependent investigation, so it depends on the observer as well and what he considers as abnormal. Hope this clears your doubts.
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