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Forum Name: Ischemic Heart Disease

Question: CARDIAC ARREST


 vikram bakshi - Sat Oct 17, 2009 7:10 am

Dear Doctor,

I AM AN INDIAN MALE OF 44 YEARS AGE RESIDING IN U.K.
I HAD A HEART ATTACK IN INDIA IN MAY 2003, AND ANGEOPLASTY AND STENTING WAS DONE.MY LVEF WAS 32%.AFTER THIS FIVE YEARS PASSED WITHOUT A SINGLE PROBLEM, THOUGH I WAS TAKING THE RECOMMENDED MEDICINES.IN NOV 2008, I HAD A CARDIAC ARREST WITHOUT ANY WARNING AND WAS LUCKY TO BE REVIVED BY THE AMBULANCE TEAM.IN THIS PROCESS I GOT BRAIN INJURY ALSO.AFTER ONE MONTH I WAS DISCHARGED FROM THE HOSPITAL WITH ICD FITTED TO ME.MY LVEF IS NOW 21%.I AM TAKING-ASPRIN/CARVIDILOL/CLOPIDOGREL/ATORVASTATIN/
AMIODERONE/RAMIPRIL/LANSOPRAZOLE.

MY QUERRIES ARE-
1-WHY DID THIS CARDIAC ARREST HAPPEN TO ME.
1-HOW DID THE LVEF GO DOWN FROM 32% TO 21% OVER FIVE YEARS.
1-WHAT DOES LIFE HOLD FOR ME REGARDING THE PROGRESS OF MY HEART CONDITION. WHAT NEW PROBLEMS WILL/CAN COME, ARE THESE AVOIDABLE.
2-IS STEM CELL TREATMENT RIGHT FOR ME
3-IS ICD ENOUGH SAFE GUARD FOR THE FUTURE
4-ARE THERE SOME MORE TREATMENTS-(LVAD OR CRT)ETC.CAN THESE BE GOOD FOR ME.
5-RIGHT NOW TODAY I STAY AT HOME AND FEEL NORMAL-THEN WHAT/WHEN WILL BE THE PROGRESS OR DETERIORATION IN MY CONDITION IN THE COMMING TIME.

WILL BE VERY THANKFULL FOR YOUR VALUABLE REPLY.
 John Kenyon, CNA - Thu Oct 29, 2009 12:07 am

User avatar Hello -- You certainly were fortunate to have been revived. Your left ventricle seems to have sustained significant damage from the heart attack, and when this happens the ejection fraction can drop dramatically. Once it gets as low as yours was, the risk of cardiac arrest becomes quite great, and yet is largely unpredictable. The ICD is a very good protection against any future episodes, but your LVEF having dropped to 21 per cent does place you at risk of other problems as well, although you seem to be tolerating this low output pretty well.

All the medications you're on do seem to be appropriate, but the combination of some of them may actually have contributed to the additional drop in already low LVEF. It may be desireable to have the medications reviewed to see if anything could be eliminated that might be weakening the heart muscle.

There are a number of treatments under study currently and some are being used in some areas. These range from stem cell implantation (this would probably do no harm and might well help, but is still a very new field of therapy), and there are sometimes surgical approaches to "tighten" the left ventricle so as to increase the cardiac output. Much depends on the condition of the free wall of the left ventricle.

Almost anyone with such a low LVEF is a likely candidate for an eventual cardiac arrest, and the ICD is a pretty reliable protection although not 100 per cent guaranteed. It is usually successful in preventing arrest. The medications should also help keep things under control somewhat. With rapid development of alternative therapies (such as surgical resection of the ventrical, bi-ventricular pacmakers, etc.) you may well live out a pretty normal lifespan. Much of this depends on how well you tolerate the low output, and again, I must say you seem to tolerate it very well so far.

I hope this is helpful to you. Good luck with this and please keep us updated as to your situation.
 vikram bakshi - Tue Feb 23, 2010 11:55 am

THANK YOU VERY MUCH FOR YOUR TIME AND VALUABLE RESPONSE TO MY QUERRIES.
AS MENTIONED BEFORE-MY FIRST HEART ATTACK -IN 2003-RESULTED IN ANGEOPLASTY & STENTING AND THE EF COMMING DOWN TO 32%.AFTER THIS FIVE YEARS PASSED AND I WAS ON MEDICINES TILL SUDDENLY ONE DAY I HAD A CARDIAC ARREST AND WAS FORTUNATE TO BE REVIVED BY THE AMBULANCE TEAM.MY EF IS NOW 21%.I HAVE AN ICD ALSO.AND AM ON REGULAR HEART MEDICINE PRESCRIBED BY THE CARDIOLOGIST.I HAVE NO OTHER DISEASE OR AILMENT.

-CAN YOU PLEAS ADVISE ME AS TO HOW SHALL I LEAD MY LIFE NOW ON.CAN I DO REGULAR 9-5 JOB.
-WHAT WILL BE THE AGEWISE PROGRESSION OF MY HEART CONDITION.
-WHICH FURTHER TREATMENTS WILL I HAVE TO GO FOR AND WHEN (FOR EXAMPLE-CRT / TIGHTENING OF LV / LVAD / VENTRICULAR RECONSTRUCTION / HEART TRANSPLANT /OTHERS.
THANK YOU .

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