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Heart Weak But Stable

In 2000, a cardiologist said that I needed a heart transplant due to heart failure. My left ventricle ejection fraction was about 20 percent. I resisted this advice since I felt fine, did not display signs of heart failure, and could ride the exercise bike at least 30 minutes a day with no problems. Since that time, the LVEF is around 20 to 25 percent. In addition, there are now signs of heart muscle damage. My cardiologist says I am doing fine on my current drugs and that he is treating the patient, not the test results. Can you offer any guidance?

Your left ventricular ejection fraction is indeed low, and it does not always correlate with symptoms, as you have found out. However, that amount of heart damage does put you in a high-risk category for a subsequent cardiovascular event, including sudden death. In fact, when the EF falls below about 35 percent, we generally recommend an implantable cardioverter defibrillator like the one Vice President Cheney received shortly after taking office. If your heart function remains stable and you continue to be asymptomatic, that (along with your medications) may be all that is necessary to do at present.

You don’t mention your age or the type of heart disease you have, both of which need to be considered before making any recommendations. However, should you experience further deterioration or become symptomatic and unable to function, a heart transplant or some other intervention might be considered.

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