A while back I argued with the Nurse PR who is my cardiac consultant at IHC, in lieu of bringing in a cardio doc, whom they appear to save for decisions above her pay grade. She is excellent, not incidentally. The argument was about having been diagnosed as having heart failure one could thereafter not escape the condition. There is no question that I have had heart failure. Let me stipulate that. As a part of this, the diagnosis exists in the record. But what I don't know is if one can escape the condition. I'd like to think so, optimist that I am.
There are many measures of heart function. A couple are the synchronicity between the atria and the ventricles which can get out of sync in a variety of ways, one of which appears to be the fluttering of the atria called atrial fibrillation. I have that condition, but it is well under control, given medication for rhythm (amiodarone) and a couple circuit ablations of over-performing circuits. I also measure that rhythm daily on my Apple watch which gives me a single lead ECG. If it shows sinus rhythm then things are good.
A second set of functions appear to owe to the heart's valves which are either bi- or tri-cuspid (genetically). These can be bad by not closing sufficiently, causing leaks between chambers, called murmurs given by their sounds through the ubiquitous stethoscope. Their function can decline with age due to stiffening produced by calsification. I have some of this happening (stenosis) as well. This may be genetic but is hugely impacted by the American diet. The docs classify mine as borderline--not eligible for replacement at this time.
But the main one I want to talk about in this post is something called the ejection fraction. Inveterate readers of this blog will be familiar with this, since I have been writing about it for sometime. It is the amount of blood that the left ventricle squeezes out of the heart into the aorta upon contraction. Not all blood is moved out. Normal amounts are thought to be in the range of 50-75%, borderline amounts in the 41-50% range. It is this measure that I think of when I think of my heart's efficiency. And it is this measure about which I was thinking when I inferred that one might be able to get out of heart failure, per se, and challenged my Nurse PR.
There are a number of ways to measure the ejection fraction, the most common of which appears to be an electro-cardiogram. It will come as no surprise that I have just had one. (It's a simple in-clinic procedure) It will also be no surprise that this was not my first rodeo with this procedure. Since 2015 I have had several.
When I was first diagnosed with heart failure in 2015, my ejection fraction was about 13%. After 2 weeks in hospital on restricted water intake, restricted diet, several cardio-versions plus medication including lots of diuretics, it rose to 35%. (This was just enough to deny me access to Medicare-funded cardiac rehab, which I had to do on my own.) And so I fell to it. Back in the gym, etc. A couple years later my ejection fraction was 50%. (For statisticians the standard error is +/- 3%.).
When we returned from AZ during March of 2020 I developed a persistent upper respiratory infection that lasted long enough that it weakened me. It seemed to have some of the same symptoms of COVID but was not. An ECG at that time showed that I had backslid to an ejection fraction of 35%. It was this number that I reacted to when confronted by my NPR. I thought I could regain my earlier EF and I thought she thought I could not.
During our meeting last week, she, after the consult part, called in a cardiologist, and I thought Oh shit, there's bad news coming. Actually there were high 5s when it was revealed that I regained the 50% EF I had before. Very pleasing. I had despaired when my appendicitis occurred a few weeks ago and I had to stop exercising to let my body repair. I thought that would scuttle any prior gains. Not so.
I would like to see my next EF up one standard error--3 points--so that I am still progressing but who knows. The NPR wants more exercise than the 2, 2-hour work outs I am currently doing weekly, if only to add another aerobic session. Confounding going forward is a mal-fitting sleep apnea mask, that I have just had changed. I am closely monitoring my exhaustion level now and I think I am seeing small gains with a new mask. A sleep study is on the horizon. Time will tell.....
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