Greetings, Dr. Roach My 73-year-old spouse was diagnosed with a profoundly dilated left ventricle and heart failure. He was pumping ten liters per minute at the time. His ejection fraction was 39% and his proBNP natriuretic peptide level was over 10,000. An abdominal arteriovenous malformation (AVM) was later discovered in him. Three radiological procedures were performed on him in order to shrink the AVM.
His ejection fraction was 54%, his proBNP level was 1,300, and his cardiac output was 5.7 liters per minute a year after the surgery. The high-output congestive heart failure was obviously caused by the AVM, and the three embolization techniques worked well. Following the operations, he no longer has any symptoms and feels stronger and more lively than he has in years. He rides a bike sometimes, treks a few miles every day, and can climb a sand dune without becoming tired.
My query is: If his heart is pumping at 5.7 liters per minute, does he still have a high-output diagnosis? If so, how should a person with this disease be treated? At the moment, Coreg and lisinopril are being administered to him in little amounts. He wants to know if his left ventricle’s dilatation is permanent or if it will go away with time. — K.B.
Simply put, heart failure occurs when the heart cannot pump enough blood to meet the body’s needs. Heart failure is broken down into big two categories based on the ejection fraction (EF) of the heart, which is the percentage of blood that the left ventricle squeezes out during each beat.
The EF is normally 50% to 75%, so heart failure with an EF of less than 50% is heart failure with reduced ejection fraction (HFrEF). Meanwhile, if a person has heart failure symptoms and an ejection fraction of 50% or greater, it s heart failure with preserved ejection fraction (HFpEF).
Most cases of heart failure are due to heart disease from longstanding high blood pressure levels, repeated heart attacks, or a condition called idiopathic dilated cardiomyopathy. High-output heart failure is a less prevalent reason of your husband’s condition. He has an AVM in his situation. This is a direct connection of the arteries and veins that usually occurs in the colon but can be found in other places within the gastrointestinal tract.
You can think of it as a short-circuit of the blood supply; all the oxygenated blood going through the AVM does no good at all, and the heart has to work extra hard to provide the blood that the rest of the body needs. Closing the AVM by blocking it up stops the short-circuit so the heart doesn t have to work as hard.
The best news for your husband is that his symptoms are better. But it s also great that his ejection fraction is now in the normal range and that his BNP is better. Of course, 1,300 is still very abnormal, but it s much better than 10,000.
It takes time for the heart to recover from high-output heart failure. I don t know if there still is some blood going through his AVM, but based on his symptoms, I am optimistic that most, if not all, of the underlying cause is gone. Lisinopril and carvidolol (Coreg) are very standard treatments for heart failure and help to protect the heart.
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