Heart issues 10 years in (Left Ventricle Hypertrophy)

[magnus68]

Has anyone experienced heart issues such as low ejection fraction (low stroke volume). I was recently diagnosed through a routine echocardiogram that I have a slightly enlarged Left Ventricle and an ejection fraction of 35-40 % (Normal is 50 -70%). Im wondering if polycythemia could cause this as my hemo is always at the higher end even with donation 53% most recent. Any thoughts? I hope its reversable

 

[magnus68]

Forgot to mention I am 47 and trt is 1 cc a week and 2 ius hgh daily

 

[GA8314]

Has anyone experienced heart issues such as low ejection fraction (low stroke volume). I was recently diagnosed through a routine echocardiogram that I have a slightly enlarged Left Ventricle and an ejection fraction of 35-40 % (Normal is 50 -70%). Im wondering if polycythemia could cause this as my hemo is always at the higher end even with donation 53% most recent. Any thoughts? I hope its reversable

The most common cause of Left Ventricular Hypertrophy is chronic hypertension. Are your blood pressures controlled?

You are young to have aortic stenosis and the Echo should have reflected that (even though the "surface" echo isn't the best at looking at the aortic valve), but you could have a bicuspid (versus tricuspid which is normal) valve which could predispose you to earlier onset aortic stenosis.

I don't think it's a valve issue, as even the surface (called transthoracic) echo would have at least commented on that to some extent. Also, any significant valve issue would produce a murmur which would likely be detectable with some ease via stethoscope.

The lower EF can also be caused by ischemic cardiomyopathy. Meaning, yes, it's plausible that you have some coronary artery disease. Do you have risk factors for coronary arterial disease?? (things like age greater than 50, obesity, hypertension, smoking, diabetes, lack of activity). Are you symptomatic? Can you climb a flight of stairs without having any chest pain or shortness of breath?

Have you had a recent EKG? I'm suspecting you DO since an Echo would typically follow that, not precede that. Have you had any stress testing?

What did your doctor say?

 

[magnus68]

Dr said if I feel fine I could try to donate some blood to reduce my blood viscosity to see if that helps and come back and see him in 3 months. I have no symptoms and I feel like I am generally in good shape I work out regularly and just happened to get an echocardiogram as a preventative. Now I'm freaking out

 

[GA8314]

Dr said if I feel fine I could try to donate some blood to reduce my blood viscosity to see if that helps and come back and see him in 3 months. I have no symptoms and I feel like I am generally in good shape I work out regularly and just happened to get an echocardiogram as a preventative. Now I'm freaking out

He doesn't sound concerned. Your feeling fine is a good indicator. However, it seems you must have a high hematocrit (polycythemia) if he is even suggesting donating blood (phlebotomy).

I asked you more questions. Can you please answer them so that I may attempt to better help you? How is your blood pressure? Do you check it regularly?

Having a suboptimal EF, then "seeing if phlebotomy helps" is a highly suspect care plan. I'm assuming there is more to the story. See if what helps? You say you feel fine. What does he intend to do, have you donate blood and then see if the Echo improves? That's suspect in and of itself, but again, I think there's more to the story. If you are unable to provide further information, then I simply can not help you.

I recommend you buy a home BP cuff.

Also, if you have labs, then posting them will be helpful.

 

[torrential]

It's only natural to react with concern but I'll echo and add to the advice above: Don't panic just because one test showed something just outside of normal. I just went through a similar scare, with initial results that were painted as "significant," a la dropping dead was suddenly a very real possibility. I went through a full round of additional tests including nuclear stress echocardiogram. The looks on the tech's faces while I was on the treadmill really scared me.

Guess what? All good. Heart strong, so signs of wear whatsoever, 90th percentile for my age group. Nevermind!

Bloodletting: how often do you donate? I shoot for the minimum interval. Couple months back I missed one and within a month my BP and hematocrit shot way up. May or not be directly related but it did drop down immediately after the draw. Some guys here go religiously every 56 days.

BP is called the silent killer for a reason. No symptoms and incremental damage that you really don't want. Easy to fix, also, but you have to be aware of it.

 

[Vince]

Dr Peter H. Langsjoen, M.D. He is probably the best authority on co-q-10 in the world.
The web link below basically describes the recommendations he did back in 2011. The only difference I'm aware of is he now recommends the blood plasma level of 5.0 micrograms per milliliter CoQ10 levels. His basic recommendation is 600 mg of ubiquinol taken in three doses at 200 mg time during the day. This usually gets you to 5.0 micrograms per milliliter blood plasma levels of CoQ10. If that doesn't get you to the 5.0 micrograms per milliliter blood plasma level of CoQ10 just take more ubiquinol until you get to that level. An example would be a patient with the 20% heart ejection fraction. Would go to 40% heart ejection fraction over 3 to 4 months time period. So his protocols are basically to use high dose ubiquinol to get your CoQ10 blood plasma levels up to 5.0 micrograms per milliliter.



The point of this is to get your heart ejection fraction up fast using the high-dose ubiquinol.

 

[Vince]

Dr Masami Sakurada had six patients he treated for with astaxanthin and low dose ubiquinol who had heart failure. He did amazing well with it. (IMO)

5 men and one women and the patients appeared to be mainly in their late 80's . There was no mention of their diet. The patients had been on beta blockers and other meds except one man who had such low blood pressure . He was only given Astaxanthin of 6 Mg initially and after 6 months raised to 6 mg of astaxanthin twice a day. He was given 100 mg of ubiquinol and six months later it raised to 100 mg twice a day . He seemed to recover pretty well but he decided to go off the astaxanthin and ubiquinol because he felt so good. Three months later he had relapse.

Basically from looking over the DVD it sounded like 6 mg of astaxanthin twice a day plus in some cases they did go up to 100 mg of ubiquinol twice a day. It worked pretty well. Thought once on the astaxanthin and ubiquinol ,if the patient went off the supplements. The patient appeared to relapse in 3 to 4 months. If the supplementation was then started again. The patient did very well.

 

[Vince]

Here is an excellent video by Dr. Langsjoen, he's a huge CoQ10 proponent.

 

[CoastWatcher]

A question not yet answered, though it has been asked, is what are your blood pressure readings like? Are you monitoring at home and not relying only on the readings obtained at your doctor's office? You have given us fragmentary information; can you fill in some details?

 

[magnus68]

My blood pressure has been pre hypertensive for at least 2 years 140/90. I just got on lisinopril last week with toprol XL 25 mg. My belief was that my blood being thick showed up as low ejection fraction. So it was MY idea to get phlebotomy to see if my EF improved in another echo. Doc did say a stent may help and that scared me. I have been on trt for over 10 years and my hematocrit has always been at the high end of range or slightly over

 

[GA8314]

My blood pressure has been pre hypertensive for at least 2 years 140/90. I just got on lisinopril last week with toprol XL 25 mg. My belief was that my blood being thick showed up as low ejection fraction. So it was MY idea to get phlebotomy to see if my EF improved in another echo. Doc did say a stent may help and that scared me. I have been on trt for over 10 years and my hematocrit has always been at the high end of range or slightly over

o.k. We need way more information. Doc said a stent may help? That's just not the way it goes. Did you have a positive stress test? A positive cath?? (If it was positive and bad enough he would have stented you right there and then) How the hell would he know if a "stent may help" without evidence of cardiac ischemia???????

Good job on the lisinipril and Toprol.

What kind of doctor is this???

Phlebotomy improving Ejection Fraction is not in any way standard of care. Again, this ALL sounds very fishy my man. We need way more information.

Who is this doctor (type of Dr)?? What other testing have you had. This just isn't adding up to a credible story the way you are presenting it. I'm not trying to make you feel bad or be too harsh but this story is ridiculous. You need to elaborate much more if anyone could possibly be able to help you.

Frankly, you should just follow up with a qualified doctor (probably a cardiologist).

 

[magnus68]

o.k. We need way more information. Doc said a stent may help? That's just not the way it goes. Did you have a positive stress test? A positive cath?? (If it was positive and bad enough he would have stented you right there and then) How the hell would he know if a "stent may help" without evidence of cardiac ischemia???????

Good job on the lisinipril and Toprol.

What kind of doctor is this???

Phlebotomy improving Ejection Fraction is not in any way standard of care. Again, this ALL sounds very fishy my man. We need way more information.

Who is this doctor (type of Dr)?? What other testing have you had. This just isn't adding up to a credible story the way you are presenting it. I'm not trying to make you feel bad or be too harsh but this story is ridiculous. You need to elaborate much more if anyone could possibly be able to help you.

Frankly, you should just follow up with a qualified doctor (probably a cardiologist).

ok let me start over again from scratch. I am 47 year old male I have been on TRT for over 10 years plus growth hormone for panhypopituitarism. Recently I got a check up on a heart bus which is similar to a bloodmobile where you pay to have seven heart tests done. EKG coronary artery disease screening echocardiogram ultrasound of the heart blood pressure and I can't remember what else but anyway my echocardiogram came back abnormal say them that I had a slightly large left ventricle and low ejection fraction of 35 to 40%. Now this was a voluntary exam that I went to. EKG coronary artery disease screening echocardiogram ultrasound of the heart blood pressure and I can remember what else but anyway my echocardiogram came back abnormal stating that I had a slightly large left medical and low eject infraction at 35 to 40%. Now this was a voluntary exam that I went to I had no issues physically going on and I decided to be proactive about my health. Now to my surprise my abnormal readings freak me out so I called a cardiologist from my plan directory and showed him my findings. He sent me for a second echocardiogram which confirmed the diagnosis. Me not knowing anything about this figured that my constantly high hematocrit may have something to do with it the doctor told me that he was not sure and would send me to get an angiogram to make sure nothing else was going on like a blockage and if there was I may need a stent. Now I went to get a second opinion and a second cardiologist who said he doesn't see why I would need a stent this quick and then if I wanted to try bloodletting he has no problem with it and to see him in 3 months and we would repeat the echocardiogram and we would repeat the echocardiogram. I hope this answers all the questions. Thank you for any advice

 

[Vince]

I agree with GA8314, a good preventative cardiologist sure would help you. Most insurances pay for second opinions. I never try to pick a doctor by his personality, I just want someone who can really help me. (sorry I wrote this before your last post)

 

[magnus68]

The first Cardiologist is an invasive Cardiologist the second opinion was preventative. So from what you guys know hematocrit has NO correlation to Ejection Fraction?

 

[Vince]

OBJECTIVES:

The dataset from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial provides a rare opportunity to evaluate the whole spectrum of associations of hemoglobin (HB) and hematocrit (HCT) in heart failure (HF). In that trial, subjective and objective data were recorded at multiple time points when HB and HCT were also measured. We investigated the relationship between anemia and ventricular systolic function.

METHODS:
A limited access dataset from the ESCAPE trial, provided by the National Heart, Lung and Blood Institute, was analyzed. Linear regression analysis, correlation coefficients and Student's t test were utilized.

RESULTS:
Besides the known association of anemia with poor prognosis, more severe symptoms, decreased functional capacity and impaired kidney function, we found a significant and very consistent inverse correlation between HB and HCT and ventricular contractility. Both left ventricular ejection fraction and right ventricular fractional area change improved with a decrease in HB and vice versa. We hypothesize that this effect can result from a change in viscosity, which decreases with a decrease in HCT, and may facilitate adaptation of the heart to a volume overload state accompanied by hemodilution.

CONCLUSIONS:
In HF, anemia is associated with poor prognosis and functional impairment, but also with mildly improved systolic function. It may represent an adaptive reaction to congestion.Relationship of hemoglobin and hematocrit to systolic function in advanced heart failure. - PubMed - NCBI

 

[GA8314]

The first Cardiologist is an invasive Cardiologist the second opinion was preventative. So from what you guys know hematocrit has NO correlation to Ejection Fraction?

In spite of the study Vince posted to, I think only extremes of Hb/Hct are going to possible play a role. I really am not certain and don't want to speculate.

I would follow up with either of those two guys, but probably the preventative one if he is practicing evidence based medicine. Yes, lots of studies are highly controversial. Yes, old paradigms may need to be reevaluated. But, this is not something I'd just blow off or go to a fringe individual for assistance on. You want someone that knows what they are doing.

I would not fret or panic about this, but just follow up as recommended and I'm sure you'll have more answers and a better game plan with a lot less uncertainty/anxiety than you have now.

All the best.

 

[GA8314]

OBJECTIVES:

The dataset from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial provides a rare opportunity to evaluate the whole spectrum of associations of hemoglobin (HB) and hematocrit (HCT) in heart failure (HF). In that trial, subjective and objective data were recorded at multiple time points when HB and HCT were also measured. We investigated the relationship between anemia and ventricular systolic function.
METHODS:

A limited access dataset from the ESCAPE trial, provided by the National Heart, Lung and Blood Institute, was analyzed. Linear regression analysis, correlation coefficients and Student's t test were utilized.
RESULTS:

Besides the known association of anemia with poor prognosis, more severe symptoms, decreased functional capacity and impaired kidney function, we found a significant and very consistent inverse correlation between HB and HCT and ventricular contractility. Both left ventricular ejection fraction and right ventricular fractional area change improved with a decrease in HB and vice versa. We hypothesize that this effect can result from a change in viscosity, which decreases with a decrease in HCT, and may facilitate adaptation of the heart to a volume overload state accompanied by hemodilution.
CONCLUSIONS:

In HF, anemia is associated with poor prognosis and functional impairment, but also with mildly improved systolic function. It may represent an adaptive reaction to congestion.http://www.ncbi.nlm.nih.gov/pubmed/22846848[/QUOTE
Thanks....should discontinue Trt?

This is my last response. You are asking if you should discontinue TRT based on what? You never even gave a Hb/Hct number, though it was asked for multiple times.

Is your likely non-extreme Hct the cause of your slightly depressed EF? I highly highly doubt it. I am done here.

 

[magnus68]

GA8314. Sorry you missed it but I posted that my latest Hct was 53%. But has been as high as 59%. I really do appreciate your replies, so thank you

 

[magnus68]

It was in my very first post....53% hemo. I meant HCT.