Low blood pressure

[Velena]

I was diagnosed with cardiomyopathy on 23 November and the cardiologist put me on enalapril 5mg daily. He told me to check my blood pressure (which has always been fairly low) every morning for 7 days then email him the results. I did that and he told me to reduce the dose to 2.5mg as my arterial pressure levels were too low. I'm monitoring my blood pressure on the reduced dose for a further week and so far the highest has been 103/79 and the lowest 93/68, which still look pretty low to me so will see what he says on Tuesday when I email him the new results. But I am concerned in case low blood pressure mean I can't take the enalapril (and from what I have been reading, all the other medications used to treat heart failure can also have the effect of lowering blood pressure so might not be suitable for me either). My EF at diagnosis was 41% (which I now know from many of you is not so bad, but it has dropped from 63% in June 2018 immediately after my mitral valve repair surgery so I'm concerned it seems to have fallen significantly quite quickly). I don't have any breathlessness or fatigue even on fairly strenuous exertion, but since starting the enalapril I've had feelings of dizziness sometimes and one disconcerting episode of strong dizziness and irregular heart rate when I'd been standing in one spot for 40 minutes, doing the ironing. It took about an hour to return to feeling normal. So if I can't take these medications, what if anything can be done to improve the condition?

[Velena]

I was diagnosed with mitral regurgitation in April 2015 which was moderate/severe at that stage. It was explained to me that surgery wasn't recommended at that stage because of my age and how many years a replacement valve (if my own couldn't be repaired) would be expected to last. My condition was monitored for the next 3 years and progressed to severe (although I still had no symptoms other than a slightly irregular heart rate), so the cardiologist then said it was time for surgery which I had in June 2018. I was told the surgery had been very successful and have had regular checkups with an echocardiogram each time since then (1 month and 3 months after surgery then two more annual checkups since). At no time up until my latest checkup in November 2020 has any mention been made that I had cardiomyopathy, although right from the initial diagnosis I was told that the left ventricle was slightly dilated (measurement still looks the same as it was it 2015). Immediately before surgery my EF was 62% and at the 1 month after surgery checkup it was 63% (figure not included in the next 2 annual checkups), and as I said it is now 41%.

I'm really struggling to understand why this has happened, to be honest. I'm to see the cardiologist again in 6 months' time so will be asking if he can explain then. I really should have asked more questions at my last appointment but all he said was that my heart function wasn't quite as good as it should be and that the left ventricle is enlarged (first part news to me, second part I already knew) , told me he was prescribing the new medication and gave me instructions about monitoring my blood pressure and emailing him the results, and it wasn't until I got home and could read his report in detail that I realised the significance of the cardiomyopathy diagnosis (described as degenerative) and the EF. I live in Spain and have always seen cardiologists and had my surgery in the private sector, so get a detailed printed report after every test, consultation or procedure - am amassing quite a collection! I'm going to ask my GP in the public system if he will refer me to cardiology at the public hospital now, but may have to wait some time for an appointment especially with the coronavirus pandemic ongoing.