what is right?

[Curryindia]

Having had chest pains and breathlessness for a number of years and told it was asthma, despite pumps not working, and originally being told it was angina GTN spray did nothing.

Also being told through the years that ECG showed something but still no diagnosis, trips back and forth to A&E.

Then four months ago after having to be forceful with GP agreed another ECG recently and found I had a left bundle branch block of the heart.

Then had echocardiogram that showed EF of 40 -45% all septal regions have abnormal motion. With mild tricuspid regurgitation

The doctor then sent me for an MRI that has also showed left ventricular EF of 59% and Mitral valve regurgitation and mid wall non-ischaemic fibrosis, Including the block in the heart.

I saw a doctor (not Cardiologist) who just said as your EF is showing 59% you are being referred back to your doctor and advised to have another echocardiogram in 2/3 years

To keep the medication I have been taking for the last fifteen years.

I am more confused than ever, what is right the echocardiogram or the mri?

Should I have a second opinion, I am 74 years old

[Chinkoflight]

I hope you get some helpful replies but it might also be worth spending a little time researching and understanding the EF metrics and what they mean. In the absence of interventions, which all come with risks, it may be worth getting advice from your GP or practice nurse how you might be able to improve your cardiovascular fitness. Helping yourself has massive benefits, but also earns points with your medical practitioners, whose support you will really need if your health declines. I have used Active 10 and Couch to 5k health programmes but there are many vyou might be referred to.

[Curryindia in reply to Chinkoflight]

Thanks, your right in that I have found the EF values difficult to understand, I intend to make an appointment with my GP to get clarification of what may happen in the future.

Keeping fit is important and difficult with leg problems, but I persevere as much as I can.

[Chinkoflight in reply to Curryindia]

This is a section from the BHF guide on understanding EF. It might help to read the whole article before you see your GP so you have some understanding of what they are saying to you. Elsewhere you have an opinion on the reliability of an MRI result.

The ejection fraction (EF) is the amount of blood your heart pumps (or ejects) with each heartbeat and is a useful way of measuring LVSD. A normal EF is about 55-65 per cent. It’s important to understand that “normal” is not 100 per cent. Measuring the EF helps your doctor to understand how well the heart is pumping. Generally an EF below 40 per cent is considered a sign that the heart is not pumping as well as it should. In cases where the heart function is reduced, and EF is below 40 per cent (sometimes referred to as heart failure), there are treatments such as medications and pacemakers or ICDs (implantable cardioverter defibrillators) that can help to control your symptoms, keep you well, and help you to live a full life.

[Curryindia in reply to Chinkoflight]

Thank you again, you have provided me with very helpful info and I will read all through today, hopefully I’ll understand more by the time I meet with the GP

[Curryindia in reply to Chinkoflight]

Than you Chinkoflight I will check in with health programmes for more info.

Many thanks

[Lowerfield_no_more]

Sounds like you should be talking it through with the GP as you have been referred back to them. Under NHS rules you can ask for a second opinion, and it will be considered , but it does not automatically mean you will get a second opinion. However if you think you need one, go ahead and ask, and take it from there.

[Curryindia in reply to Lowerfield_no_more]

Thank you very much for your reply, I will ask if I can have a second opion

[Blearyeyed]

You should definitely request a face to face appointment with your GP to explain your heart results and options with you, and ask for a double length appointment at that point noting with the receptionist that you will need that extra time because of the serious questions you have.But I can also understand that you are confused and concerned and may not have complete faith in just getting answers from the GP if you feel like your just concerns about your heart were not taken seriously enough by the GP earlier. So at this appointment you could ask all the questions you want answered but also politely but firmly request that you are referred back to the cardiologist to speak about the results too.

You can also contact your local cardiac team or cardiac nurse and talk to them as well as getting the opportunity to speak about your concerns about your current medication or doses not working well for you and reminding them that you also have asthma, you can also ask for the opportunity to be referred to cardiac rehab or physiotherapy and for any local services or links that will help you take the right steps to improve your heart function.

Reading up on these conditions and checking if the care you are being given at the moment for them is in line with current advise on the BHF website is something you could begin today.

If you feel your current medication does not do enough for you the information on the website may also provide you with alternative medications that you could ask to try with your GP. Although you will also need to consider that these options will be appropriate to use alongside your asthma medications , so you may need to do a bit of research about which heart medication options you can use alongside your asthma medications ,

Just keep in mind that you double check the recommendations you are given to help your heart condition with those you are given for asthma care , because on the odd occasion any self care or exercise you need to do may need to be adjusted to a pace that is appropriate for your lung capacity too. Hope you get the help you need soon , Bee

[Curryindia in reply to Blearyeyed]

Thank you so much for your thoughts, you’ve really helped with your advice and straight talking. I will be attempting to get through to the surgery tomorrow but I expect to be told of the three week wait when I get through. Many thanks again.

[Bluehope81]

In my opinion Cardiac MRI is generally considered more reliable than Echo for LVEF measurement, the discrepancy occurs because they calculate the LVEF in different ways.

[Curryindia in reply to Bluehope81]

Thank you. Yes I have heard this and I will be following through with the GP, thank you for replying.