Echocardiogram & Heart Failure

[Nybroc]

After recent echocardiogram my GP tells me they weren't able to put a figure on my ejection fraction. They are assuming it is at an acceptable level as my systolic was good, even though a separate BNP level blood test was described as very high, indicating diastolic dysfunction and heart failure. Is it OK to make this assumption. If I was classified as reduced ejection fraction I would be eligible for additional medication, which is not allowed with this assumption on grounds of NHS economic benefit.

[Lezzers]

Hi, were you told why they wasn't able to put a figure on your EF & do you know what your EF was prior to having the echo? I don't know if it's ok to assume it was at an acceptable level because your systolic was good, however a high BNP level doesn't always mean HF. Do you know what your BNP level was?

A high BNP level is used as a marker to be referred for further investigation to rule in/out heart failure, a high level isn't always caused by HF, a infection (amongst other things can cause a high BNP reading. Have you ever had a diagnosis of HF? If so you may have previously been under a HF clinic, you could phone and ask them if this is acceptable or alternatively perhaps phone the BHF nurses tomorrow and ask their advice.

I assume the additional meds you're referring to are dapagliflozin &/or Entresto? Usually, though not always these are only prescribed if you have moderate to severe HF, Entresto in particular is usually only prescribed if your EF is 35 or below. Whilst this is an economic decision I do believe it's also because it's not shown to have so much benefit if your HF is mild.

Sorry lots of questions in my comments but I do hope you find the answer to your question.

[Nybroc in reply to Lezzers]

Thanks VM. Yes, dapagliflozen. Heart attack 13 years ago. AFIB around the same time. Eventually became permanent about 4 years ago. Have had bouts of HF like symptoms for years. Short of breath, wheezing, gurgling lungs, lethargic, falling asleep at odd times. Got much worse over last 9 months. Previously, as long as it was on the level, I could walk all day. Now I walk very slowly, and only for a few hundred yards. HF has been queried and hinted at a few times but never a clear diagnosis. Apparently the echo wasn't clear enough, particularly at the relaxed state to come up with a EF number. What you said about dapagliflozen reassures me. I'm reluctant to challenge my GP. He is the most common sense and helpful GP I've ever had. Yes he follows the algorithms but he personalises his interpretation and diagnosis. When you've got a great GP, you don't want to risk the relationship. Especially since my symptoms are much better after he doubled one diuretic and added a second. The difficulty walking is decreasing. Thanks again. If I can take two stone off that will be it sorted.

[Lezzers in reply to Nybroc]

HF doesn't necessarily follow a heart attack even if your heart is damaged. My husband had a massive heart attack & Cardiac arrest with quite a bit of damage to his heart but he did not developed heart failure for another 15 years.

Unfortunately some echos aren't easy to view but I would have thought they'd do another if it wasn't clear. I understand you don't want to upset relationship with your GP but I think I would be asking why he thinks increasing your diuretic has improved your symptoms, as they do sound like fluid retention, & asking for a referral to a heart specialist. Unfortunately in my experience most GP's are not experts with the heart & HF in particular.

Yes, obviously losing the weight would help considerably but how do you or your Dr know if any of the weight could be contributed to fluid retention? Have you ever monitored your weight?

Do you mind me asking what diuretics you're taking and how often you have blood tests to check your kidneys? Have you had any blood tests since the increase in meds?

[Smitty1956 in reply to Nybroc]

Hi, Nybroc,

I was wondering whether a different procedure/test might give a better idea about your EF. After my HA in March 2022, I was administered a nuclear stress test, which provided resting EF and EF following exercise (simulated by chemical injection). Perhaps that might be an option for you?

Also, I have read that some people can be retested with echocardiogram when something is not clear during the first attempt.

I am just trying to offer some possible suggestions that you might discuss with your doctor.

Good luck with getting it all sorted. ❤️

[Bobkins99]

After endocarditis and a mitral repair at the Brompton my echo showed an ef of 37%. I was put on Empagliflozin on top of the usual cocktail of heart pills. Being told you have heart failure after having open heart surgery is a bit of a shock. HOWEVER.... The scan was done 4 days post op, when I was still carrying 10kg of additional fluid. After 3 weeks another scan showed my ef to me more like 45%. I'm now a year post op and have done cardio rehab and try to be as active as possible. My latest scan showed an ef of 55% which is apparently fairly normal. I'm fairly sure my heart isn't magically mending itself. The cardiologist still says to stay on the empagliflozin though🤔