Improving EF

[PinkKizzie]

I didn't realise until I joined this forum that EF can be improved upon. I have LV imparement with an EF of 25% and after a failed attempt at a pacemaker implant my question is - can I raise my EF even although I don't have a pacemaker? I take lots of meds, feel well and keep active. Your thoughts appreciated, thank you.

[Deejay62]

Quite a few people have improved their EF through exercise, diet and medication. I’m not sure how many of those don’t have a pacemaker fitted or what actually caused their heart failure in the first place. Maybe someone who knows more will come along and let you know.

My EF is 23% and most of the time I feel awful and I have a CRT-D device fitted.

[PinkKizzie in reply to Deejay62]

Hi Deejay62, thank you for the info, and sorry to hear you don't feel well. I feel really well, just get tired and breathless. Take care.

[Blearyeyed]

A standard pacemaker does not improve EF , but it may improve symptoms which helps your other medical care and lifestyle changes to improve heart failure and your EF can increase because of it.A Biventricular Pacemaker is used for someone to hopefully help to improve EF , it's effects are more significant, but again it's function is to help manage your hearts rate with a knock on effect on regurgitation to reduce symptoms so that you can feel better while you are active and can manage more exercise and lifestyle changes to improve your heart function and EF.

An ICD can also help you manage your symptoms too as well as having a function in reducing the severity in an active cardiac event , as you had a failed pacemaker operation have they said that they can't try it again , or have they discussed an ICD?

As, you can see , a pacemaker isn't a "cure" for low EF , it's just an extra aid that helps improve your heart functioning and this in turn helps you to increase your EF along with other changes. They basically just make it easier to improve your heart function with certain types of heart failure but other things are involved and it's these that make it possible to reduce your cardiac symptoms and improve your EF.

You can still improve your EF without a pacemaker if you follow the medical guidance and lifestyle changes your cardiac team suggest for you.

Things that help are:

1. Taking your Medication as required, even though this can be hard to get used to at first . Don't take unprescribed medications or supplements without checking whether they are suitable for you.

2. Keeping physically active.

Doing activities or exercise , little and often, through the day and within your comfort zone really makes a difference. Don't forget housework , going out , shopping, even having a shower and getting dressed are all activities.

You don't need to be breaking records on a treadmill or exercising for whole classes or hours at a time.

You don't even need to be standing up.

You can begin by just exercising in a chair for a few minutes a few times a day , and having a few 5 minutes strolls and build you way from there.

Keep it simple , drink water as you go , don't push yourself to finish a particular route or a set of repeats or laps , rest between activities when you need to.

If you can't get a pacemaker and have low EF it's also more important to go to cardiac rehab for help and safe supervision as you exercise, if you haven't been referred yet call your cardiac team and ask to be signed up.

You can begin with chair exercises with a physio and then go onto other physio.

They may suggest that , or you can ask to do that at first , just explain you want to build up more confidence and strength first before you do standing or more physical exercises.

3. Get regular monitoring of your condition from the GP or Cardiologist Team so that you can keep track of your progress and get medication changes if you need them.

Keep important phone numbers at hand and ring your cardiac nurse any time you need support or advice.

4. Change your diet to one low in salt and sugar.

Drink the recommended amount of water/fluids each day.

Check your portion sizes, eat smaller amounts 5 times a day instead of three big meals that can make you feel overwhelmed to digest.

Only eat healthy fats. Get lots of fruit and vegetables, grains, beans and pulses and lean meat , fish, dairy and eggs rather than lots of white carbs.

Avoid saturated fats , artificial sweeteners and processed foods. Keep lean red meat to occasional treats.

If you are your ideal weight try and eat in a way to stay there.

If you are overweight , make adjustments to your diet and get advice if you need it to reduce your BMI.

If you are underweight , increase protein and try to get up to your ideal weight.

5. Avoid alcohol , do not smoke or take unprescribed recreational drugs.

6. Pace Yourself everyday.

Look at your daily activity and replan it so that you have chance to rest properly for 5-10 minutes an hour.

Don't try and fit too many things into your schedule but do keep busy both mentally and physically in a gentle stress friendly way.

If your old routine is too active and creates symptoms , assess what you do and reduce that routine to a manageable one , including the things you want to do , and need to do and dropping the things you feel you should do or must do.

Be willing to say No , even if you're tempted to say Yes if you already have a busy day.

Do everything at a slower pace , it will still get done.

7. Reduce Stress

Find ways to reduce your Stress.

Talk to people and be honest about your health and how you feel with others.

Get help with strenuous and household jobs.

Don't keep going because you feel you must finish a job if you feel bad , have a rest, the job will still be there when you are ready to go again.

Join a support group for heart or chronic illness where you can get help and a friendly ear from people whom understand what you are dealing with.

Learn Mindfulness activities like deep breathing , muscle relaxation , journalling , distracting relaxing activities.

Get enough rest , have a regular bedtime routine and shut off your phone and other devices at least an hour before bed. A good sleep pattern is essential, but even if you aren't asleep don't get anxious about it just allow your body to get a good rest.

Don't beat yourself up or put yourself down if you can't do things or because you are unwell. Being ill can feel like a full time job in itself so you should always remind yourself that you are doing brilliantly just by coping with how you feel and reward yourself with praise even for little steps and changes.

All of these things are the essentials that can help you to improve your heart function and EF and help you to feel better whether you have a pacemaker or not.

Hope things improve for you soon , but don't forget getting better is a marathon not a sprint , with time , patience and paced activity you should find the road less rocky in time.

Take care , Bee

[PinkKizzie in reply to Blearyeyed]

Hi Bee, thank you so so much for your detailed reply, very much appreciated. The 3rd lead of the pacemaker implant pierced my heart and emergency OHS was performed to repair the hole, that is why I don't have a pacemaker. I'm reluctant to try again but in the future who knows, I might feel brave enough to try again. Anyone reading this should not be put off by what I've said as it's extremely rare for this to happen. Thanks again for your reply. Take care x

[Jeremyrunicles in reply to Blearyeyed]

Great reply bleary-eyed. Sounds like you much experience. Many can take heed of these wise words.My self for one. I do most of it, just my brain works very fast and I find it hard to go slowly and not do too much. I've always been so busy, and enjoy it.

But I'm getting there... as you say, it's a marathon, not a sprint, that took me a good year to fully appreciate before I accepted it.

Thanks again.

[Blearyeyed in reply to Jeremyrunicles]

It's true , slowing down your pace is as hard as changing your diet, especially if you were always on the go , I still have to tell myself to slow down now after many years of learning what I need to do.Good luck on your journey and keep pacing, Bee

[PinkKizzie in reply to Jeremyrunicles]

Hi Jeremyrunicles, agree, great reply, thank you

[Lezzers in reply to Blearyeyed]

excellent & very informative response. The only thing I don't understand is why it's thought that an ICD would improve symptoms as its only an internal defibrillator? although it can be set to pace your HR up if it goes too low. My husband's ICD is set to pace him at 50, so if his HR drops lower than that it will pace him back up to 50 again. My understanding is it's resynchronisation devices, such as a CRTd) that help improve symptoms?

[Blearyeyed in reply to Lezzers]

Yes the CRTd and resynchronization shows the most significant effect on EF . Studies have shown that the pace setting and appropriate shocks of an ICD also seems to help improvement in LVEF when testing people whom go for replacement. It sounds like it helps because of the pace control and AS much like the control that your hubby has.Of course , we should also consider , whether the EF improvements found on both devices are partly because of patients making life and diet changes after their initial treatment and diagnosis which improve both their EF and Mortality risks .

But I would have assumed the researcher's took those factors into account when looking at the results.

[Lezzers in reply to Blearyeyed]

That's interesting because my understanding is an ICD wouldn't be able to calculate your EF nor would a shock have any impact on your EF. Your EF is calculated by an echo or MRI & these are not routinely carried out when you have a battery change. ( I hasten to add this is in the UK, it may be different in other countries) The pacing function doesn't work like a pacemaker inasmuch it doesn't regulate your HR but just brings it up should it fall below the set rate, not everyone has the pacing switch on though . I belong to an ICD support group & this question comes up regularly and the answer has always been an ICD itself would have no impact on improving your heart condition. Would you mind posting a link to the studies so that I can pass it on? I really wish I'd seen this previously as we were at the pacing clinic at Papworth on weds, I would have loved to have asked this question but will definitely ask when the EP phones, hopefully that won't be too long 🤞

Having another thought though!! Maybe it would depend on the type of ICD you have. My husband has a one lead ICD, that won't improve his condition in any way. However, there was talk of inserting another lead so that his ICD paces him from the top of his heart, his ICD currently paces him from the bottom (the ventricles) and too much pacing of the ventricles actually damages the heart & can cause/worsen heart failure whereas you can be paced 100% from the top without causing any damage.

[Blearyeyed in reply to Lezzers]

The improvement they found in LVEF in patients with ICD was also part of research and from EF and ECG tests done actively when people came in for replacements . I'll look up the studies again over the weekend and get them to you as soon as I can .I can't remember whether it specified whether it was done from the top or bottom of the heart off hand.

I'll have to have a read through again when I look it up for you as I'm intrigued myself now too.

[Lezzers in reply to Blearyeyed]

Thank you, would really appreciate seeing the study. Very interested in how the ECG would show improvement as well. This is all very topical for me as my husband has an ICD, he's now on his 2nd one. Last year he had serious VT's resulting in his ICD shocking him a couple of after an ablation, but his EF has reduced considerably.

[Coffeeandwalnut]

you can improve but I’ve been told that ef is just one of the factors. Some people with low ef do better than someone with higher ef. Mine is roughly same as yours and I’ve done ok for last 18 years. It did at one point go up to 35 but is back down again now. I do have crtd implanted. I basically just carry on life the same. I eat healthily , take all my meds, don’t drink or smoke. I’d like my weight to be lower but that’s a struggle in itself with all the meds I’m maxed out on. If you feel well I’d carry on with what you’re doing and don’t get too hung up on numbers and hopefully in time ef will go up x

[PinkKizzie in reply to Coffeeandwalnut]

'morning Coffeeandwalnut, thank you so much for replying. I'm the same as you, never smoked and don't drink, love gardening and try to keep healthy. I've been encouraged by your reply. Keep well, and have a good weekend x

[SLK-14]

Hi Pinkizzie...My EF was 25 4 years ago. I'm taking Dapagliflozin, Perindopril, Nebivolol and Spironolactone. I follow a healthy diet but not too regimented (life is short)and exercise regularly. My EF is now 41, I'm 75years of age, so it can be done. Good luck and take care 🙂

[PinkKizzie in reply to SLK-14]

Hi SLK-14, thank you for reply. You are correct, life is short. It's great your EF is now 41 and I'll keep active to improve mine. I'm not scheduled to see my consultant until Aug 25 so I won't know if my EF has improved until then, unless I go private. Thanks again, keep well x

[BicuspidBloke]

Mine has gone from 20 to 25% eighteen months ago to 55 to 60% now. A little down to diet, a lot down to exercise (running mainly) but mostly down to the meds (particularly Entresto). Oh, and I guess having an actual working valve plays a big part too!!

It's very doable but you can't aim for it. A lot of it is pure luck & good fortune. Just do the right things and hope everything else falls in to place (they may, they may not, but they certainly won't if the right things aren't being done).

[PinkKizzie in reply to BicuspidBloke]

Hi BicuspidBloke, it's great your EF has improved greatly, I'm always encouraged when I read this. I still have LV imparement and take lots of meds, including Entresto 24mg/26mg. Thank you for your reply, keep well.

[Elsabounre]

I have improved my EF fom 37 to 49.17 with two druga..entresto and bisoprolol..the latter causes hair loss in my case..witnin 2yrs..dosage I can take is minimal...but In my case there is no reason found for my HF..in extreme cases as someone I know...who needed an ICD..her heart is now also normal size again..and EF is 65...and results are normal..also no reason found for this HF...but ever since that pandemic was given to us it has certainly changed the picture of heart disease.

[PinkKizzie in reply to Elsabounre]

Hi Elsabounre, thank you for replying. It's great to hear your EF has greatly improved. As well as Intresto I also take Carvedilol 12.5mg, Eplerenone, and Empagliflozin so hopefully my EF will improve too. Keep well. Enjoy your weekend x

[uzininemm]

Yes for certain but it may well depend on the person, my cardiologist moved away from a pacemaker at my first yearly check due to the improvement through medication, diet and exercise. It's not a quick fix and take time, but for me it was well worth the time.

[PinkKizzie in reply to uzininemm]

Hi uzininemm, thank you for your reply. It's reassuring to hear you are well. What would we do without medication! I do exercise and try to eat healthy but that's not always the case. I hope you keep well. Thanks again.

[uzininemm]

Hello PinkKizzie, thank you I know what you mean, I certainly eat well, but can't do without my treats either (hopefully in moderation), my weight has gone up slightly about 6kg which isn't a problem as I was bordering underweight, i do check each time at the gym and keep an eye on things though and don't over do it.

I think you don't need to neglect the mental side as well (having something to look forward to I call it really helps (and that's not just food treats).

Take care yourself.

P.S. Mine was 20% when I started, and is near enough normal now.

[PinkKizzie in reply to uzininemm]

My goodness, 20% to nearly normal, well done. I think you are right about the mental side of things and I'm a positive person, glass half full which helps. Hopefully my EF will improve too. Take care.

[Shar28]

Hello. Sound advice from Blearyeyed. My husband has DCM and when he eventually had a MRI it turned out he had a biscuspid aortic valve, which was replaced. His EF at first diagnosis was 10-15%, meds increased it to 25%, 18 months or so after surgery it was up to 44% and a couple more years it was up to 66%. He puts the improvement down to taking Ubiquinol. His cardiologist and GP are happy for him to take it as it’s certainly not causing any harm and although they can’t say for certain it’s what’s helping, they agree it could be.

Best wishes for you and your loved ones.

[PinkKizzie in reply to Shar28]

Hi Shar28, thank you so much for your reply and best wishes. Blearyeyed's info was indeed brilliant. It's always great to hear success stories, makes me feel positive that my EF will improve too. I don't take Ubiquniol but take Entresto and Carvedilol. I keep active and today I've spent most of it gardening as it's warm in the sunshine. Take care and wish you and your hubby all the best for the future x