Heart Failure - No Symptoms

@poppy0344
Good evening,
This is just my uneducated two cents worth and what I may do if I were in your place. But first I’m curious to know what your doctor said when you refused to take the prescription? Did you discuss the benefit risk factors associated with beta blockers taking them versus not taking them. Also, do you know what your ejection fraction is? How often do you have your heart failure evaluated by your cardiologist?
My cousin has heart failure but is symptomatic. Basically heart failure is when your heart muscle isn’t pumping as efficiently as it should. Since beta-blockers improve the volume of blood from your heart I’d be inclined to take them for long term improvement and decreased risk of sudden cardiac death.
Very best of luck to you,
Jake

Hello @poppy0344,

Symptoms of a disease such as pain, fever, headaches, rashes, etc. are important even though bothersome. These symptoms are what bring us to the doctor to get medical help and sometimes that help is life-saving. In your situation, however, you have no symptoms which most likely leaves you feeling somewhat complacent about treating this problem.

As heart failure does have serious consequences I think that @jakedduck1 makes some good points in his post. It might be a good idea to talk with your doctor about the pros and cons of not treating this heart problem with medication.

Do you have a follow-up appointment with a cardiologist currently scheduled?

Thanks Jake. I did not discuss the pro and con of beta blockers (BB) with my cardiologist. I saw him after the EKG and stress test. We discussed the results. I carried him a graph of my blood pressure and oxygen saturation over 18 months. He showed me the EKG video and said the bottom of the heart was not pumping as vigorously as the top. He said he thought I had had a heart attack. I told him I had not experienced any pain or other symptom. He said he thought I probably I should take medication. He then scheduled me for a "non-stress" stress test the next day; i.e., no treadmill just with the heart at rest. I did not talk with him after this "no stress" stress test but his nurse did call and talked with me and confirmed his diagnosis and said he recommended BB. She also stated correctly that the doctor and I had talked about medication and I was not interested in taking BB. A year ago after EKG and stress tests I was told I had a leaky heart valve. So this is the first time he has said I had heart failure. I have great confidence in my cardiologist since I know several people who he has treated for many years. However, I have researched BB and they basically lower the blood pressure, slow the heart rate. As I mentioned I check my blood pressure every day and have been doing so for a couple of years or more and I don't have high blood pressure. Therefore, based on blood pressure; exercise and no symptoms, I don't think BB would be beneficial. And of course BB have side effects. I am not ignoring my doctor's analysis and I will certainly watch my blood pressure and potential symptoms closely and if things change I will go see my cardiologist. The following is my diagnosis in medical language: NYHA class 1 heart failure with reduced ejection fraction; EF estimated 37% on myocardial perfusion study 2/4/20.

Thanks Leonard. I am new at this so maybe I should say thanks Jake. Thanks Both :). I did not discuss the specific benefits and risk factors with my doctor. The scheduling of tests and appointments did not put us together after all the data was in. My doctor told his nurse, who was the last one to communicate with me after all the test data were in, that I didn't want to take the beta blockers. I confirmed that was true. This was the first time I have been diagnosed with heart failure. Previously, last year, I was diagnosed with a moderately leaky Aortic valve (actually the original diagnosis 6 months before was moderately leaky Tricuspid). I see the cardiologist once a year. Below is the ejection fraction.

NYHA class 1 heart failure with reduced ejection fraction; EF estimated 37% on myocardial perfusion study 2/4/20.

George

Hello @poppy0344,

While I understand that you have been posting with @jakedduck1, I just wanted to post again to you because of some of the new problems you mentioned in your previous posts. You mentioned having an EF of 37%, are you aware that this is quite low?

You also mentioned having a moderately leaky aortic valve, which I have as well. Has your cardiologist suggested an ACE inhibitor med? ACE inhibitor meds are great for heart failure. They help the heart function at a higher level and have fewer side-effects (especially is you take them at bedtime) than the beta-blocker. I now take an ACE inhibitor med as well as a beta-blocker. The combination provides improved heart function.

Also, you mentioned that your doctor suspected that you had a heart attack but you were doubtful because you don't remember any symptoms of such. Are you aware of the term, "silent heart attack?" I mention it because my dad had perhaps several of those. The only symptom he had was discomfort in his neck/jaw area. Heart attacks do not carry the same symptoms for everyone as you probably already know.

I'd also like to invite Martin, @predictable, to this discussion. He has had a lot of experience with heart problems and perhaps he can add something as well.

@poppy0344
Hello again,
There’s a number of nurses here who know far more about heart failure than I ever hoped to know and although I probably shouldn’t say anything, that hasn't seemed to stop me yet.
I didn't think an Ejection Fraction of 37 provided our bodies with an ideal amount of oxygen rich blood. I assume your cardiologist is well aware of all of your vital signs and I wouldn’t think he would recommend beta blockers if he felt that they would bring your blood pressure or other vitals down to dangerous levels. Your doctor may be trying to get your Left ventricle to pump out more blood for the bodies use and also trying to prevent or at least lower the risk of sudden cardiac death especially since you’ve already had one heart attack.
If it were me I’d be on a plane to the
Cleveland Clinic ASAP. perhaps you’ve already had a thorough heart-to-heart with your cardiologist but if you haven’t I would want to know exactly why he wants to start you on beta blockers, find out his reasoning. My gas and of course it’s an educated guess at best But I’d assume he wants to try and raise your ejection fraction as well as the fact that you’ve already had a heart attack so he wants to try to lower that risk as well and also your stroke risk. I don’t understand the fact that you’re asymptomatic with an ejection fraction of 37. Hopefully one of the nurses here can shed some light on symptoms vs function vs staging.
Take good care of yourself,
Jake

Thank you Teresa. I know that 37% is quite low. I have not talked to the doctors in depth about the meds. I have an appointment with my GP 3/10/2020 and I am researching Beta Blockers in as much detail as possible before that time, and based on your comment I will include ACE inhibitors. To be honest what really puzzles me is that I walk 5-6 miles over very rugged terrain every week with very high heart rates with no problems. I really appreciate your information and experience.

Hello again, @poppy0344,

I certainly applaud you for all the research you are doing. It is very important these days to be your own advocate for your health needs. Doctors only have a certain amount of time to listen to their patients and research. It is vital that we help them to take care of us. Most doctors worth their salt will not object to you bringing in your research.

Yes, please look at the ACE inhibitors meds. It is especially useful for heart failure with minimal side effects and fewer problems to the kidneys than other meds of its type. It relaxes the heart and helps it to function better.

Here is some info about ACE meds from Mayo's website,
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/ace-inhibitors/art-20047480
As ACE meds relax the veins and arteries it also relaxes me all over, so I take it at bedtime.

Well i want to add to this discussion that i don't think 37 is dangerously low. I was never considered low until under 30 which os the point im told they normally consider being in Congested Heart Failure. When i first started having problems with mine i was at 5% and a pacemaker with difibulator installed. I went home on Amiordione and Cardivolol. I lived that way for over 3 years living a normal life until my pacemaker had to shock me back one time. But my point being is mine never got better than 40-45 untill my Heart transplant 2 years ago. So at least for me i was at 37 for years without any major issues. My pacemaker only had to shock me because of arrythmias not heart failure. Just my history with Low ef.

Thank you hopeful33250 for the information and link to the ACE meds. I certainly will investigate ACE along with Beta Blockers.