Ejection fraction 35-40% and no symptoms

@scaredkat
It takes time for the Entresto to work. It will be important to see what next echo shows. There are a lot of other medications out there that can help with heart restructuring like Jardiance. Talk to your cardiologist about others that can be taken along with Entresto.

How is your blood pressure? Is your heart enlarged. A large heart has trouble contracting and can affect EF. An enlarged heart has many causes but a common one is high blood pressure.

Did your cardiologist tell you that EF for echocardiograms are subjective. You can have two cardiologist look at same echo and see a different number. Also the EF can fluctuate day to day. All coming from my Heart Failure Specialist and my Electrophysiologist at Mayo Jacksonville.

My EF when diagnosed was 48. It steadily went down to below 30 and that is when I got an ICD/Pacemaker. When your EF gets to 30 or below they normally order a ICD or dual device like mine ICD/Pacemaker. Why at 30 don't know just was told these by all my cardiologists.

My EF has been the same for over 10 years.

@ruth36 I have been on it for two years and I have never experienced any side effects

@jc76 So did you get your ICD because after a year your EF went down? My EF has stayed the same after 4 months on Entresto (20-25%) so it is considered stable but quite serious. I need to decide on staying on Entresto for another 3 months or going ahead with an ICD. Do you think it is too early for the ICD and I may see improvement staying on Entresto another 2 or 3 months? So hard to decide!!

@beebo On Entresto for two years, but did you have an ICD implanted? That is my huge dilemma. Give Entresto more time and take my chances or go ahead with an ICD because of a stable 20-25% EF for the past 4 months.

@ejbb Never had any discussions about an ICD. To be honest, I don’t really know what that is. Bob

@ejbb
I was not on Entresto when my EF reached 30. I was seeing a local cardiologist who said that may EF had gone down to 30 and was referring me to a electrophysiologist for ICD.

It was at that time (2006) that I sought a second opinion at Mayo Jacksonville. They agreed with the ICD but recommended both a ICD/Pacemaker device. The reason for that is I had electrical problems (LBBB and PVCs).

The Electrophysiologist then referred me to a HF doctor there at Mayo and it was him that changed my medications. When Entresto came out I was put on Entresto by my HF Mayo doctor. It is then my EF stabilized.

Entresto and other medications can affect your heart rate and those medications did bring down my BPM to 40s and the pacemaker of my device was changed to pulse me at 70 bpm.

The ICD surgery is very common and considered an outpatient procedure. What it will give you is if your heart ever goes out of rhythm (tachycardia) it will read it and provide the appropriate level of shock to bring it back into rhythm. I was told by my EP that is 99% effective. Now having said that 99% refers to electrical issues not having a heart attack where the heart muscle is damaged. But a low EF can cause tachycardia.

For me the ICD brought a reassurance of if I did have problem would be there to address it. What my EP told me it is like having your own EMS team waiting to help you and you and your heart does not have to wait until EMS arrives and sets up cardio converter.

I would suggest talking your cardiologist. But just know that I was told when EF gets to 30 it is where cardiologist usually recommend a ICD so your cardiologist is following AMA guidance.

It takes time for Entresto to help reshape your heart. And that is what has to happen. Staying on Entresto even after ICD is probably what your cardiologist will recommend. There are also other medications (which are fairly new to help restructure heart) that help restructure your heart. Asked about them to take along with Entresto.

If you have an ICD and your EF improves to above 30 then you are going in right direction and your ICD will just be there if needed. I went 10 years without ever getting a shock. And then one day got shocked to correct tachycardia. We found out later I had got dehydrated and affected heart rhythm

I was told by one cardiologist that after taking medications for HF hearts will either get better, stay the same, or get worse. When I was put on Entresto my EF stayed the same and has been there 22% for over 10 years. As I mentioned I recently was put on additional medications that help remodel heart and time will tell if helps.

An ejection fraction of 35 to 40 is considered low, but with no symptoms, I would not be concerned unless you are not able to do the things you normally do. My husband has a low blood oxygen level--like 92 to 94 and the docs always ignore that because he, too, has no symptoms of distress. It is his "normal" and only when he is in for something else do the physicians get agitated about it--like when that monitor keeps going off and beeping!