Greetings, Dr. Roach My 73-year-old spouse was diagnosed with a profoundly dilated left ventricle and heart failure. He was pumping ten liters per minute at the time. His ejection fraction was 39% and his proBNP natriuretic peptide level was over 10,000. An abdominal arteriovenous malformation (AVM) was later discovered in him. Three radiological procedures were performed on him in order to shrink the AVM.
His ejection fraction was 54%, his proBNP level was 1,300, and his cardiac output was 5.7 liters per minute a year after the surgery. The high-output congestive heart failure was obviously caused by the AVM, and the three embolization techniques worked well. Following the operations, he no longer has any symptoms and feels stronger and more lively than he has in years. He rides a bike sometimes, treks a few miles every day, and can climb a sand dune without becoming tired.
My query is: If his heart is pumping at 5.7 liters per minute, does he still have a high-output diagnosis? If so, how should a person with this disease be treated? At the moment, Coreg and lisinopril are being administered to him in little amounts. He wants to know if his left ventricle’s dilatation is permanent or if it will go away with time. — K.B.
Simply put, heart failure occurs when the heart cannot pump enough blood to meet the body’s needs. Based on the heart’s ejection fraction (EF), or the proportion of blood that the left ventricle pumps out with each beat, heart failure is divided into two main types.
Heart failure with an EF below 50% is known as heart failure with reduced ejection fraction (HFrEF), since the EF typically ranges from 50% to 75%. A person has heart failure with preserved ejection fraction (HFpEF) if they have heart failure symptoms with an ejection fraction of 50% or above.
The majority of heart failure cases are brought on by idiopathic dilated cardiomyopathy, recurrent heart attacks, or heart disease from chronically elevated blood pressure. High-output heart failure is a less prevalent reason of your husband’s condition. He has an AVM in his situation. Although it can occur elsewhere in the gastrointestinal system, this direct connection of the arteries and veins typically takes place in the colon.
The oxygenated blood that passes through the AVM is completely useless, and the heart must work harder to pump the blood that the rest of the body requires. You may think of it as a short circuit of the blood supply. By blocking the AVM, the short-circuit is stopped and the heart’s workload is reduced.
The fact that your husband’s symptoms have improved is the best news. However, it’s also fantastic that his BNP has improved and that his ejection fraction is now within the normal range. Although 1,300 is still highly unusual, it’s still far better than 10,000.
The heart’s recovery from high-output cardiac failure is gradual. I’m not sure whether blood is still passing through his AVM, but given his symptoms, I’m hopeful that the majority, if not all, of the underlying cause has been eliminated. Heart failure is commonly treated with lisinopril and carvidolol (Coreg), which also protects the heart.
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