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Is EF Of 30-35 A Cause For Concern While Treating Congestive Heart Failure?

Posted on Thu, 19 Jan 2017

Question: My wife suffers from CHF. The latest test showed her EF to be 30-35, donw from 49 a year ago. My guess she is at stage 3B. She also has slight COPD, is in her second remission of follicular lymphoma after two years of maintenance rituxan completed in Sep 16, has a stent in one leg with both legs now showing ABI > 90, three blocked heart arteries, being treated with meds, and is diabetic. For the past two months she has been out of bed about 4-6 hours a day and is constantly sleepy. A shower wears her out. She was treated for a UTI two weeks ago. Her vitals now range from normal to O2 as low as 78, BP to 95/55 and pulse over 100, and temperature slightly above 100. Are the fluctuations in vitals caused by worsening CHF or could her general failing heart condition making it difficult to recover from the rituxan treatment and UTI?

Answered by Dr. Geeta Sundar (4 hours later)

Brief Answer:
I have seen all the reports and read her history.

Detailed Answer:
Hi, I have seen all the reports and read her history. Can you answer these queries?
What are the results of the following reports--

Blood sugar levels?
Serum creatinine levels?
LFT?
TSH?
All of these could add to her weakness.
I think her drowsiness is primarily because of low oxygen levels. She should be given intermittent oxygen.
Her cardiac capacity is not too bad. Although she does have a biventricular pace maker.

I will be better able to advise you after receiving answers to my queries.
Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Geeta Sundar (19 hours later)

Blood Sugar levels-last on Dec 13-270, four month average about 210

Creatinine-last on Dec 13-1.1, four months range from 1.1-1.6

Lft - not sure what this is

TSH- last in Oct, 2015-3.15, Sep 2015-13.3, Aug 2015-15.3

Answered by Dr. Geeta Sundar (5 hours later)

Brief Answer:
So besides being low on oxygen, her creatinine levels are fluctuating

Detailed Answer:
Hi, LFT is liver function tests.
So besides being low on oxygen, her creatinine levels are fluctuating and sometimes above normal. Her blood glucose too is on higher side.
Please arrange for home oxygen--and give her intermittently under guidance of your doctor.
Encourage her to do breathing exercises.
Keep her blood glucose under control.
Monitor her creatinine frequently.
Get Liver functions done if not done already.
I sincerely hope my advise helps her.
Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Geeta Sundar (32 minutes later)

I assume her CHF condition will continue to deteriorate even with the O2 and at some point will require some form of nursing home care. Is this something I should be arranging for in the next year or will the O2 sustain her living at home beyond a year? Finally, what is your experience in terms of longevity once O2 is required for CHF and her other issues?

Answered by Dr. Geeta Sundar (3 hours later)

Brief Answer:
her left ventricular ejection fraction is good.

Detailed Answer:
Hi, as her left ventricular ejection fraction is good, with home oxygen, proper sugar control and CHF medication which she is already on except for Lanoxin which can be added, she can be maintained.
If her lungs are very emphysematous and fibrosed. Then the prognosis is bad. Yes, the COPD part is more worrisome than the heart.
And in addition there is the relapse in lymphoma.
Longevity and prognosis varies a lot. Some patients whom we do not expect to do well, carry on for years.
In her case, it does look bad at present. Play it by the ear--arrange for nursing care only when needed.
I wish you the best.
Regards

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Above answer was peer-reviewed by : Dr. Remy Koshy