I went to see one of my two cardiologists on Wednesday to get the results of an echocardiogram I had the previous week. I was diagnosed last summer with reduced heart function. The amount of blood my heart was pumping (the ejection fraction) was measured as 35 percent of the volume of the chamber at rest, which is somewhere between 50 and 65 percent of normal (there is a range because the average amount of blood the heart pumps relative to the volume of the chamber has a range of 55 to 70 percent). An ejection fraction of 35 percent is the point below which dangerous heart arrhythmias can occur, thus indicating that an implantable defibrillator might be warranted. The ejection fraction measured this time was 45 percent, which is somewhere between 64 and 82 percent of normal. This cardiologist, whose specialty is electrophysiology, said he wouldn’t need to see me again.
So this was good news. My heart function has improved by almost 30 percent over the last few months. I’m not sure why. It could have been medications; studies have shown that the medication I’m on can help increase ejection fraction. It could be the increased exercise I started after the diagnosis. Aerobic exercise has been shown to improve ejection fraction. Or I could be recovering from a possible unknown and undiagnosed viral infection.
I suppose it’s also possible that a different person read the echo results and calculated the ejection fraction differently. It’s hard to get a good idea how accurate and repeatable ejection fraction calculations are using a 2D echocardiogram.
The second bit of good news was that the short EKG I had in the office showed no premature ventricular contractions (PVCs). PVCs don’t necessarily indicate a serious heart problem; a lot of people have them with no serious consequences. I, on the other hand, had a very large number of PVCs when I first went to the doctor. I suspected that an EKG would show a decrease in PVCs because the things I associated with them had almost disappeared. Those things included discomfort when I laid on my left side, and the inability of my home blood pressure monitor to count my pulse accurately. When I mentioned to the doctor that there were no PVCs, he said, “But that was only over six seconds.” I said, “Yes, but I had so many before that I would have expected to see some in that time.” He looked back at the previous EKG and agreed with me.
I was relieved as we walked out of the doctor’s office. I had already decided to stop worrying about it, and now I think I actually have a good reason to do that. Leah is also relieved, but she still worries. She also thinks that doctors should be able to say why I had the problem in the first place and why my heart function has improved. I have a much less sanguine attitude about the state of medical knowledge.
I was a little amused by the doctor. I could almost see him losing interest in me as he looked at the echocardiogram results. Since I was no longer a candidate for an implantable defibrillator, I was no longer a candidate to be his patient. He didn’t exactly give us the bum’s rush, but he was not inclined to talk about what might be going on with me.
I guess I understand that attitude. Doctors like him see lots of patients every day (multiple appointments at the same time) and it must be hard to look at every patient as an individual rather than as a heart that needs some work. I do think a doctor ought to be able to hide that attitude.
My heart function is still below normal, but I’m also still asymptomatic. I walk the dogs a couple of miles every day, down the mountain and then back up. When I get back home, I ride a stationary bicycle for 50 minutes. And then I go outside the work on the house. I’m hopeful that my heart function will continue to improve. It will be interesting to hear what the other cardiologist has to say at my appointment in September.
Great to hear this good news. Sorry to hear how your doctor “lost interest” in you. My daughter reports a similar thing with her OB, with whom she would likely become a “regular.” My brother specifically became a “country doctor” so he could have more interaction with his patients.
That sounds like really good news, Mark. I understand Leah’s continued worry and her sense of relief as well. I have lost confidence in doctors over the years. They seem to know more and less at the same time.
Pablo — Thanks. My primary care doctor is not like the cardiologist. He at least seems to take some personal interest. We saw Leah’s surgeon on Friday, and I think he also does it well. He’s interested enough to ask me how my retirement is going.
Robin — I think medicine is at a strange state. It has advanced tremendously int the last few decades, but they still don’t seem to have a real understanding of a lot of physiological processes.
Happy to hear that your heart is doing it’s job better.
Agree that a doctor should at least be able and willing to feign interest in the person.
Minnie – Thanks. Yes. The surgeon might have been truly interested — after all, he’s the one who did Leah’s colon cancer surgery 15 years ago — or he might just have the bedside manner down.