Lexiscan due to decreased ejection fraction

I've had a PM since I was 2...I'm 41 now.  Throughout the years my PM checks and cardio appts were all pretty smooth, no concerns, etc.  I had a treadmill stress test back in Nov 2018 and everything looked good. I was supposed to get the Lexiscan but refused after reading all the horrible experiences.  Also had an Echo around the same time and EF was around 50%...had an echo in February and EF dropped to 38% so doc wants to do another stress test but this time told me it needs to be the Lexiscan.  I've struggled with anxiety when it comes to my heart and notice every little abnormal feeling.  I must admit, I really don't want to do this test.  Is there any safer alternatives?  
 

Also, in regards to my reduced EF, I feel fine.  Exercise regularly and eat a somewhat healthy diet.  The only thing that really changed was doc gave me Lipitor for high cholesterol. I've taken that for the past 18 months.  I read that statins could possibly weaken the heart muscle.  I wonder if that should be a talking point my next visit?  Doc thinks blockage or pacemaker syndrome are two must likely culprits of decreased EF.  Anyone on here have any thoughts or wisdom on any of what I just addressed?

 


4 Comments

Blockage or pacemaker syndrome

by AgentX86 - 2020-05-17 12:39:31

This is getting a little too far into the medical advice territory for my comfort but I trust my cardiologist and if I didn't, I'd find another who I did.  Yes, all pricedures involve risk but the downside of not taking his advice is pretty grim as well (if you do have a blockage and ignore it...).  Almost all health decisions are a risk/benefit tradeoff.  Your doctor is in a better position to weigh these risks but you certainly have the right (and perhaps obligation) to question the procedure and make your own decisions. Informed consent is exremely important.  However, the key word is "informed".

Atorvastatin and the heart

by Selwyn - 2020-05-17 12:54:11

Lipitor ( Atorvastatin) is not known to damage heart muscle. It has some properties that encourage blood vessels to grow in the muscle and also can be helpful to reduce abnormal muscle thicknness.  I take atrovastatin to help prevent coronary atheroma . My cholesterol has never been high, however all the evidence points to the lowest possible cholesterol being of benefit in preventing ischaemic heart disease. 

Lexiscan ( regadenoson)  is a drug with unique properties. I don't think there is a safer alternative. The drug dilates coronary arteries.  It is the most widely used drug for doing ejection fraction radioactive imaging. Cardiac departments have all the relevent gear on hand to help if there is a problem. It is at least as safe as an exercise ECG and the effects can be reversed partially with an antidote ( aminophylline).

There is no action  in life without risk. The change in your ejection fraction puts you at further risk if there is a reversible cause that is not found.  Ultimately, are you going to accept the risk of a catastrophic  decrease in your heart's ejection fraction, leading to heart failure, when something can be done to prevent it?

You need to start trusting your EP team

by crustyg - 2020-05-17 13:03:18

PM since 2, so you've got congenital CHB - probably: your bio doesn't say.

It's my impression that folk with healthy heart muscle who have long-term RV apical pacing don't develop LV remodelling, *but* that's an opinion not based on a literature review or clinical practice.  Plenty of CCHB folk here who have been paced for decades with no reduction in %LVEF.  Which suggests to me that your EP doc thinks that there may be an underlying heart muscle problem - hence the treadmill in Nov 2018, which you say was reported as normal, *BUT* your EP doc wanted the Lexiscan.  Not a good sign.

And now, here you are with an EF of 38% at 49years.  Not great.  But you feel ok, so I'm guessing that you aren't as active as you might be, because I'm fairly sure that you would have noticed this yourself.

OK, what's caused this?  You *may* have LV remodelling, you may have coronary artery disease (IHD), but until you submit to the tests you won't know.  And until your EP doc knows, you can't have a grown-up conversation about can be done about it.  Because your EF will probably carry on getting lower and if you have IHD then, untreated, you'll end up with a heart attack.  Don't forget, doing nothing also comes with risks.

I know I'm being blunt, but I really think you need to trust your medical team.  They actually know the medicine and the natural history of disease, they have the practical experience, and you're using Google to decide to ignore them.

Thinking it through

by Gotrhythm - 2020-05-17 19:48:17

I've had this test twice now.

Yes, it's unpleasant for 3-4 minutes. But I have endured worse for longer. And when it becomes too unbearable, the tech is right there to administer the antidote.

Pardon me if I speak very frankly. It sounds to me as if you're not afraid of the risks of the test going wrong and harming you. You're afraid of feeling the physical sensations of pounding heart, etc. You are allowing fear to override your ability to think rationally about what is in your best interests. You're letting what you could feel for 3-4 minutes to matter more than your future health.

I don't know whether there is a substitute for the test. I do know that your doctors would not want the test if they didn't think they needed the information the test would show.

Rather than resisting the test, it might be more useful to tell your doctor how you feel, and discuss what could be done to make the procedure more bearable for you.

 

 

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Hi, I am 47 and have had a pacemaker for 7 months and I’m doing great with it.