Let's talk ejection fraction

[Gizmo]

I know this topic has been discussed a couple of times mainly because people were having issues. How about starting a thread that'll contain a lot of info on ejection fraction (the amount of blood the heart pumps with one beat) because I think it is an often overlooked side effect of steroid use with really not a lot of information out there about it. From studies ( that I found) it is not even clear if a low ejection fraction is reversible, although I've seen people mention they reversed theirs (i.e. Maldorf). Is it preventable while using steroids? Does low ejection fraction happen fairly quick or is it a gradual change which takes long term use? What causes the ejection fraction to lower? Is it a direct result from the hormone use or is it a secondary result from increased hematocrit increasing load on the heart, or is it both?

Now we know certain supplements like ubiquinol have shown promise to raise ejection fraction, but does it prevent lowering of ejection fraction using steroids? I don't know. What I'm seeing is that it's not that clear how severely and how quickly AAS affect EF (although they obviously do) I was hoping maybe some of the sharper minds could talk about it since I didn't even know what it was until I read Maldorf's story and it is IMO one of the most dangerous and possibly deadly and a lot of times asymptomatic side effects.

Anyways, just hoping to get a discussion going.

 

[nothuman]

There have been studies posted here about certain supplements increasing ejection fraction. The ones that help are ubiquinol, pycnogenol, ribose, citruline malate, and Arjuna (possibly others too but those are the big ones). A normal EF is between 55-70%. As for what mechanism actually causes EF to lower, I'm not entirely certain, but perhaps others will be able to fill in the blank.

 

[tenny]

resting heart rate and blood viscosity play
major roles in ejection faction.

males under 60 should be under 60bpm resting.

 

[bananas007]

The main reason AAS will cause low EF is cause of the Hypertension. OVer time initially the heart will hypertrophy constantly pumping against the blood pressure. It may even initially increase the Ejection fraction, but eventually the heart start giving out and will drop the Ejection fraction.

the second less common ways would be via blockages or also knows as cornoary artery disease. As you know AAS effects lipid profile which inturn predisposes you to building up plaques in the coronary arteries. This overtime can lead to a low EF but this is probably not as common in "healthy" bodybuilder that do cardio and workout and stay lean. It probably negates some of the abnormal lipid effect. However if you eat like slob, and stay on high doses and are fat I guess it is possible eventually.


Ejection fraction is actually quiet a bit reversible. It depends on the insults. THERE is a lot of times with the correct medications patients will recover in their ejection fraction from 25% to back to 50+ %. The main medications used are beta blockers like carvedillol and ACe Inhibitors like lisinopril. Both have shown to have cardioprotective effect.

Lot of times after a heart attack the EF will drop. The cardiologist will start the patient on the above two medications if there are not contraindications and re evalute at short time intervals. it is not uncommon for the Ejection fraction to get back to normal.

Having said that the Ejection fraction is large part but not all of the equation. There is more to the heart than just contracting. It also has to relax appropriately to allow the blood to fill in, and it all has to contract as designed by god. If a scar tissue forms from heart attack, it may not contract completely, and even though the ejection fraction might be good, there might be a part of the heart that is not beating as needed.

 

[bananas007]

resting heart rate and blood viscosity play
major roles in ejection faction.

males under 60 should be under 60bpm resting.

That is definitely not entirely true. Low resting heart rate in healthy young athletes usually does mean a good heart, but if someone is healthy and 25 and has a resting heart rate of 72 thats just their genetics.

Cardiact output = stroke volume X Heart Rate.

So if your heart rate is low you have really good stroke volume meaning really good pumping ability of the heart, but it doesnt have to be less than 60.

 

[bananas007]

Anybody with high blood pressure over sustained period of time (years) can and probably will develop heart problems such as heart failure, but AAS magnifies it cause not only does it cause high blood pressure, but now the user has substance floating in the blood that causes muscle to hypertrophy really fast. So it is like adding fuel to the fire.

In my lay mans opinion if blood pressure is STRICTLY monitored while on AAS a lot (not all) of the cardiac problems can be avoided. Also the blood pressure should probably be measure multiple times through the day. If you are 120/80 when you wake up, but 160/85 in the afternoon while stressed out at work or from your pre work out, it may cause issues.

 

[tenny]

That is definitely not entirely true. Low resting heart rate in healthy young athletes usually does mean a good heart, but if someone is healthy and 25 and has a resting heart rate of 72 thats just their genetics.

Cardiact output = stroke volume X Heart Rate.

So if your heart rate is low you have really good stroke volume meaning really good pumping ability of the heart, but it doesnt have to be less than 60.

thanks Debbie downer...

it just checked mine at 65

 

[nothuman]

The main reason AAS will cause low EF is cause of the Hypertension. OVer time initially the heart will hypertrophy constantly pumping against the blood pressure. It may even initially increase the Ejection fraction, but eventually the heart start giving out and will drop the Ejection fraction.



the second less common ways would be via blockages or also knows as cornoary artery disease. As you know AAS effects lipid profile which inturn predisposes you to building up plaques in the coronary arteries. This overtime can lead to a low EF but this is probably not as common in "healthy" bodybuilder that do cardio and workout and stay lean. It probably negates some of the abnormal lipid effect. However if you eat like slob, and stay on high doses and are fat I guess it is possible eventually.





Ejection fraction is actually quiet a bit reversible. It depends on the insults. THERE is a lot of times with the correct medications patients will recover in their ejection fraction from 25% to back to 50+ %. The main medications used are beta blockers like carvedillol and ACe Inhibitors like lisinopril. Both have shown to have cardioprotective effect.



Lot of times after a heart attack the EF will drop. The cardiologist will start the patient on the above two medications if there are not contraindications and re evalute at short time intervals. it is not uncommon for the Ejection fraction to get back to normal.



Having said that the Ejection fraction is large part but not all of the equation. There is more to the heart than just contracting. It also has to relax appropriately to allow the blood to fill in, and it all has to contract as designed by god. If a scar tissue forms from heart attack, it may not contract completely, and even though the ejection fraction might be good, there might be a part of the heart that is not beating as needed.

Do you know if aortic regurgitation can lower EF at all? Mine is mild but my EF was 60% last I checked so it's something I have to keep an eye on.

 

[bananas007]

thanks Debbie downer...

it just checked mine at 65

Tenny you are a different beast bro. Us average humans cant compare .

 

[bananas007]

Do you know if aortic regurgitation can lower EF at all? Mine is mild but my EF was 60% last I checked so it's something I have to keep an eye on.

Over period of time it can but it also depends on the degree of aortic regurg. If you randomly do echocardiogram on healthy population lot of people will have trace regurgitations of their aortic and mitral valve and go on to live normal lifes.

If it is moderate I guess it can over time cause issues and has to be watched.

If it is severe I am assuming it will need to be fixed or the valve replaced if there are no other contraindications.

(NOT a cardiologist)

 

[nothuman]

Do you know if aortic regurgitation can lower EF at all? Mine is mild but my EF was 60% last I checked so it's something I have to keep an eye on.

Always love seeing posts from guys who know what they're talking about as it pertains to heart health.

 

[maldorf]

If you suffer a heart attack

If you suffer a bad heart attack like me and a large part of your heart muscle dies, then your EF is going to be quite low and really not recover much. Most of the evidence point to the fact that once the cardiac muscle dies it is going to form scar tissue and then that is it. There is a large part of my heart that is all scar tissue so that it doesn't squeeze at all, no contraction. The heart becomes more stiff and the pumping action goes way down. I am not really sure why my EF has gone up. I think the part of my heart that is still living has compensated to take over more of the pumping action and perhaps the ubiuqinol and humanofort have somehow helped in this regard.

I went up about 5-10% EF, and that is over about 5 echocardiograms so it is more than just differences in who is reading them. One time I had 3 different cardiologists look over the results. There has been small improvement. Another thing is that the improvement has come while I was taking the medicine, and so it wasn't the medicine I take that caused the increase. It would be erroneous for me to claim improvement if I was comparing an echo done before the meds to an echo done after meds.

The cardiologists I have are not amazed at what has happened with me but I do see that they are pleasantly surprised and not at all used to seeing this. Usually the best someone like me can expect is to maintain the EF over time, stave off the inevitable decline. So far I have improved some. I do know that in the future if I live long enough that I will need a transplant. I ask the doctors and they all agree.

Ejection fraction is a very important measurement and in heart patients they recommend a defibrillator like I have if your EF is below 30%.

 

[Dagreasyitalian]

Interesting...this is something I never even thought about...

 

[nothuman]

thanks Debbie downer...



it just checked mine at 65

65 on TRT or are you on anything right now? Mine is in the 60s on just TRT personally but only if I'm eating clean and not holding water

 

[ShortStop]

At rest my heartbeat has always been at or around 60.... They called it Althletic Heart Syndrome..
I just did my blood pressure 142/80 65 heart rate. I have hypertension but still a good heart rate. This is my morning rate. My blood pressure after work is much higher. I'm a heart attack waiting to happen. Scares me.
Im due for electrocardiogram and some blood work in a couple months.
I use to have text book bloodwork when I kept things simple but when I started experimenting with other compounds is when I fucked things up a bit

 

[Gizmo]

That is definitely not entirely true. Low resting heart rate in healthy young athletes usually does mean a good heart, but if someone is healthy and 25 and has a resting heart rate of 72 thats just their genetics.

Cardiact output = stroke volume X Heart Rate.

So if your heart rate is low you have really good stroke volume meaning really good pumping ability of the heart, but it doesnt have to be less than 60.

So will a decrease in ejection fraction always be accompanied by an increase in heart rate? It's kind of curious an elevated heart rate is not mentioned as a symptom of decreased injection fraction unless it is really low (<30).

 

[bananas007]

So will a decrease in ejection fraction always be accompanied by an increase in heart rate? It's kind of curious an elevated heart rate is not mentioned as a symptom of decreased injection fraction unless it is really low (<30).

Yes that's correct. Decreased ejection fraction will cause an elevated heart rate usually cause it has to beat more to provide the same cardiac output.

But that doesn't mean every heart rate increase is cause by ejection fraction drop. Just want to put it out there so it doesn't freak out people.
Heart rate varies a lot from day to day depending on lot of factors such as sleep, heavy training, diet caffeine etc.

 

[nothuman]

Yes that's correct. Decreased ejection fraction will cause an elevated heart rate usually cause it has to beat more to provide the same cardiac output.

But that doesn't mean every heart rate increase is cause by ejection fraction drop. Just want to put it out there so it doesn't freak out people.
Heart rate varies a lot from day to day depending on lot of factors such as sleep, heavy training, diet caffeine etc.

To what degree (or percentage) does EF have to decrease before it starts elevating HR at rest?

 

[maldorf]

To what degree (or percentage) does EF have to decrease before it starts elevating HR at rest?

Well, since Cardiac output equals heart rate x stroke volume, any decrease in ejection fraction (stroke volume) would have to lead to an increase in HR if the same CO is to be maintained. So theoretically I would say any decrease would lead to an increase. It is just simple mechanics. Compare to someone trying to bail water out of a boat. If the person is using a bucket to bail out the water and you go and give them a bucket that is half the size then it is going to take them nearly 2x as long to bail out that boat.

In my example, when I had cardiomyopathy, I knew something was really wrong because my resting rate in the morning lying in bed was up over 100. You also notice decrease in cardio ability and ability to do just about everything was reduced. My EF that time was around 35%.

Here is a good thread I started about heart rate recovery after exercise, something else to consider.
http://www.professionalmuscle.com/f...overy-after-exercise-predictor-mortality.html

A slow heart rate recovery after exercise can be correlated with a greater chance of death.

 

[bananas007]

To what degree (or percentage) does EF have to decrease before it starts elevating HR at rest?

Like Maldorf Said, in a hypothetical world if everything is equal any drop in EF will cause an increase in Heart rate as the body has to maintain the cardiac output.

In real world things are dynamic and bodies are changing hour to hour day to day. There is no magic number such as a drop in EF by 5% will cause the Heart rate to increase by 4 beats per minute. It is not an exact science.

There is also the other part of the equation which is the how efficient is the muscle at pulling the oxygen off the blood. If TOM is 25 years and his EF his 65% but he is a couch potato his HR might be 84 at rest. If the TOM now is 50 years old but suffered some heart failure and his EF his 45% however TOM has dedicated himself to a conditioning program and his muscles are very efficient his resting heart rate might be 72.

I have read the article Maldorf linked too, and agree that I have heard a few cardiologist mention that recovery of your heart rate is a better indicator of your heart health.