Q: What should be the normal percentage of LVEF in the echo report for a person who is diabetic for the last 14 years and hypertensive for the last 10 years? Is it possible that a diabetic patient would not have symptoms of chest pain during heart attacks?

A:LVEF or left ventricular ejection fraction in a normal person should be in the range of 60-70 percent. Presence of diabetes, high blood pressure, does not change the values of normal ejection fraction. However, in patients with long standing high blood pressure and diabetes mellitus, there may be some deterioration in the function of the heart, both in terms of its contraction and its relaxation. Diabetes patients have damage to the nerve endings (autonomic denervation) and therefore may not have the classical chest pain of either angina or heart attack and may have atypical symptoms in form of breathlessness, sinking sensation, increased sweating, gas or abdominal distension, restlessness or some times no symptoms.