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Heart Disease (Expert Forum)
Abnormal Stress Echo
Answered by
Cleveland - OH
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Abnormal Stress Echo
by chrisr, Jun 19, 2006 12:00AM
Dear Doctor, Thanks for taking my questions. Following are results of a recent (5/22/06) abnormal Stress Echo done at CCF. There are a few numbers which are either abnormal or appear to be incorrect. I have highlighted these. Could you kindly comment? I still have nausea with chest discomfort almost similar to preCABG done Sep 05 also at CCF.
MEASUREMENTS:
Aorta (at leaflets - cm): 2.8
Left Atrium (cm): 3.8
Left Ventricle ID ( dia - cm): 3.8
Left Ventricle ID (sys - cm): 1.9 ??
Intravent. Septum (cm): 1.3
Post Wall Thicknes (cm): 1.3
Ejection Fraction: 55
Left Ventricle EDV (ml): -
FINDINGS:
LV is normal in size and systolic function. EF = 55 +/- 5%. The LV appears normal in size. LV systolic function is normal. Baseline LV diastolic function is consistent with abnormal relaxation (stage 1). ??
RV is normal in size and systolic function.
LA/Pulmonary veins - The LA is normal. The LA cavity appears mildly dilated. The LA cavity area is 21.0 cm ? during systole.
RA/IVC/SVC - The RA is normal.
Mitral Valve - There is trivial mitral regurgitation
Tricuspid Valve - TV is normal with trivial regurgitation. Regurgitant velocity is 243.0 cm/s and estimated RV systolic pressure is 28 mm Hg.
Aortic Valve/LVOT: There is a mechanical valve (St.Jude #23). The peak gradient is 14.0 mm Hg. The mean gradient is 8.0 mm Hg. There is trivial aortic regurgitation.
Pulmonic Valve – The PV is normal.
Pulmonary Arteries – The pulmonary arteries are normal.
Pericardium – The pericardium is normal.
STRESS ECHO RESULTS:
The LV cavity is decreased with stress.
The stress echo results are negative for ischemia at 99% MPHR and 11.8 METS
The LA cavity of 21.0 cm is obviously an error ? and the LVID of 1.9 cm?? Could this be also an error? and what would the LV diastolic function with abnormal relaxation (stage 1) mean?? I still do have some chest discomfort but it is more of a spasm type feeling in the front rib-muscle area. I hope its just a post traumatic sensation but it does induce some anxiety and panic whenever it occurs. Thanking you, Chris.
MEASUREMENTS:
Aorta (at leaflets - cm): 2.8
Left Atrium (cm): 3.8
Left Ventricle ID ( dia - cm): 3.8
Left Ventricle ID (sys - cm): 1.9 ??
Intravent. Septum (cm): 1.3
Post Wall Thicknes (cm): 1.3
Ejection Fraction: 55
Left Ventricle EDV (ml): -
FINDINGS:
LV is normal in size and systolic function. EF = 55 +/- 5%. The LV appears normal in size. LV systolic function is normal. Baseline LV diastolic function is consistent with abnormal relaxation (stage 1). ??
RV is normal in size and systolic function.
LA/Pulmonary veins - The LA is normal. The LA cavity appears mildly dilated. The LA cavity area is 21.0 cm ? during systole.
RA/IVC/SVC - The RA is normal.
Mitral Valve - There is trivial mitral regurgitation
Tricuspid Valve - TV is normal with trivial regurgitation. Regurgitant velocity is 243.0 cm/s and estimated RV systolic pressure is 28 mm Hg.
Aortic Valve/LVOT: There is a mechanical valve (St.Jude #23). The peak gradient is 14.0 mm Hg. The mean gradient is 8.0 mm Hg. There is trivial aortic regurgitation.
Pulmonic Valve – The PV is normal.
Pulmonary Arteries – The pulmonary arteries are normal.
Pericardium – The pericardium is normal.
STRESS ECHO RESULTS:
The LV cavity is decreased with stress.
The stress echo results are negative for ischemia at 99% MPHR and 11.8 METS
The LA cavity of 21.0 cm is obviously an error ? and the LVID of 1.9 cm?? Could this be also an error? and what would the LV diastolic function with abnormal relaxation (stage 1) mean?? I still do have some chest discomfort but it is more of a spasm type feeling in the front rib-muscle area. I hope its just a post traumatic sensation but it does induce some anxiety and panic whenever it occurs. Thanking you, Chris.
Doctor's Answer
by Cleveland Clinic, Jun 19, 2006 12:00AM
, Jun 19, 2006 12:00AM
chirs,
Overall your echo results are pretty normal and while some of the measurments are slightly out of the normal range, there is nothing of concern with that echo report. All of these numbers are based on normal distribution of measurments found in the population -- of which some will be slighly higher and lower than the averages. Unless they are markedly abnormal, there is no reason for concern.
Abnormal relaxation refers to a number derived from the velocity of flor that is measured entering the left ventricle while the heart relaxes and fills. There is a natural tendancy as we age, for the heart to stiffen and the chamber to relax less. Further, open heart surgery can also impact this finding. The changes for relaxation lei on a continuum, with stage 1 being a not unexpected finding in someone with your history.
Generally these numbers are compared over time. If we see a progression of sympoms that mirror changes on an echo, it is helpful in diagnosis.
Stress test are not perfect. It is possible to have a negative stress test with abnormal blockages and a positive stress with no significant blockages. If you continue to have symptoms, your physician may order another type of stress or proceed with a catheterization.
good luck
Overall your echo results are pretty normal and while some of the measurments are slightly out of the normal range, there is nothing of concern with that echo report. All of these numbers are based on normal distribution of measurments found in the population -- of which some will be slighly higher and lower than the averages. Unless they are markedly abnormal, there is no reason for concern.
Abnormal relaxation refers to a number derived from the velocity of flor that is measured entering the left ventricle while the heart relaxes and fills. There is a natural tendancy as we age, for the heart to stiffen and the chamber to relax less. Further, open heart surgery can also impact this finding. The changes for relaxation lei on a continuum, with stage 1 being a not unexpected finding in someone with your history.
Generally these numbers are compared over time. If we see a progression of sympoms that mirror changes on an echo, it is helpful in diagnosis.
Stress test are not perfect. It is possible to have a negative stress test with abnormal blockages and a positive stress with no significant blockages. If you continue to have symptoms, your physician may order another type of stress or proceed with a catheterization.
good luck
I wish others would also respond!! georgie
I am an Aortic Regurgitation Patient and have following Echo parameters as per the last echo take before 2 months ago.
EF : 70%
LVIDd : 7.19 cm
LVIDs : 3.62 cm
I am taking following medicines and taking law salt diet.
Digoxine 0.25 mg (1 per day from Mon-Fri)
Tozzar 50 mg (Twice a day)
Selkon XL 100 mg (1.5 a Day, 1 in morning and half at night)
Listril 10 mg (Twice a day)
Nicardia CD Retard 30 mg (Twice a day)
Aldacton (One per day)
Lasix (Half per day)
It would be very helpful if anyone can let me know how sever these parameters are.
thanks