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Another Echo Question

I hate to use both my questions on the same echo report but.... I received a copy of my echo report from last week and everything looks good within normal range with the exception of my left atrium which was enlarged to 4.9 cm and my LV wall at 1.2 cm. Both my family doctor and cardiologist's PA called to go over the results. Both said it was a good echo report, and no one seemed concerned about the enlarged atrium when I pointed it out and explained it could just be due to my daily exercise program. Even the LVH that they made a point of telling me about on the phone was only borderline and not a problem to them, just something to watch over the next few years. EF is 63%, (up from 55% 18 months ago) normal wall motion throughout, normal left ventricular function, all other chambers and walls within normal size and function, all valves structurally normal with no leakage except trace leakage in my tricuspid valve. Also, RV systolic pressure was normal.

I am a 48 year old male, non smoker, no early onset CAD history in family, blood pressure and cholesterol controlled. I had my last echo to get cleared to start exercising which I have done daily since. I do a 500 calorie burn in 45 minutes on a treadmill daily with no symptoms what so ever. I am extending my routine weekly it seems as my conditioning improves and I have lost 60 pounds in 13 months and I feel great,  better than I have in years and the only thing holding me back from doing more is arthritic knees.

How big of a deal is an enlarged LA at 4.9 cm? Should I cut back on the exercise?

Thanks in advance for your input.

Tony
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Avatar universal
Thanks for your input, I wish the doctors I see face to face were able to explain the issues this well. I will keep up on the exercise, I have another 40 pounds to go and as I said before, I have not felt this good in many years!
Thanks again.
Tony
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242509 tn?1196922598
MEDICAL PROFESSIONAL
You have to understand the limitations of echocardiography in assessing left atrial size: although they are telling you that it is dilated at 4.9 cm, and the upper limit of normal is 4 cm, it may actually not be dilated at all. This 4.9 cm was most likely obtained on a single 'slice' of the atrium and may not be representatitive of actual left atrial size. For instance if you slice a banana perpendicular to its long axis you may get a small value, but if you cut it at a 45 degreee angle you may get a larger value: simply because you were not perpendicular to its main axis. Often patients, especially patients who may have been heavier in the past ( you mention that you lost 60 pounds) does not have the standard  orientation in the chest and may be rotated to the left, causing the standard echocqardiographic views to be off axis and the consequent innacuracies in measurements. The most accurate way to measure the left atrial size is to report atrial volumes,  but this is difficult to assess in most patients, and in general has very little prognostic value in most patients. The exception are patient with atrial fibrillation whose likelyhood of responding to treatment depends on the left atrial size.
The wall size at 1.2 cm is normal; mild LVH begins at 1.3 cm, so I wouldn't concerm myseft witht that parameter at the present time.  
I think you should continue with exercise provided you do not have symptoms of chest discomfort, shortness of breath out of proportion to your usual level, or palpitations.  It has already resulted in a significant weight loss and it will likely cause an improvement in your blood pressure, cholesterol and decrease risk for heart disease. The weight loss may have yet  another benefit:  it may decrease the amount of effort of breathing during the night ( a problem seen in overweight patients called obstructive sleep apnea )  decrease nocturnal hypoxia, which can lead to pulmonary high blood pressure, left atrial enlargement. and atrial arrhythmias.
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