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
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.