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Heart Disease (Expert Forum)
Atrial septal defect?
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Atrial septal defect?
by mmfd, Jan 16, 2004 12:00AM
First of all, thank you for taking my question. I am thrilled to finally get through.
I have IDCM with an EF of 15% at diagnosis, June, 2002. I also have pulmonary hypertension, originally with a mean PAP of 34 at RHC, now down to 35 by echo. I also have a history of multiple arrythmias, both atrial and ventricular. I have had SVT with AVnodal reentry tach, rapid atrial fib with a rate up to 230, and an ectopic atrial tach. I have nonsustained VTach . After a T Wave alternans test, it was determined by 2 EP's that I needed an ICD placed. The attempt was unsuccessful due to persistent left superior vena cava, and extremely tortuous vessel on the right side. I am now on Amiodarone, and doing well with the arrythmias. I also had an unsuccessful ablation attempt for the AVNRT, due to a *huge* coronary sinus. I have mild to moderate restrictive lung disease, presumably secondary to the PH which is supposedly secondary to the LV dysfunction. My left atrium has gone from 40 to 48 mm since diagnosis. Finally, I am on 2 liters of O2 at night for desats down to the 70's. Sleep study times 2 reveals no apnea, just hypopnea which is worse on my left side and much less while on my back.
Sorry about all the history, but I am an RN and want to give you the whole picture!
Is it possible that I have a small ASD that wasn't found on cath or echo? Should I have a TEE to rule it out? The pulmonologist thinks the PH came before the cardiomyopathy. The cardiac guy doesn't agree. It seems like all this stuff goes along with an ASD; restrictive disease, PH, the arrhythmias.
I have IDCM with an EF of 15% at diagnosis, June, 2002. I also have pulmonary hypertension, originally with a mean PAP of 34 at RHC, now down to 35 by echo. I also have a history of multiple arrythmias, both atrial and ventricular. I have had SVT with AVnodal reentry tach, rapid atrial fib with a rate up to 230, and an ectopic atrial tach. I have nonsustained VTach . After a T Wave alternans test, it was determined by 2 EP's that I needed an ICD placed. The attempt was unsuccessful due to persistent left superior vena cava, and extremely tortuous vessel on the right side. I am now on Amiodarone, and doing well with the arrythmias. I also had an unsuccessful ablation attempt for the AVNRT, due to a *huge* coronary sinus. I have mild to moderate restrictive lung disease, presumably secondary to the PH which is supposedly secondary to the LV dysfunction. My left atrium has gone from 40 to 48 mm since diagnosis. Finally, I am on 2 liters of O2 at night for desats down to the 70's. Sleep study times 2 reveals no apnea, just hypopnea which is worse on my left side and much less while on my back.
Sorry about all the history, but I am an RN and want to give you the whole picture!
Is it possible that I have a small ASD that wasn't found on cath or echo? Should I have a TEE to rule it out? The pulmonologist thinks the PH came before the cardiomyopathy. The cardiac guy doesn't agree. It seems like all this stuff goes along with an ASD; restrictive disease, PH, the arrhythmias.
Doctor's Answer
by CCF-M.D.-RCJ, Jan 16, 2004 12:00AM
mmfd,
Thanks for the post, and you are certainly welcome.
Q1:"Is it possible that I have a small ASD that wasn't found on cath or echo?"
Yes, it is possible. But if it was so small as not to be seen, or heard, then it would be very unlikely for it to be the culprit for your troubles. Also, although ASDs can cause PH, they usually lead first to RV dilation way, way before the patient ever develops the other findings you mentioned.
If you lived in a third-world country, and were elderly (I don't have your age) then it would be conceivable that an ASD might have caused these issues. In the US, which I'm assuming is where you live, your scenario would be exceedingly unlikely to be caused by an ASD.
Although you didn't state as much, I'm assuming (again) that the reason you bring up the issue of ASD is the nighttime, positional desaturation? This drop in oxygen at night is very common in CHF patients due to the phenomenon of Cheyne-Stokes breathing pattern. This pattern is a cyclic pattern of breathing whereby a person first accelerates (unwittingly) their respirations, then decelerates their respirations. Several other types of physiologic shunts could also explain the nighttime desats without having to invoke an ASD.
Hope that helps.
Thanks for the post, and you are certainly welcome.
Q1:"Is it possible that I have a small ASD that wasn't found on cath or echo?"
Yes, it is possible. But if it was so small as not to be seen, or heard, then it would be very unlikely for it to be the culprit for your troubles. Also, although ASDs can cause PH, they usually lead first to RV dilation way, way before the patient ever develops the other findings you mentioned.
If you lived in a third-world country, and were elderly (I don't have your age) then it would be conceivable that an ASD might have caused these issues. In the US, which I'm assuming is where you live, your scenario would be exceedingly unlikely to be caused by an ASD.
Although you didn't state as much, I'm assuming (again) that the reason you bring up the issue of ASD is the nighttime, positional desaturation? This drop in oxygen at night is very common in CHF patients due to the phenomenon of Cheyne-Stokes breathing pattern. This pattern is a cyclic pattern of breathing whereby a person first accelerates (unwittingly) their respirations, then decelerates their respirations. Several other types of physiologic shunts could also explain the nighttime desats without having to invoke an ASD.
Hope that helps.
just went for my ultrasound today and all is well, he or she is very active already! I also spoke to the ob about the PVCs and the tachy and she said it is very common and not to be too concerned about it, but to be on the safe side i will still have another echo and heart monitor - this is because of my lousy family history. Cardiomyopathy is a disease of the heart muscle - it is very rare. Some forms of cardiomyopathy are inherited, some are not. The form that my brother had was idiopathic (no known cause) dilated cardiomyopathy - it is not heritable but I am still wary. No PVCs can't cause it (thank god!) but sometimes uncontrolled very fast tachycardia or afib can (this was probably the situation with my brother). PS my morning sickness is still with me :(