Borderline left ventricular enlargement with low-normal systolic function

[jace201]

hello doctor,

          i am 24 years oldfor the past 5 years i consistently exercises 5-6 times a week combined with cardio and heavy lifting. i am 162 pounds 5'8 im am probably 7% body fat, i do not take steroids or take anything bad. i do not smoke or drink. I am in nursing school so balancing school, life, and work has been stressful as of late. I consulted with my doctor because i have experiencing fluctuations in my blood pressure it can get as high as 140 systolic but diastolic is within normal range (70) but when im stress free its about 116-67. It could be from stress, i told her about some issues anxiety and palpitations but my heart rate is about 50-60 most of the time. So anyway she prescribed me 1/2 mg of atenolol a day and she sent me for an echo. My blood pressure has been good since i have been on atenolol. i had the echo and here are the results which has been concerning to me.

aorctic root 29, left atrium 27, LVOT 20, septum 10, posterior wall 9, LVEDD 52, LVESD 38.

The study is of good technical qualtiy. The left atrium is normal in size. the left ventricle is at the upper limits of normal in size with borderline systolic function. The estimated ejection fraction is 50-55%. NO regional wall motion abnormalities were identified. The mitral valve demonstrates normal excursion. There is mild mitral valve regurge. The aorctic valve is tricuspid and is normal in appearance. There is no aortic insufficiency seen. The right ventricle is normal in size and function. The right atrium appears normal is size. The tricuspid valve is normal in appearance with mild tricuspid valve regurg. The estimated PA pressure is 33 mmhg. The pulmonic valve is grossly normal in appearance with no insufficiency seen.

There is no pericardial effusion.

Impression:

Borderline left ventricular enalrgement with low-normal systolic function
Mild mitral and tricuspid regurgitation.
Boderline pulmonary hypertension.

Anyway she told me since i workout very much and look very muscular there could be some overexertion, i couldnt really understand why this could cause it. She wants me to have another echo in a year. She asked how i was doing on atenolol and i told her i was tolerating it well and ask me if i would like to continue to be on the drug and we both decided there is no harm into that. She told me not to worry about it but if it continues to get bigger there is a cause for concern. So i ask for a cardiologist opinion here to help me breath a little easier thank you so much..

[kenkeith]

Report: The study is of good technical qualtiy. The left atrium is normal in size. the left ventricle is at the upper limits of normal in size with borderline systolic function. The estimated ejection fraction is 50-55%. NO regional wall motion abnormalities were identified"

>>>>>>It seems you have two minor issues that are of no medical significance at the present time, but there should be an evaluation as to a possible cause as primary, and/or ideopathic (cause unknown) to low range of EF...subsequent echo at a later date would be appropriate.

For some insight to ejection fraction, it is an estimate of the amount of blood pumped into circulation with each heartbeat.  The heart dilates normally within a range (50 - 70%), and it helps maintain a balance of blood flow between the left and right side of the heart with other compensating factors that include the heartrate and blood pressure.  When the heart dilates it increases the contractility and stronger contractions more blood is pumped into circulation (the phenomon relates to Frank/Starling physics).  Increased heartrate and higher blood pressure also increases blood flow and the converse is the opposite effect of cardiac output.  So the low EF at the time of the test is not an absolute and based on an estimate of volume of blood pumped at the test time.

For another perspective on your heart's pumping ability is the fractional shortening.  That is to evaluate the heart's functionality  based on the dimensions of the left ventricle after filling phase...diastole( highest measurement of chamber), and measurement after systole, pumping phase...lowest measurement.  This relates to the heart's capacity to fill and its strength to pump. It is useful to evaluate whether or not the dimensions inhibit cardiac output although the volume pumped as a fraction of the filled chamber is normal.  Your heart at the time of the test has fractional shortening is 26.9% (52 - 38 divided by 52).
Above 30% is considered normal, 26 to 30% representing mild decrease in the cardiac output and that is consistent with the EF estimate.  That indicates there is no structual impediment that would show normal EF as a percentage but the cardiac output is decreased.  For instance, if the heart walls were abnormally thicked the filling capacity would be less but the contractility function pumps a normal percentage (EF).  However, the cardiac output is reduced and indicates a structual problem.

Q:  "The tricuspid valve is normal in appearance with mild tricuspid valve regurg. The estimated PA pressure is 33 mmhg. The pulmonic valve is grossly normal in appearance with no insufficiency seen.


>>>>>Grossly normal indicates an observation without intervention and no insufficiency seen means no regurgitation (back flow).  There are 3 types of changes can affect the pulmonary arteries and cause PH: The walls of the arteries tighten and that causes the arteries to be stiff  at birth or become stiff from an overgrowth of cells, or clots (thrombosis) in the pulmonary artery, and or clots (emboli) in the lungs.  The resistence of these abnormal conditions increases the pulmonary pressures. These changes make it hard for the heart to push blood through the arteries and into the lungs. Therefore, the pressure in the arteries rises. Also, as a result of the heart working harder, the right ventricle becomes strained and weak. For reference, pulmonary hypertension is an average pressure in the pulmonary artery when higher than 25 mmHg at rest or 30 mmHg during physical activity.  Your one-time reading reported is not an average, but can serve as a baseline for future estimates.

Finally, welcome to the forum.  We are a group of volunteers with many different aspects from education related to the medical field and most of us have experienced heart related issues as well and can identify with the medical problems presented.  As a medical student it is obvious you are interested the medical field and we can appreciate any contribution you make to the forum.   MedHelp prefers participation take place on an open forum so we can all benefit from any questions and answers going forward.

Thank you for sharing, and if you have any further questions or comments you are invited to respond. Take care,

Ken

  

[erijon]

Well, this is not too bad really. Your LV size is due to dilation, not hypertrophy, or a thickening of the walls as they are normal at 10 cm and 9 cm. The increase in size may just be due to the high blood pressure and it may well go down in size with keeping your BP under control. Hypertrophy hearts do not go down in size so this is good.

I can't explain the low-normal EF%, don't know why that would be as your valves are clean with only mild regurgitation ( a fairly common finding) and wall motion beings normal. It sounds like your exercise tolerance is good so I don't think it's much of a risk at this point. I would agree that checking it again in a year makes sense, but it doesn't look too worrisome to me, but I'm not a doctor, there are none on this board. You may want to post your question on the expert forum as well. You will be getting a cardiologist to answer.

PM sent.

Jon