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Contrasting ECHO results from 2nd opinion
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Contrasting ECHO results from 2nd opinion

I was admitted into Cardiology from the ER in Nov. due to chest pains.  There, they did Echo, Stress Echo, MRI and coronary CTA.  

Diagnosis/Results: Chordal SAM, mild mitral regurgitation, Stage 2 Diastolic Dysfunction, no evidence of MI. MRI shows normal cardiac MRI evaluation, CTA shows normal CT angiography

Went to get 2nd opinion where they did another echo and stress echo.

Diagnosis/Results: quite abnormal appearance of anterior mitral valve leaflet, significant redundancy, SAM, LVOTO at least 45mmHg to 115mmHg at peak exercise, NO evidence of diastolic dysfunction, soft mid-peaking systolic murmur & single extrasystoles from squat to stand

EKG readings: normal sinus rhythm w/ biphasic t-waves in V3/V4, inverted t-waves in III and aVF, early depolarization pattern

Questions:

1- What accounts for such differing ECHO results from just a 2-month span?

2- Abnormal mitral valve leaflet w/ significant redundancy w/ SAM: is this the same as MVP? How serious is this?  I'm wondering how they caught this on the 2nd ECHO and not on the MRI.

3- LVOTO 45mmHg to 115mmHg during exercise: what's the normal range? I'm trying to quantify how bad my situation is.

4- Mostly, I just want to get a very general assessment on how serious a case this is. Very hard to find info on this.

Thank you in advance for all your help!

Tags: mvp, LVOTO, Sam, inverted T-waves, mitral valve chordae, childordal SAM, Mitral regurgitatio, mitral redundancy
Avatar_dr_f_tn
Congratulations on being so well-informed about your health. Your case is a complex one and should be discussed thoroughly with your cardiologist. Based one what you tell me, it sounds like your first echo was a resting echo and the second was an exercise stress echo.  Really, the two readings are not so different. Both showed chordal systolic anterior motion of the mitral valve and mitral regurgitation. The second shows left ventricular tract outflow obstruction at rest and with exercise, which can vary from exam-to-exam based on your blood volume, heart rate, etc. It is also something that the examiner has to actively look for.  It is abnormal to have left ventricular outflow obstruction at rest or with exercise.

It is not clear from what you report whether you have isolated systolic anterior motion of the mitral valve or whether you also have asymmetric septal hypertrophy leading to systolic anterior motion of the mitral valve and left ventricular outlfow tract obstruction. These are two separate phenomena, so I can't tell whether you have something on the mitral valve prolapse spectrum or something else.

The biggest question for you and your doctors to determine now is whether you have symptoms and how best to treat them. You should also consider taking all of your data (including the original echo images) and seeing a cardiologist who specializes in mitral valve disease.
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Avatar_n_tn
Sorry, wanted to update my first echo said "moderate LV diastolic dysfunction with pseudonormalization of the mitral filling pattern. This is consistent with increased LV filling pressures in the setting of impaired LV relaxation" with no comment regarding any obstruction, whereas obstruction was the guest of honor on my 2nd ECHO.

Thanks!
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