I was diagnosed with mild mitral valve prolapse over 20 years ago and started Atenolol to help control syptoms (symptoms) of fatigue and mild shortness of breath. 10 years ago I had a Superventicular Tachycardia which was ablated but still have irregular heart beat off and on. 2 years ago I had a short run of Atrial Fibrillation and rescently I had an echo done which revealed that I have grade 2 diastolic disfunction. My cardiologist told me not to worry about it but after reviewing all of the information online I can't stop worrying, so here are some questions that I have. Any help you can give me is greatly appreciated.
Looking at the echo results below, how bad is my situation?
Is there anything I can do via diet or exercise to help slow the progression of DD?
Are there any additional medications that I should be on to help slow the progression of DD?
Is it reversible?
How is DD going to impact my life moving forward?
Here are my eccho results from 2 years ago and 2 weeks ago as a comparison. Can you please let me know what these numbers mean. I am currently taking 40mg of Nadalol for BP which is controlled 122 not sure about the bottom number. Cholestorhol is high 189 total 419 triglicerides (triglycerides) 30 HDL . I am now on Welcol and watching my diet so these numbers should be lower. I am 5'3 150 lbs. 55yrs old.
echo 2years ago
LVIDd:4.1 cm (3.7)-5.6)
LVIDs:2.5 cm (2.0-3.8)
Ejection Fraction 2D:70+%
IVSd:.7 cm (0.6-1.1)
LVPWd 1.0cm (1.0cm (0.6-1.1)
Aortic Root Diam:2.7 (2.0-3.7)
LA Diam:35 cm (1.9-4.0)
Tricuspid Valve TR Gradient 23mmHG
LVIDd:3.8 cm (3.7-5.6)
LVIDs:2.0 cm (2.0-3.8)
Ejection Fraction 2 D: (60-65%)
LVPWd: 1.0 cm (0.6-1.1)
RVIDd: 2.2 cm (0.9-2.6)
Aortic Root Ddiam: 2.5 cm (2.0- 3.7)
LA Diam: 3.6 cm (1.9-4.0)
E/A 1.1 (1.1-1-5)
Decel time:205 msec (160-240)
Aortic Valve Peak Vel 1.64 m/s (1.0-1.7)
TR Gradient 26 mmHG
Grade II diastolic dysfunction is called pseudonormal filling dynamics. This is considered moderate diastolic dysfunction and is associated with elevated left atrial filling pressures. These patients more commonly have symptoms of heart failure and many have left atrial enlargement due to the elevated pressures in the left heart Other than that, your numbers are pretty much the same on both reports with a slight drop in EF% but still in the normal range. All heart structure looks good unless I've missed something, I'm sure someone else will pick it up.
I would be more concerned about your lipid panel. To have a HDL at 30 is way too low. It should be a minimum of 40. Also, your tri's are very high and both put you at risk of CAD. Your LDL is very well controlled so that is good. You should ask your doctor about lifestyle changes with regard to diet and exercise. You need to elevate your HDL and drive your tri's down.
Thank you so much for for your response Jon.
May I ask just a few more questions....
Any idea what may have caused the DD grade 2. My cardiologist told me that is it unual to see it in someone my age, it is usually found in older patients.
Can the EF rate be increased by excersise and lifestyle changes ? What causes it to get lower?
What is the longterm prognosis for a patient with DD grade2?
I had the same thing on an echo in 2006 and it was not noted on my echo the following year. I was told that it was either an misinterpretation on the first one or a result of better conditioning as I had started working out. What DD means is that your heart muscle in your left ventricle is not relaxing enough to allow it to fill properly. This is usually caused by a thickening of the muscle, which does not seem to be the case in your report. Your walls are a little thicker, but still in the normal range. Your EF% is the amount of blood pumped out of the heart with each beat. DD causes less blood to get pumped out lowering your EF%, but your number is still well within the normal range of 55% - 75%, so I wouldn't get too concerned about that number. Again, resolve the underlying issue and your EF% will increase again. Also, the chance of DD increases with age.
The diagnosis of diastolic dysfunction is now fairly common, especially among older women, most of whom are shocked to hear they have a heart problem at all. While some of these patients will go on to develop actual diastolic heart failure, many will not - especially if they get appropriate medical care, and also take care of themselves. Chronic high blood pressure is usually the underlying cause of DD. If you resolve the underlying cause the DD will improve. There is no real danger if the underlying condition is identified and corrected. The other primary causes are diseases of the heart itself which don't seem to be a problem since you have a normal heart structure based on your echo results.
Thanks again Jon. My cardiologist recommended that I get my cholestorol down and to loose weight. Both good ideas, my problem is with the cholestorol. I am one of that small percentage of people that get the chronic muscle and joint aches, so I have tried Zetia,Lipitor, Crestor, Zocor and now I am trying Welcor. So far so good.
Also I have to let him know in the if I am going to have surgery as I cannot have interveneous fluids with DD. Other than that nothing. I was just mainly concerned because I went from not having DD 2 years ago to now having DDgrade 2. That's a little scarry...
I have put on 15 pounds and have been more sedentary than before so maybe that's part of the problem.
I know what you mean, I had no DD in 2005, did in 2006 and it was gone again in 2007. The only thing that changed was I controlled my blood pressure & cholesterol and started working out 45 mins per day at 80 -85% of my max heart rate and lost about 50 pounds the first year,
You just need to find a cholesterol drug that works for you, There are many options to choose from, luckily I have no issues with statins.
you always hit the nail. I had DD1 two years ago and now DD2. all this time i have exercised hard with no problem, dieted, and taken my carvedilol. Like life, it ain't fair. How about an ACE as well as the betablocker? The cardio was the same for the two tesst. First one was a bit grim. This time. Dec 1, he said congrats, you're fine. But now I have the results it's too late to get to him about the DD. He saw it, I know. Should I stop worrying?
Thanks for the kind words. Here's my thinking about this, I've said it before and some will disagree with me. I choose my doctors carefully and I trust their opinion. When a doctor I trust, especially a specialist like a Cardiologist, tells me I'm fine and I feel fine, I usually accept that and move on until something changes. You can always call and leave a question for your doctor, they will get back to you. Mine always calls me back or at the very least has their Nurse call.
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