Dilated Right Ventricle

I applied for a health insurance and the application was posponed because the echocardiogram which I had done as part of the medical requirements showed in it's report (LVIDD=55.0   Mildly dilated right ventricle)  The company the will reconsider my application after I have been investigated by a cardiologist and the subsequent report is satisfactory.Can you tell me how serious is a condition like what was identified?
The eco. report also stated AO=29.7  Normal size left ventricle with good systolic function. EF 81% LA=43.2  Normal wall thickness. LV diastolic dysfunction, RV=28.8 No wall motion abnormality, IVSD= 5.0 Mildly dilated left atrium., PW=7.6 Structurally normal valves, LVIDS=31.3 Mild TR. RVSP 45mm Hg. and EF= 81% Trivial mitral regurgitation. Normal pericardium.
This all sounds like so much. Will I be all right with treatment after visiting a cardiologist? Will I have to take a lot of medical treatment? I am not accustomed to being ill and this has me a bit concerned, especially with the medical costs of treating heart illness in our country.
I will be 60 years old next month. I can walk long distances without any problems and I sleep well. Can you please advise me?
Thank you,
Liz.

[maggiemag]

Well i am a little confused.  Your title says right ventricular enlargement.  The report references the LVIDD as mildly dilated RIGHT ventricle, but those letters mean left vent, diastolic dimension and the 55 would be appropriate for left ventricular numbers, possibly very mildly dilated.  Your EF is actually elevated at 81% with normal being 55-70%. The left atrium does appear mildly enlarged.  The mild TR (tricuspid regurgitation), and the trivial mitral regurg. are normal.  The RVSP is elevated.  I wonder about the accuracy of the echo.  Was it done by an experienced cardiac sonographer and read by a board certified cardiologist?  Maybe they could just repeat it in 6 months.  You might not need treatment at all, but the good news is that you have no symptoms!  Just make sure you follow up with a GOOD cardiologist.

[Vea]

Hello maggiemag,

thanks for your response but what I have mentioned is exactly what was communicated to me in writing. The letter from the insurance stated exactly what i wrote and was written by the company's medical consultant in a letter. "we posponed your application pending investigation of a Dilated Right Ventricle which was identified on Echocardiogram done on etc,etc." Attached to the letter was the Eco. report from the imaging department which was signed by the cardiologist. The report is exactly as i wrote in my forum letter. All this as i said is new to me i don't understand any of the medical terms. I will, however, get a second opinion by doing another test. Thanks again for your response.

[kenkeith]

The mildly dilated RIGHT ventricle and the LV (end)IDD  is 55 mm (normal is 35 - 57 mm).  The left atrium 5.0 (normal is 36 - 47) exceeds the upper dimension but dimensions are an estimate (the tech attempts to outline a moving, fuzzy looking border with a transducer) and the margin of statistical error is about 10%.  I watched my procedure and was told it is difficult to be exact, and the faster the heart beats the more difficult.

Your EF is somewhat high and again this is an estimate.  A high EF can indicate the heart is compensating and should not be sustained at that level, and probably isn't as you don't have symptoms, etc.  The compensatory EF happens when the heart dilates causing more forceful contractions.  This happens normally to help maintain a balance of blood flow between the left and right side of the heart and just as normal as an increase in heart rate.  

Right ventricle systolic pressure (RVST): the expected value is less than 35.  Above 40 is considered mild pulmonary hypertension.

The questionable results (at the time of test) include a marginally large RA, an EF that is compensating, and an elevated RVSP.  There is an inter-related consequence, for instance, a high RVSP can dilate the right ventricle, and an increase in RA can cause an imbalance between the right and left blood flow that increases the EF.  If there were a serious problem there would be shortness of breath, and a subsequent test may have different parameters and show no problem whatsoever.

[Vea]

Thank you for your very informative information. Much appreciated. I have decided to see a cardiologist and hear what he has to say. The test that was done was at the expense of the insurance company and their affileated clinic as an evaluation for health insurance and was sent to me advising that i have the results investigated by a cardiologist.

Once again thanks. I believe with following medical advice and Gods help this will be will work out right.

[LouAnn53]

Please help:  This is the results of my echo stress test.  Cardiologist tells me that he does not think it is my heart that is causing my symptoms of being aware of my heartbeat, palps, etc.  He said my lung pressure is a little high and to see a pulmonolgist.  I feel terrible at the moment with more frequent PVC's.  Had holter monitor on for 24 hours and doctor states there were a few PVC's.  I can feel my heartbeat in my throat.  I am female, 57 years old.  I do not need to see this cardiologist for another three months.  I am feeling horrible and very scared.   I called the doctor but he has not returned my phone calls.  

Baseline Echo:  All walls show normal thickening and endocardial excursion.  No regional wall motion abnormalities are noted.  Global left ventricular function is normal.  The left atrium is top normal in size.  There is mild mitral regurgitation.  There is mild right ventricular dilation with normal right ventricular systolic function.  There is mild tricuspid regurgitation with an estimated right ventricular systolic pressure of 38 mmHg.  E wave is 0.9 with an E prime of 0.08 and an E to E prime ratio of 11.  An intra-atrial septal aneurysm is noted without left to right shunt noted by color flow Doppler.

Exercise Echo:
Post exercise all walls become hyperdynamic.  All walls show normal thickening.  No regional wall motion abnormalities are noted.  Overall left ventricular function is hyperdynamic.  Estimated right ventricular systolic pressure rose to 62 mmHg post exercise.

Conclusions:
1.  Both echo and ECG portion of exercise stress echo are negative for ischemia.
2.  Intra-atrial septal aneurysm noted without evidence by color flow Doppler of shunt flow.
3. There is mild dilation of the right atrium and right ventricle with estimated right ventricular systolic pressure of 38 mmHg at rest and rises to 62 mmHg post exercise.

Please, any info would be greatly appreciated.  

[kenkeith]

QUOTE: "Conclusions:
1.  Both echo and ECG portion of exercise stress echo are negative for ischemia.
2.  Intra-atrial septal aneurysm noted without evidence by color flow Doppler of shunt flow.
3. There is mild dilation of the right atrium and right ventricle with estimated right ventricular systolic pressure of 38 mmHg at rest and rises to 62 mmHg post exercise"

>>>1. There are no blockages of the coronary arteries.

>>>2.  The septum is the wall that separates the upper left and right chambers.  There is a defect, but there is no shunting between the left and right atria.  Sometimes from birth there remains a hole between the chambers and blood passes from left to right atria (shunting) that doesn't close after birth.  

>>>3. The right side of the heart is slightly enlarged.  That can be due to an obstruction to the aorta valve, the valve opeing is narrowed, there can be high pulmonary pressure due to blood clot in the pulmonary vessel, and/or clots in the lungs.  Any of these conditions can cause the higher than normal right ventricular pressure.

Hope this helps, If you have any further questions feel free to ask. Thanks for sharing.

[LouAnn53]

Thanks for the reply and info Ken.  Is this high pressure in the lung mild?  I have been doing some reseach and I am very nervous about being diagnosed with pulmonary hypertension and so far I have seen results like mine indicating that this reading is not quite considered "high".  I do see a pulmonologist in two weeks.  Thank you!

[kenkeith]

LouAnn, I answered your question in your other post.  You porbably should gauge the PH condition on your symptoms rather than the numbers because the number is not static.

[cardiomohs]

YES ITS POSSIBLE THAT YOU MAY HAVE AND SILENT HEART PAIN OR MYOCARDIAL INFARCTION RECENT OR WITHIN LAST 6 MIONTHS

BUT YOUR ECHO SEEMS TO BE U R HAVING A SUGGESTIVE FEATURES OF DILATED CARDIOMYOPATHY FOR WHISVH WE DONT KNOW THE CAUSE BUT SOMETIMES ANGIOGRAM MAY HELP


BETTER CONSULT A INTERVENTIONAL CARDIOLOGSIT

ALSO WE DONT KNOW WHETHER U HAVE ANY DIABETES . HYPERTENSION ETSC

IF NOT GO FOR ROUTINE HEALTH CHECKUP AND DO IT

-----DR.MOHAN

[DenTek]

go to the Cleveland Clinic

[DenTek]

I too have dilated right ventricle and dilated right atrium without cause on two reports (2007 and 2008 reports) and on a 2012 report states: decreased dilation of right ventricle and atrium.  Something caused the dilation. Could it be PH?  I did have  a Systolic pressure of 35mmHg on a transthoracic echo report.(2012 report) also trivial regurgitation in my mitral valve, pulmonary valve and tricuspid valve.