I had the same results on my echo last month and I asked the doctor's forum about it, here's what he told me that you have to understand the limitations of echocardiography in assessing left atrial size: although they are telling you that it is dilated, it may actually not be dilated at all. My 4.9 cm reading was most likely obtained on a single 'slice' of the atrium and may not be representatitive of actual left atrial size. For instance if you slice a banana perpendicular to its long axis you may get a small value, but if you cut it at a 45 degreee angle you may get a larger value: simply because you were not perpendicular to its main axis. Often patients, especially patients who may have been heavier in the past ( I have lost 60 pounds in the last year) does not have the standard orientation in the chest and may be rotated to the left, causing the standard echocqardiographic views to be off axis and the consequent innacuracies in measurements. The most accurate way to measure the left atrial size is to report atrial volumes, but this is difficult to assess in most patients, and in general has very little prognostic value in most patients. The exception are patient with atrial fibrillation whose likelyhood of responding to treatment depends on the left atrial size.
The left atrium rarely goes back down is size and dilation is usually caused by high blood pressure. The biggest risk is developing AFIB at some point.
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