ECHOCARDIOGRAM

[XFACTOR2009]

I have an issue.  I had  an echo  this year  that was  reported as  showing LVH at 1.3  mm  

I wanted the  docs  to c onsider  whether exercise had c aused this

The  technicians  1.3mm was changed by the consultant to    "1.0 mm  to 1.2mm "

images enclosed

Surely this is a wide margin of change,  what advice would anyone have for me.  1.0mm  is  well under the  LVH margin and  1.3mm is within it.    It feels very strange to me  to be redefined.  The technician is a  fully  accredxitted one of  many years experience, and the consultant appeared not to want me to have her show my echo imaghes  and explain the measurement, which may  possibly  be because he  didnt want me to mention the nmeasurement was  changed.  
Also  is the technical  qaulity oif the  relavant  echo  image  very  good  ?

Thank you  for any advice you can offer

[grendslori]

I TOTALLY agree with you. Your echo should be repeated in another year. I turned 60 a couple of weeks ago and a few weeks before that, I was diagnosed with LVH on the echo. Fifteen months before that my echo was borderline and before that was perfectly normal. Unlike most adults who have LVH diagnosed, I do not have, have never had, high blood pressure so that is ruled out as the cause of my LVH. In me, it is probably genetic in nature considering it hit my daughter so hard. Your other option is to seek a TOTALLY seperate opinion as in you do not see a cardiologist partner or any doctor affiliated with the hospital your cardiologist works in.

On a side note, unfortunately, my daughter is not doing too well. Her transplanted heart is now in chronic heart failure and she cannot be retransplanted. The transplant has added 12 more years onto her life which I hold dear. It's very hard on her husband as they have only been married for three years.

[XFACTOR2009]

What happened  to your  daughter is breathtakingly bad.  I find it hard ti imagine  a Cardiologist would be unable to identify a problem as  serious was presented.   I have no clear idea  why he wanted to declassify me from LVH  status, and of course I  would be happy, if I was sure it was  correct.  I  can appreciate there is a margin between opinions.  Eg one might think the measurement is a  tiny  bit  different to another person, as  there is an issue of judgement about where to start and end from with the measurement. But given my stress  test results, whilst themselves  an acceptable acheivement endurance  wise,  did  show a  disturbing and sustaiuned  rise  in  diastolic  BP.        I would have liked to be told  the echo  wopuld be repeated in 6  or  12 months rather than it be said he no longer agreed LVH was demonstrated.   The measurement of  1.3 mm isn't too worrying itself, but it  ought to be re scanned at a  later date, not written out altogether,
It isnt  unknown for  adults  in the  fourth or  fifth decade of life,  to suddenly develop hypertrophic  cardiomyopathy.  That too is a possibility in my case,
So unfortunately  I am left  somewhat in the air.  

I hope  your  daughter is well  after  her  enormous ordeal

[grendslori]

Boy, this is going to take on a whole new twist: We lived in England for 7 years and my daughter was diagnosed by her pediatrician with bi-ventricular (Concentric) LVH. It was pretty obvious because her walls were already as thick as a grown mans' and she was only 6 years old. We were sent to London (I'm sure most of you can figure out to where) and the tech there also agreed on that diagnosis. Everyone agreed....except the cardiologist who said nothing was wrong with her wall thickness!! (I even have that in writing) I don't know what happened to her heart walls that they grew so thick she had no chambers left in her ventricles and had to be transplanted because her heart was so bad. I don't really hold some UK cardiologists in high regard after that. As bad as that sounds, it really makes me question what this doctor is doing with you!

[erijon]

I am familiar with that link, I have it bookmarked. I don't know what your training consists of, but it takes consistent training over an extended period of time to increase heart muscle mass, even on a recreational basis. As stated, I do a little over an hour per day of hard riding at 13 mets with a reserve well above that and have done so since 2004 and have missed maybe a total of 20 days in that time and my echo shows 1.2 cm. There are some that call my routine recreational. Also, your extremely high BP during your test is consistent with LVH. I'm surprised they let your test go that long as it is normally stopped when you reach 200 systolic BP.

Just something to think about. In either case, if your cardiologist is not concerned, I would be either.

Jon

[XFACTOR2009]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC481456/pdf/brheartj00144-0034.pdf

is  an interesting study which shows  that moderate exercise caused thickening of  LV , though not enlargement of the  cavity

What I had wangted was to be shown the echo  and so they could explain how  they got to  the  figure, because it  had changed, quite a  bit betweenb the tech's  conclusion, and the cardiologists, and I  'suspect'  the cardio took the view  that  even if  1.3 mm it was no big deal, and not wanting to spend  further time on   whether or not it was LVH of  concern, or  exervcise induced LVH,  he  simply  decided it was  short of  1.3mm  without really being bothered  which was  true/accurate

However,  he was interested in the  study  which I had  suggested showed  that recreational  trainers like me  can develop thickened  LV, and not only elite  athletes

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC481456/pdf/brheartj00144-0034.pdf

[XFACTOR2009]

Thanks  :)     Well yes  athletes heart  as  such  does  require intensive training,  but LVH in the region of  plus  12mm ...  so technically  LVH  but perhaps of limited concern,  can result  from far more modest exercise, especially if the  LV is on the thicker side to start with.     It doesn't  take much to  send it from   say  1.5  to plus  12.   I  did a exercise test and got to 104  per cent of  age predicted  heart rate, and  did 11.5 mets and could have gone on a bit more but they invited me to  stop.  They seemed happy with that, as I am 48, and  11.5  mets is apparently pretty reasonable. However,  my  BP  did  acheive  230 / 115   during   the test

interesting  study of normal subjects  not athletes,  showed that moderate exercise caused thickening of  LV walls  

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC481456/pdf/brheartj00144-0034.pdf

[XFACTOR2009]

Thanks for your  reply.  I know it was changed because  I have the original report and the Cardiologists  follow  up letter.   The  normal practice where I live in central England, UK,  is that techs  make the findings and the cardiologists invariably accept them.
I had  raised  exercise as a possible cause of LVH because a study done of non athletes by a Birmingham hospital in conjunction with the University  found that 15  to 30 mins of exercise  daily  over a relatively few  weeks  saw appreciable thickening of the left  ventricle without enlargement of  cavity  size.    Whether  LVH  develops, by how much, and  whether  the cavity also enlarges  depends on a  variety of factors, including  extent of  training,  type  of exercise  etc `
This was the point at which  the Cardiologiust decided  that in fact the echo was not 1.3 mm, but might be as little as  1.0 mm,  which to my mind is a reduction of a  significant percentage.   Mine is a complex  case,  I produceblood pressures   of  diastolic  around 120 mm/hg  quite  often, but on 24  hr  monitoring am within normal range or just on the borderline.
BTW,  I read a paper of the University Hospital in Bucharest, in which  it is descriobed that tissue  doppler imaging can be an echocardiographic  technique that helps  them  distinguish between whether  the  LVH is pathological or physiological caused.  I had  hoped they might try  and  work out whether  training had  ledf  to the LVH but then the Consultant decided LVH no longer applied

[erijon]

grendslori gives you some excellent advise. Techs are techs for a reason, they did not go to medical school or do an internship as a cardiologist. They should never give their opinion during an echo, but many do.

LVH is considered anything greater than 1.2 cm but it is not cionsidered a problem until it reaches 1.5 cm. In order to develop an athlete's heart, you need to be training daily and a fairly high level. Routine work outs 3 or 4 days a week won't do it. I personally cycle 10 to-20 miles every day and can maintain 13 mets for an hour or so and my echo came in at 1.2 cm which I was told was normal for some one of my size and level of exercise tolerence. I'm sure your cardiologist considered this in looking at your images. A tech just takes the images and gives his interpretation of the measurments, but the final say is from the cardiologist, not the tech. The doctors I spend time with complain about techs doing this almost daily, it is a concern most face and some of the cardiologists will avoid specific techs for this reason.

I agree, be happy you don't have it and enjoy life.

Jon

[Occupant]

First of all you are off by an order of magnitute - it is 1.3cm. How do you know it was changed? In my latest Echo it was listed as 1.1 cm (0.6-1.1cm) with the bracketed term as the permissible range and yes, exercise can cause it, so does high B/P. However, I've also read that readings below 1.5cm are considered to be generally caused by athletic hypertrophy - so stop exercising for a while and do it again.

[grendslori]

A tech is a tech and as one tech told me one time: "If I want someone to have heart disease, I can give it to them" You ALWAYS want to have the cardiologist's report, not the tech's. Having said that, a reading of 1.0cm is normal for a grown man. Athlete's Heart, which is what I believe you are asking about is a whole different story. All of the walls of the heart become enlarged, unlike LVH where only one or a couple of walls are affected. This is one of the major ways of distinguishing between the two. Obviously, history plays a large roll in this mix as well. The doctor didn't want the tech to go over your results on the machine, probably because she has a tendency to do this with patients and he has had to deal with people panicing as a result. Techs, and I don't care which field they are in, should NEVER discuss the results of any tests with their patients. To give you an example: I went in recently for a chest x-ray which had to be repeated because of the clarity or whatever. The techa came out with a puzzled look on his face and asked me if I had ever had chest surgery done before? No. So them he asked me if I had ever had lung cancer before? Luckily, I don't panic very easily, someone else might have; can you imagine what one thinks after being asked those kinds of questions? There are many things that can alter a reading, everytthing from the tech's experience to how well hydrated you are on the day of the test. I would waste my time worrying about this, just be happy you don't have LVH!