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 "
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 ?
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!
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 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.
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
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
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
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.
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!
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
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.
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