Echo Report

Last time I posted a detailed question on my heart condition. I did not get any response, probably it was too detailed for someone to attempt a response. I am now attempting smaller questions with a hope to get a response.

My recent Echo reads:

Mitral Valve: Slope  110 cm/sec; DE amplitude 18.6 mm; EPSS  14.9 mm.
Arotic Valve: Arotic Root diameter 29.8 mm; Cusp Separation 18.1 mm.
LA Size: 45.2 mm; LA dilated
Tricuspid Valve: Normal
Plum Valve: Normal
Left Ventricular Parameters:
- LV Size(diastole) 61 mm
- LV Size(systole) 55.4 mm
- LV Volume(diastole) 118 mm
- Stroke Volume 39 ml.
- Cardic Output 3.33 L/min
- Ejection Fraction 30%
Mitral Valve Flow Velocity: e wave 108 cm/sec; a wave 34 cm/sec; e/a 3.5
IVS(diastole) 7.7 mm; IVS(systole) 9.0 mm
PW(diastole) 7.7 mm; PW(systole) 8.7 mm
LV Enlarged; Varying degree of hypokinesis of most of LV walls seen; The lateral wall is best preserved.
RV Normal

Tissue Doppler Analysis: LV systolic velocities are reduced.

I am 48 male. Had MI in august 2007 with LAD 100% blocked. LV has damaged muscles in parts of heart served by LAD. Stent was implanted. I also have ICD. My pulse rate remains 70-80 bpm most of the time. I walk 1.25 mile daily in 30 minutes. After walk my pulse rate is 100. Last time (Nov 2007) my E/A was 1.3.

Questions:
1. Which values are dangerousely abnormal:
2. I take corag(betablocker) 18.75 mgx2; Ramipiril(ACE-I) 5mg(morning) 2.5 mg(evening); Ald4ectone 12.5 mg; Aspirin; Clopidogrel; Tonact Plus(for cholestrol). Are medicines OK for this heart condition?
3. Do I need to reduce my pulse rate further by increasing betablocker and ACE-I?

I hope I get advise this time.

[Momto3]

Hello.

I'm sorry your earlier post did not result in a response.  Hopefully, someome will be able to help you out this time.  Also, please try posting your question on one of the Expert Forums (links to the right).  The doctors accept a few questions each day, and because your questions are quite technical/medical, they would likely be able to help.

These are great questions for your cardio.... When is your followup?  

One thing that appears (I am NOT a doctor, so this is just a personal opinion) significant are the LV values and accompanying comments (LV Enlarged; Varying degree of hypokinesis of most of LV walls seen; The lateral wall is best preserved) and the low EF.  Hopefully, your medication regime will help to increase your EF and improve your overall health. Despite all that is going on, how are you feeling?  

[Tinu1959]

Hi, thanks for the response. My cardiologist says that my condition has not deteriorated since MI in august 2007 and I need not go into specific numbers. My beta blocker has been increased from earlier 12.5mgx2. I have no other way to understand my condition. I know this forum has lot of members who are knowledgeble on these issues. I hope someone with relevant information will respond. Yes, I understand LV dilation and hypokinesis of LV walls is serious. For that reason I have provided all the details, if someone needs to make an assessment. I am feeling good but I am worried whether my condition can get better.

[Momto3]

Tinu1959,

You might try sending a private message to "kenkeith" or "ericjon".  They mighb be able to help you understand your echo results a bit more.  They are not doctors, but they have knowledge on how to interpret these reports.

Good news that you are stablized since the MI!!  HOORAY!!  Hopefully, you will see improvement with the medications and the ICD. Do you have a Bi-Vent ICD/pacemaker?  Are there 3 leads?

[Tinu1959]

I have a single lead ICD. I did write to Kenkeith and he was kind to respond. But I am feeling uncomfortable in putting too many questions to him. I know he responds to many questions from forum members and his replies are very accurate. I hope sees my mail and responds. Thanks for following up.

[erijon]

Mom is correct, your readings concerning your LV are the most important along with the hypokinesis and your low EF of 30% which is bordering on CHF. Also, your left atrium is enlarged which could lead to Afib. This is normally caused by high blood pressure, is yours under control? The "LV systolic velocities are reduced" which I understand means that the pumping part (contraction) of each heartbeat has a reduced velocity also know as systolic dysfunction which is tied to your EF%.

The good news is that you are stable and I'm aware of many others that have been able to improve their EF % in time with cardiac rehab. It sounds like you're able to exercise which will help as you build up your tolerence. I don't think your heart rate sounds too high, but that's a question better directed to a doctor. I also don't think anyone on the forum would be qualified to answer your questions concerning your meds as none of us are doctors. It would be a great question for the expert forum. Try checking it at different times of the day. My understanding is that it is available for questions at different times during the day based on time zones in order to make it more available to everyone, so you may find it full in the morning but available for questions after a couple of hours.

I'm sure kenkeith will get back to you, he is very knowlegable and always willing to help answer questions. Another person you may want to reach out to is flycaster, he also is very well versed on these topics.

Good luck and let me know if I can help.........

Jon

[vienna13]

You right about feeling uncomfortable.

He is a very kind man yes, and obvious he will say it is OK, because he is kind.
But this is why this  open forum is here to ask questions and get answers.
People here offer their time to each other by reading and answering.
  IF THEY CAN OR WANT.
In my opinion  you got a very kind but unprofessional advice from the community leader, she has no right to tell people to PM their reports to members of the board, she wasn’t right the name of her kindness to suggest to you to disturb Kenkeith or Ericjon with a long ‘questionnaire’ like that on PM.

They are answering if they see a question here and they feel to answer, if not they wont.

Also please keep it in mind none of us is a  doctor here.
  
YOU DO NEED A DOCTOR TO HELP.

You should present your post to a doctor on the expert forum, or sit down with your cardiologist and ask questions, you pay him, he works for you.
  

  

[vienna13]

And now you are telling her go to Flycaster.

It is NOT ethical ...might sound kind from you at the moment as it did from the CL..but not ethical  to suggest  to disturb people …. That is not right.

Yes Fycaster an other wonderful kind man and I am sure he will answer for the OP as he does answer to others IF  he is around here and  has something to add.

[Tinu1959]

Thanks Jon. I take this opportunity to ask related questions if you can spare time to reply.
My EF had gone upto 38-40% in December 2007 but came down in January 2008 after ICD was installed. Could this be due to reduction in dose of betablocker and ACE-I at that time?

After MI my BP has always been 110/70 with a variation of not more than 5%. Yes my pulse was of the order of 80-90 bpm earlier.

Can the redustion in LV systolic velocities be due to increased dose of beta blocker. About three week back I started increasing coreg from 12.5mgx2 and now I am on 18.75 mgx2? Does yhis mean I have high afterload and need to correct it by increasing ACE-I, if doctor advices?

Getting to write on Experts Forum has not been possible so far. I will as advised by you.

Thanks for responding and sharing valuable information.

[Tinu1959]

Hi Vienna13 Thanks for the response. I agree with you that voulantry response from members should be the preferred way. But I also appreciate the community leader's gesture, which was aimed to help a fellow member to get the correct guidance. At the time of post she was not knowing that I had already posted some of the questions to Kenkeith. I appreciate their gesture and hope that the referred members will respond to my question if they feel that they can provide some information.  .

[erijon]

You are very welcome, I enjoy trying to help where I can as do most all others here. I wish I could answer your questions about your meds, but I just don't know enough to give you a good answer and I don't want to mislead you with bad information. It is GREAT news that your EF is up, shows that you are recovering and your heart is getting stonger with increased function. Also, your BP looks great as well.

Don't ever hesitate to reach out to me if I can help. I'm no doctor but I have been around these issues as well.

Good Luck,

Jon

[Tinu1959]

Jon, I probably did not communicate properly. My EF at the time of MI was 30% in August 2007. It increased to 38-40% by december 2007 but after ICD was installed in January this year it came down to 30% by April this year. Can you please review again? What does Afib due to LA enlargement mean? Thanks for prompt response.

[erijon]

Afib is a type of arythmia that causes the left atruim to quiver rather than to beat in conjunction with the rest of the heart. This can happen without any symptoms and will normally convert back to a normal rythm on it's own. This is not normally a dangerous or life threatening issue but can make someone more predisposed to stroke as the quivering allows blood to pool in the LA and can form a clot which can travel elswhere. This is not always the case with an enlarged LA, but is a possibility you should discuss with your doctor.

Hope it helps.

Jon

[maggiemag]

I am not a doctor but I am an RN and I see nothing dangerously abnormal.  Your LV and LA are enlarged of course and your EF is down.  I know nothing about velocities or e's or a's. :-)  An enlarged atrium can lead to AF but it could still decrease in size as well as your LV.    The target dose of Coreg is 25 mg. twice a day or up to 50 mg. twice a day depending on weight.  Some, like me, never get to that level due to low BP (80's systolic).    I think your heart rate is a bit high and I would think they might increase your Coreg further, which will help possibly remodel your heart to decrease size of the enlarged chambers.  Possibly they could increase your ACE as well.  They generally want the BP as low as you can stand it without too many symptoms.  That will decrease the work of the LV.  110/70 is not too low at all.

Try not to get too caught up in the numbers.  The important thing, really, is how you feel.  You are relatively stable so that is great!

It has been a long time since I tried to post a question on the expert forum, but I have had the best luck trying at the top of each hour, starting early morning EST.  Good luck.

[Momto3]

To: erijon, maggiemag, tinu1959
erijon,

Thanks for jumping in to help out.  I was pretty sure you would come running if we needed you.  Thanks again!


maggiemag,

I didn't realize you were an RN!!  That's awesome!!  Thanks for your interpretation and for your insight!!  What setting do you work in?  Thanks again!!!


Tinu1959,

I'm glad that you were able to touch base with kenkeith.  These guys are great!  We've got a great community here!!  You are always welcome to post or PM a member, and I'm sure you understand they also have the option to "ignore" or respond to your questions.  Hope you are feeling better about your report.  : )

connie

[Tinu1959]

erijon

Thanks for insight into LA enlargement issue. I will certainly takeup with my cardiologist.The present size of my LA 45.2 mm is same as it was at the time of MI in August 2007. In between it went down by 5-7 mm. If lower pulse rate and low BP can bring it back, I will talk to my doctor to advice appropriate medications.

maggiemag

Many thanks for the explanation. A great releif that things are not dangerously bad. But I understand that immediate measures need to be taken to creat conditions for remodelling of LA and LV.

As you have rightly pointed out, my cardiologist has already set a target of 25mgx2 for coreg. It is me who is taking time as I was feeling some discomfort during my walks due to increase in coreg. May be in next 3-4 weeks I will reach that dose.

But one thing which bothers me and I request you to advice on that. On one hand it is important to keep pulse and BP low to facilitate remodelling of heart chambers(and increased dose/target dose of beta blocker and ACE-I are recommended) whereas it is also recommended that the patient should have daily walk, which increases pulse. Does it mean that walking shall be reduced?(I walk 30 minutes daily and do yoga for 15 minutes) I have a table job at my work. Is it advisable not to go to work in order to keep pulse rate low? How much time it takes for remodelling process, normally? What should be the target for pulse rate??

maggiemag, I am not familiar with the term RM but I guess it is related to medical profession. I am thankful to you for reassuring that my heart conditions are at a stage where they can still be corrected with proper care. It is certainly great relief to me. I will talk to my doctor for corrective measures.

Momto3


Thanks for being with me. Your followup has helped me a lot. Otherwise I used to worry a lot. Not so much because of my conditions but because of many unanswered questions about my health. Some doctors do not reply straight. This forum has been a great place for me. Now I know a lot more. I look forward to continued support.