Echocardiogram questions

[jupiterfat]

I had an echo back in 9/13. Conclusions show mild assymetric LVH. Estimated ejection fraction is 55-60%. The E to A reversal flow pattern suggests diastolic dysfunction. There's trace mitral, tricuspid, and pulmonic regurgitation present. I have a history of high blood pressure that was under control for awhile but lately it's been elevated. My PCP added Verapamil to my current meds which include 60 mgs Cymbalta, Hyzaar , One half .25 mg Xanax nightly ( I have been trying to get off Xanax completely for awhile now, but that's another forum). I am 59 years old and able to do low to moderate  impact exercise 6 days a week, however I can't climb stairs without feeling short of breath. There's also a family history of pulmonary problems and that makes me extremely anxious. I should add I've never been a calm laid back person and I don't have an appointment with a cardiologist until the beginning of May! Anyone out there that can help?

[ed34]

I couldn't tolerate it because it affected my heart rhythm. A heart attack only results if a blockage is 100% but of course it can be anywhere between 1% and 100%. Only when it's over 60-70% do they consider intervention. You can usually have a stent if a single blockage or even 2 are problematic but this depends on factors such as location in the vessel. Ischemia means a restriction in a blood vessel, which is not allowing enough oxygen to body tissue, in this case the heart muscle. It doesn't mean it is causing permanent damage as in a heart attack. There could still be 20-30% of blood flow getting through. You could just straight to the best choice of determining restrictions (Angiogram) or you could go for a Nuclear scan which is non-invasive. Both would reveal ischemia and both would detect if a prior heart attack has occurred. However, if the nuclear scan detects ischemia of the reversible kind, then the cardiologist will likely perform angio anyway to stent the problem/s.

[jupiterfat]

Thanks for the quick reply. The PCP was the one who ordered the Verapamil, why couldn't you tolerate it? I see the Cardiologist the beginning of May.
I have been wondering if I might have some blockage.My EKG has been abnormal for years, but I'm not quite sure why. I always ask if it shows I've had a heart attack and I'm told no. Wouldn't that be why I'd have Ischemia ?Would I have to have a cath to determine blockage or ischemia and isn't the only way to treat either with a CABG?

[ed34]

It would seem that you have the symptoms of high blood pressure and your heart has been remodelling itself as a result. Your valves were fine from your last report. I am shocked at all your meds and verapamil was particularly intolerable for me. I would normally have high blood pressure, with the diastolic over 100, but just 2.5mg Ramapril twice daily keeps it fine. I think if you have shortness of breath, you need a repeat echo scan. If you have just trace/mild valve regurgitations, then this is nothing and if your EF is still 55-60% then they need to establish why the shortness of breath. An EF of 55-60% would show the left ventricle is working sufficiently, so another cause must be there. Perhaps ischemia? a partially blocked vessel or something. If I was in your position, I would ask for a batch of new tests to ensure he doesn't keep working to the old results. He needs to match the two to look for patterns.