Echocardium results

I am a 67-year-old male who just had an echocardium because my primary care physician was concerned about a heart murmur, My doctor isnt too concerned about the results but I am asking for other opinions. The basic findings are an moderate aortic valve scierosis with no measurable gradient. Also stage 1 diastolic dysfunction. Some other numbers. Left ventrible is 4.3 cm. Ejection fraction is 69%. Estimated RV systolic pressure is 36. Diastolic flow across the mitral valve shows an E/A of 0.9, deceleration time of 296. E/E prime is 15. Thank You.

[kenkeith]

There are 4 stages for diastolic dysfunction.  DD is a failure of the filling phase and almost always due to increased dimensions of the chamber and that restricts the capacity (volume of blood) that will decrease preload of the left ventricle if the DD is the right side of the heart and cause heart failure.  If the DD is the left side, the reduced filling will decrease cardiac output.  Also chamber filling can be compromised due to stiffness of heart walls.   STAGE 1 is impaired relaxation.  Stage 2  E/A less than 0.9; deceleration greater than 220.  What is involved is the E/A (E wave, A wave) ratio and is the timing of the inflow valves opening and time to closing of the other valve associated with ventricle.  Velocity of blood flow is the highest at the beginning when intraventricular pressure and velocity begins to decrease as pressure increases.  There is moderate aortic valve sclerosis (narrowing of the valve opening...orifice) and that effects the pressure negatively.

"On echocardiography, the peak velocity of blood flow across the mitral valve during early diastolic filling corresponds to the E wave. Similarly, atrial contraction corresponds to the A wave. From these findings, the E/A ratio is calculated. Under normal conditions, E is greater than A and the E/A ratio is approximately 1.5". RV systolic pressure is an estimate and slighty higher than the expected of 36 mm/hg.

Left ventricle (diastolic) dimension 4.3 cm...normal 3.5-5.7 cm.  Your left-side pumping \functionality is good.


Left ventricle EF 69% indicates the heart is able to pump out 69% of the input, but with RV DD there may be a deficit of blood going to the LV. Normal LVEF is 55 to 70%.

The murmur comes from a narrowing of a segment of the pulmonary artery above the pulmonary valve or the narrowing can be in one of the pulmonary artery branches (right
perfused.

Source:
QUOTE:
"Conventionally, diastole can be divided into four phases: isovolumetric relaxation, caused by closure of the aortic valve to the mitral valve opening; early rapid ventricular filling located after the mitral valve opening; diastasis, a period of low flow during mid-diastole; and late rapid filling during atrial contraction. Broadly defined, isolated diastolic dysfunction is the impairment of isovolumetric ventricular relaxation and decreased compliance of the left ventricle. With diastolic dysfunction, the heart is able to meet the body's metabolic needs, whether at rest or during exercise, but at a higher filling pressure. Transmission of higher end-diastolic pressure to the pulmonary circulation may cause pulmonary congestion, which leads to dyspnea and subsequent right-sided heart failure. With mild dysfunction, late filling increases until the ventricular end-diastolic volume returns to normal. In severe cases, the ventricle becomes so stiff that the atrial muscle fails and end-diastolic volume cannot be normalized with elevated filling pressure. This process reduces stroke volume and cardiac output, causing effort intolerance. Figure 117 summarizes the pathophysiology of diastolic heart failure.
In addition to providing fundamental information on chamber size, wall thickness and motion, systolic function, the valves, and the pericardium, two-dimensional echocardiography with Doppler is used to evaluate the characteristics of diastolic transmitral and pulmonary venous flow pattern.
In early diastolic dysfunction, relaxation is impaired and, with vigorous atrial contraction, the E/A ratio decreases to less than 1.0. As the disease progresses, left ventricular compliance is reduced, which increases left atrial pressure and, in turn, increases early left ventricular filling despite impaired relaxation. This paradoxical normalization of the E/A ratio is called pseudonormalization. In patients with severe diastolic dysfunction, left ventricular filling occurs primarily in early diastole, creating an E/A ratio greater than 2.0."