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Ejection Fraction, Myocardiopathy question
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Ejection Fraction, Myocardiopathy question

Dear Drs.

Here is my recent post: http://www.medhelp.org/posts/Heart-Rhythm/Myocarditis---Heart-Rhythm-question/show/1663231?camp=watch_list

The long and short of it is that I am a 28 y old male with a good heart history and no previous problems who had a really nasty infection followed by a month of chest pains and other symptoms. Myocarditis has been my worry (and myocardiopathy)

My question is about my recent stress echocardiogram results.

Here is the exact statement from the cardiologist verbatim regarding EF:

" Echocardiogram at rest shows normal wall motion with ejection fraction measured at 51%, although subjectively it looks higher than that and probably closer to 60%. Following exercise, there was a global increase in contractibility with ejection fraction rising to 83%."

Also, stress test was done at heart rate up to 176 before termination before and after echo readings. no arrythmias or chest pains noted.

Baseline ECG also showed sinus rhythm and nonspecific ST-T wave changes which are more prominent after standing and are seen diffusely in the inferior and anterolateral leads.

His final impression was:

"Normal stress echocardiogram with normal left ventricular function at baseline, and no evidence of inducible ischemia at a significant workload."

My questions are:

1. What does all this mean? My G.P. was not concerned at all and thinks I have no issues in light of other tests. Do I need a second opinion?

2. I thought 51% is a below average (55-65%) EF volume??? Shouldn't this be a reason of concern regarding my "myocarditis like" symptom presentations mentioned in previous post? How is it that the cardiologist and my G.P. are not concerned about a low EF in a normally healthy and atheletic young male?

3. Would you expect viral myocardiopathy to show subtle yet low EF volumes like 51%, or do you generally see more drastic results?

Am I worrying needlessly? Do I need 2nd op. or merely reassurance?

Thank you!
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1. This is a normal result. It indicates normal heart structure and function, and no evidence of an area of the heart that is not getting enough blood (ischemia).
2. While most cardiologists would regard 55% as the lower limit of normal, and 50-55% as something of a "grey zone", it must be emphasized that measuring EF on echo is technically difficult and sometimes while the measurement may be borderline, the overall visual impression of an experienced cardiologist looking at your heart from various angles over the course of the entire study is that the EF is normal. In these cases, the visual impression is taken as the most accurate result. So I would regard 60% as the true EF and that is normal.
3. You have not (as far as I can tell from your posts) had any objective evidence of myocarditis. The symptoms you report also do not sound like myocarditis to me. Given the extensive normal investigations you report (EKG, stress echo, blood work, chest x-ray) I would think you could be reassured.
Thank you for the response! It is reassuring to hear you say that. What really scared me is the symptoms manifesting right after a major infection and persisting even today (5 weeks later), though in lesser magnitude.

I have been paranoid about sudden cardiac death as a result of undetected myocarditis, almost to the point where it has started to affect my life a little. The left side chest pains and lightheadedness seem to reinforce that.

I guess my only follow up question is that isn't the nonspecific ST-T wave changes on the EKG indicative of myocarditis, pericarditis, or other infections?

Thank you again for the reassurance... it's worth every penny and more.

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