Heart

[Gregarious113]

I had and Echo Stress test 10 yrs ago after taking the diet drug Redux.  It showed FDA positive for Aortic Regurgitation and tri-cuspid valve damage as well.  Just did another stress echo about a months ago.  Showed no AV regurgitaion but still tri-cuspid damage along with LV hypertrophy.  How is this possible?

[skydnsr]

There is an Experts forum that is answered by Cleveland Clinic doctors.  On the MedHelp bar at the top of this page, click Experts.

[Gregarious113]

After examination of the two ECHO's....the latest one is 2D/Doppler and the former one is 3D TSW which also states:  

Maximal TT + for sepdal, anterior & inffemoral ischemic..
No cp, no pvg
significant ekg changes
lvef  51@

Can you give me any insight on the difference?  Thanks!

[skydnsr]

Anyway, Gregarious113, don't you have a cardiologist that you trust, because the real issue is whether you need any treatment, right?  Were you not satisfied with the feedback from the doctor who ordered this more recent echo?

[skydnsr]

Wait, sorry, I take back what I said about the LVOT.  I was confusing the diameter with the area.  3.8cm would be large for a diameter, lol.  Forget what I said about it being large.  See, you don't want me interpreting this stuff.  

[skydnsr]

As far as the difference in your two EF values, I'm not sure that means anything.  The previous estimate of 51% presumably had a range around it, like the new estimate of 55-65% does.  Maybe the old range would have been something like 45-55%, so you would have overlapping ranges.  If the "true" EF was between 50 and 55% both times, then there's no real difference.  Even if the "true" EF was 51% the first time and 56% the second time, I don't know that it means anything practical for you.  It's not a fixed value down to the exact percentage point.  It would change to some degree from test to test -- even if they could measure it exactly, and in fact they can't measure it exactly.  All of the echo result numbers are estimates, based on a model.  The device is bouncing sound waves off of your internal organs, and then a computer program "translates" the length of time it takes for the sound wave to echo back and generates a visual image from the data.  There's a lot room for error.      

[skydnsr]

LVOT (left ventricular outflow tract) seems large.  I'm going way out on a limb here, but that could suggest some issue with the aortic valve.  Someone needs to either back me up or slap me down.  Ed34?

[skydnsr]

I have actually heard of what ed34 is proposing, but only with the mitral valve.  When the LV enlarges due to years of hypertension, it stretches the mitral valve leaflets apart, and when the LV remodels back to a normal size, the leaflets come back together. I actually had this happen to me.  I had mitral regurgitation prior to my AVR (secondary to LV changes which were in turn secondary to aortic regurgitation), but not now.  I'm not so sure that that kind of LV enlargement would affect the aortic valve in the same way.  I've never heard of it doing that to the AV, but I can't say that it absolutely couldn't, either.  But even just thinking about the anatomy, it seems to me more likely to cause a problem with the mitral valve.  When people have AV regurgitation, it's usually due to some other identifiable cause, such as BAV-related issues.  Just my two cents, and I certainly don't know everything that can or can't happen to the AV.  I do find it interesting to speculate, though.

[ed34]

I can only think of one reason. Imagine you have a rubber seal (O-ring) between your fingers and the valve is in this circular space. If you squeeze the rubber seal just slightly, you can see how the circle is distorted. This would cause the valve to leak because the leaflets can no longer meet at the centre properly. If the heart muscle in that area enlarges, it can sometimes push on the valve area, distorting it. This could be through years of high blood pressure for example. However, if the heart is able to reduce the enlargement then the valve would be a much more snug fit again.

[Gregarious113]

2D ECHO
LV Dias Diam                3.9cm
LV Syst                          2.6cm
IVS Dia Thickness         1.2cm
LVPW Dia "                    1.3cm
LA Sys Dia Thick            4. cm

DOPPLER
LVOT                              3mgHg
LVOT Diameter               2.2 cm
LVOT Area                      3.8cm?
Mitral E Point Velocity    43.3 cm/s
Mitral A    "        "             67.5 cm/s
Mitral E to A Ratio           0.64
MV Deceleration time      151 ms

I was told no MV regurgitation in this ECHO,..10 years ago I had mild aortic regurgitation.  I had both mild tricuspid regurgitation both now and then also LV hypertrophy both times.   Old ECHO showed LVEF 51% but now I am told EF is 55-65%.  I am confused. How does this happen?
        

[skydnsr]

Feel free to post the results openly, but it might not be worth your time to PM them to me.  I'm not the best at interpreting the actual data.  There are other people on the forum who are much better than I am at that.  Maybe you should start a new thread, and title it something like, "Need Help with Echo Results."  I'll be looking for it, and if I have anything to say, I'll chime in.

[Gregarious113]

If I may..I would like to send you the results from the latest Echo for your interpretation.  The first Echo results are unattainable but I don't believe he would have been biased since he had nothing to gain from the situation.  He was a referral from my personal physician/friend of 25 years.

[skydnsr]

The only little scrap of information I can offer that might explain the discrepancy (assuming both echos were competently administered and read) is that if blood pressure is greatly different between the two echo tests, then the function of the aortic valve can look different.  If you have the actual reports from both echoes, I would take them to a cardiologist that I trusted, and get his or her opinion about it.  If you're lucky enough that both echoes were ordered and read by the same cardiologist, then that would be the best person to explain the differences, because you should be able to expect him to interpret the same type of data in the same way, both times.  

I've seen this type of question come up  before, not very often but every once in a while, and it is hard to know what to make of a valve that supposedly got better.  I actually think my own cardiologist would tell me something like this:  we're not going to worry about the past; we're going to work with what is going on now.  But some doctors might be more willing to speculate.  

Actually, I agree with my own doctor that the important thing is what is going on now.  In that context, though, it would be important to me to know that the current echo findings can be relied upon.  I mean, if you're going to work with what is going on now, and you're going to disregard the previous echo, you want to know that the echo that you're working from is reliable.  That's where the doctor's explanation of the differences would be relevant to me.  If the doctor couldn't explain it, and I still felt nervous about the situation, then I'd probably ask for the next echo to be done sooner than might be usual.

Also, I hate to say this, but if by chance the first echo was done by a doctor to whom you were referred by a class-action litigator, it kind of brings up the question of whether the interpretation might have been biased toward finding the maximum degree of pathology.  Of course, that thought could be nothing more than my own nasty paranoia at work.