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Heart Disease (Expert Forum)
Help! Discrepencies of Echo's. Recommendation for a Cleveland Clinic CHF doc?
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Help! Discrepencies of Echo's. Recommendation for a Cleveland Clinic CHF doc?
by NittanyLion, Mar 17, 2004 12:00AM
Hi. My husband is 35 years old. He has a doctor in NY (Medical Director of a Cardiac Transplant Unit of a well known hospital)that we see and a local heart doc in NJ. My husband has Dilated Cardiomyopathy due to a viral infection in Jan 03. We've been seeing the NY doc since March of last year. According to both docs, this time last year, his Ejection Fraction was 25%. That was the first and last time they agreed...According to the NY Med Director now, it's still around 25% and the NJ doc after a Muga in July which claimed an EF of 37% and an Echo just in Jan. claimed and EF 41%. Based on the reported study of March 8, 2004 the medical director in NY is advising him to see her recommended physician for an ICD (internal defibrillator). We are going to go to the Cleveland Clinic for concurrence with her findings but have already scheduled an appt just in case with the physician for the ICD. My husband is on all the CHF meds (Topril-XL, Altace, Coumadin etc) and he's obviously not improving by her standards. I just don't get how echo's differ so much? Can anyone relate??? Any recommendations for CHF doc at the Cleveland Clinic? Thanks a million to all of you who reply! This is my first time on the board ;o)
Doctor's Answer
by CCF-M.D.-RCJ, Mar 17, 2004 12:00AM
NittanyLion,
Thanks for the post.
We often see outside echos that show discrepant EF findings. The EF is based on a visual estimation made by the reading doctor, not by any fancy measuring techniques. Thus, discrepancy is often seen.
We have many great heart failure doctors at the CCF. Two of the doctors with whom I have closely worked include Dr. Randall Starling and Dr David Taylor, but many of the other heart failure doctors here also have great reputations.
Best of luck.
Thanks for the post.
We often see outside echos that show discrepant EF findings. The EF is based on a visual estimation made by the reading doctor, not by any fancy measuring techniques. Thus, discrepancy is often seen.
We have many great heart failure doctors at the CCF. Two of the doctors with whom I have closely worked include Dr. Randall Starling and Dr David Taylor, but many of the other heart failure doctors here also have great reputations.
Best of luck.
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Symptoms, etc.? And what type of virus causes it? Thanks-JJ
wmac
A dialated cardiomyopathy may have many different etiologies. 'Cardiomyopathy' means heart muscle disfunction, and dialated simply means 'enlarged'. In dialated cardiomyopathies, all the heart chambers are enlarged, and therefore don't contract well, or pump efficiently. Consequently, the symptoms are generally related to heart 'failure' ranging from non-specific fatigue, to shortness of breath with activity or even at rest. Because the chambers are enlarged, the conduction pathways are often disrupted leading to arrythmias. That's why in otherwise young healthy people who develop PVC's etc., an echocardiogram is often requested.
Viral infections are often blamed, esp in young people. Many small heart attacks can lead to it, some medications may be implicated, often it is billed as my favorite, idiopathic, which means no one knows why it happened.
Nice to see a real "physician" responding to such questions!!
Dilated Cardiomyopathy or dialated cardiomyopathy.
Dilated cardiomyopathy is an enlargement the ventricles, they but aren't able to pump enough blood for the body's needs, resulting in heart failure.
the most common cause is coronary heart disease, but also an acute inflammation of the heart muscle such as myocarditis from a viral infection can weaken the heart muscle and produce dilated congestive cardiomyopathy( sometimes called viral cardiomyopathy). The coxsackievirus B is thought to be the most common cause of viral cardiomyopathy.
uncontrolled diabetes and thyroid diseases can eventually result in dilated cardiomyopathy also.
Alcohol , cocaine and some antidepressants drugs can also cause dilated cardiomyopathy.
In very rare cases it can result from pregnancy or connective tissue diseases, but this tend to be a very small percentage.
When a specific cause can not be identified it is trem idiopathic (of unknown cause or origin).
Usually the first sign on an echo of cardiomyopathy is a reduced EF( ejection fraction) of below 50% termed mild , 40% and below moderate, below 30% severe.
Note I am not a qualified or certified "physician", but when I receive my degree I will enlighten you more.
flip(Lyn)
As you can see we all make spelling errors, it is the ability to read between the lines and mispelled words that count!!
flip(Lyn)
Any help or reassurance would be so appreciated!
:-) :-) I didn't even notice disfunction, I was feeling so dialated at the time, be shur to profreed agn + agn :-) :-).
only one that yelps is the one that gets hit. :-( :-(.
Dr. Terry,(seriously) if I offended you I'm very sorry and I sincerely apologize. I just merely wanted to point out that we all make little mistakes not matter how educated or qualified in a certain field we maybe and that anyone can learn from a common person no matter how smart , educated or qualified, they are.
As a physician you have learned from and received help from the common posters on this board who researched and helped themelves as'hankstar'reminded you in his comment to you after you agreed with 110% with the person that really went out a limb to give him a real undeserved bashing.
As a regular viewer of this board, everyone apparently has the right to voice their opinion once it is done in the right manner.
No one should take the comments, opinions or suggested advice given on this forum over the advice of their doctor.
You as physician had the qualifications and the right to experiment and find out what may or may not work for you, apparently some of the suggestions on this board was of great help to you in eliminating your PVCs and irregular heartbeats, I just wanted to remind you of that.
You have the right to your opinion as we all do, but I would like to remind all who comment and post here that we should really think about what we write on this board to criticize others before taking a careful look at ourselves first, including
myself and the cheap shot I took at you today, it was undeserving and I sincerely hope that you accept my apologies.
all the best,
flip(Lyn)
In one of your reply, you'd mentioned the word 'idiopathic', which is one I was diagnosed with. I posted my story in another thread, but here it is again.
'Hi,
I am new with the Forum. I have what one EP doctor called 'idiopathic ventricular tachycardia', which started a few days before my 35th B-day (March 20). I always knew that I have a irregular heart beat, but this one Saturday while were at work, my heart was pounding away in my left ear. The condition persisted, but was too late to see my doctor. I waited until the following Monday. After my doctor saw my EKG, he called the ambulance. On the way to the ER, the paramedics gave me some Lidocaine, which worked almost immediately. All sorts of machines were alternately used on me while in ER, including X-Ray, and ultrasound. Only a minor heart murmur found. I was admitted into Garden Grove Hospital, while an EP doctor (Kelly Tucker) prepared more paperwork for me to be transferred to St. Joseph Hospital. I did not remember how viles of blood were drawn, and how many tests were done on me at GG hospital. All come back excellent.
I were transferred to St Joseph after 1.5 days at GG hospital. Dr. Tucker explained to me the EP study procedure, as well as the ablation, which he fully expected to perform following the study. Another cardiologist was there with Dr. Tucker, and performed the aniogram, which again yieled excellent result. The EP study went well with my condition being an inducible one. However, Dr. Tucker could not find the culprit and decided to withdraw without an ablation.
The next morning, Dr. Tucker informed I and my wife about an ICD or perhaps some beta blocker. He set an appointment for my visit after 2 weeks. Upon which, my 'idiopathic venticular tachy' was confirmed. Furthermore, Dr. Tucker prescribed some beta blocker and asked to see me every 6 months (I think out of curiosity). He informed me that he see thousands of patients every year, and my case is extremely rare, which he encountered less than 1 every 3 to 5 years.
Idiopathic just simply means 'unknown cause'. I seeked council from another EP doctor from UCI, Dr. Broadski, and a Cardilogist Dr. Vinh-Khiem Nguyen. Both Doctors did not seem to give much credit to Dr. Tucker EP study. Both recommended their own EP study. I requested my medical files to be sent to both Doctors prior to my visit. However, Dr. Broadski did not care to review any finding from Dr. Tucker, while Dr. Khiem Nguyen did not receive my record.
Since then, these episodes returned around my birthday once in 2000, 2002 and last night (March 18, 2004). I drove myself to the ER in 2000 and checked myself in. The ER doctor did not believe me that it is VT and not SVT. He insisted to try Adeavocard 6 mg, then 12 mg without any affect. I informed him that Lidocaine worked the first time (1999). 75 mg of Lidocaine did the trick within less than a minute. The episode in 2002 seemed to be triggered by mild dehydration. I continue to drink water for 1.5 hours upon confirmation of my tachy, using my heart monitor (ECG). By the time I got myself outside the ER, my heart rate had converged back to normal. I hang around the parking lot for 15 minutes, before drove home.
Yesterday was totally new for me. I exercised during lunch, with 10 minutes on the elliptical machine, 10 minutes on the stationary bike, some light sit ups and weight excersise, followed by 10 minutes jogging. Everything went well and I felt great. I got back to my desk at 1:00 and around 2:00 I noticed the onset. I drove myself to Garden Grove Hospital ER and were confirmed a 200+ tachy condition (3:00). Dr. Sun took my advice with the Lidocaine and I was administered with 100 mg. Thing did not work as expected. I requested for another dose of Lidocaine in less half an hour apart. The second dose seemed to stay in my system 5 times longer with a much more hard hitting side affect (heavy headed, short breathness). Adevocard 6 mg then 12 mg were administered shortly there after without any affect. A cardiologist was contacted and Amerodione 150 mg was given, which brought my HR down to 150. Sometime in the next 2 hours, ASA 162 mg was given, but my HR steadily climbed back up to 190. Dr Luc Nguyen, an EP doctor finally showed up, and prepared to shock me. I signed the consent and all the nurse and doctors standing by for the procedure. As the last ditch effort, Dr. Luc Nguyen ordered 5 mg of Virapomil, which promtly converged my HR down to 100. I was spared from the shock treatment with this last drug.
I am in the process to request for my medical record from St. Joseph (my EP study) and hopefully find some recommendation from Dr. Luc Nguyen. Is there anyone out there with 'Idiopathic VT'?
Thanks for reading my story and look forward to hear some respond'
I would love to hear your comment.
Thank you
Thai
Most arrythmias, VT SVT etc, in young healthy people are 'idiopathic', meaning no objective cause can be found. I strongly support you seeing another EP. Because one didn't identify the culprit pathway, doesn't at all mean another won't. If they are unable to ablate the aberrant pathway, then you will be offered medications to try and control it. The fact that lidocaine stops it but adenosine didn't does support your belief that it is VT and not SVT. Adenosine virtually always aborts SVT. Depending on how often your episodes are, an implantable device MAY be recommended, but patients describe the firing of them akin to "being kicked by a horse".
Perhaps others reading this forum can recommend a good EP in Orange Co., or S. Calif. Maybe one ot the doctors who respond to this forum would be able to recommend one.
Good luck! and lets us know what happens.
Hi,
i know this was directed to trrtrix, but you might ask your Ep doctor about idiopathic LVVT, a tachycardia that comes from the low left ventricular septum, it is a form of idiopathic ventricular tachycardia that usually responds to verapamil, a drug that is usually contraindicated in the use of ventricular tachycardias.
Trrtrix is a physician , I am not, ask your doctor about the possibility of your idiopathic tachycardia being LVVT, idiopathic ventricular tachycardia if it responded to verapamil.
best wishes ,
flip
Hi,
flip again, not to be intrusive and you don't have to respond if you don't care to. Please ignore my cheap shot at trrtrix, I apologised and hope she accepts,she is obviously a good doctor who through her own experiences is just trying help others, as I stated I'm not a "certified" doctor but through my own experiences and research and a little bit of medical knowledge trys to help also,I just noticed thai. Would you happen to be from southeast asia or Thailand or a descendant or of southeat asia ancestry?
If so You might get checked out for Braguda syndrome as it is more privalent in Thailand and south east Asia, just a thought, Take Trrtrix advice and get a second or even third opinion. Try to find a very reputable EP doc and don't be afraid to suggest things that you have learned here to them. Surprising when a doctor realises how much the patients knows how their response in treating them changes and they really try to get to the root cause, if it is even termed "idiopathic".
best wishes and good luck
flip.
I did not expect to see reply so quickly about my story. I want to thank you both for responding. I read elsewhere on this website that Verapomil also comes in oral tablet form. Should I ask either my primary care physician or my Cardiologist for a prescription of it? Can either one of you comment on the fact that Lidocaine worked the first 2 times and did not this time (2 doses, half hour apart)? The nurse administered the Verapomil also told me that it could be potential lethal if Verapomil is incorrectly given to a WPW patient. I am confused in this last part, since EP study followed by RFCA treatments, I thought is commonly done to WPW patients. Does it mean that my first EP doctor could not performed an ablation on me eliminated my WPW potential?
My first EP study was inducible does this warrant that the next one will also be inducible? My episodes have been rare and far in between made me reluctant in seeking for drastic measures. How can one EP study be so different from another? Is the difference in the ability of each EP to interpret the electrical mapping of the heart?
I want to thank you both once again. It is good to know that my condition is just as rare as almost everyone else on this forum. It is even better to get response and sympathy from others like myself.
Thai
Those are difficult questions, yes verapamil can be lethal in someone with WPW, because it blocks the transmission of electrical impulses through the atrioventricular node. In WPW you have an accessory pathway that links the atria directly with ventricle, by blocking the conduction through the AV node , it is chance that the impulses have a chance to conduct one to one from atria to ventricle, thus resulting in an extremely fast ventricular response and causing ventricle fibrillation , this usually happens if you have a-fib with WPW.
You probably have just what the doctors stated idiopathic VT, ask your doctor about LVVT that responded to verapamil, it is a very rare form of idiopathic VT. Verapamil does come in tablet forms and is used to treat suprventicular tachycardias, ask your doctor , if it worked for you, it might prevent your episodes.
You don't have WPW, at least that is my personal opinion and if you had SVT and not VT, adenosine should have worked, in fact adenosine used to established the difference between VT and SVT in broad complex tachycardias that doctors aren't sure if it VT or SVT with abberancy. If it is SVT , the adenosine usually stops it. It has no effect on VT.
Check with doctor or seek a second opinion , there is definitely an answer for you out there , you just have to find the right doctor.
Best wishes and good luck,
flip.
wmac
What is LVVT? I have not found anything for this acronym. If my arrythmia is inducible, do you think one EP doctor may be able to have a very different interpretation of the electrical mapping from another EP doctor (from 2 different EP studies of course)? What do you think the chance that I may have multiple foci? My condition is still very infrequent (less than once a year). Most of EP that I discussed my case with, all started out very optimistic about an EP study following by an ablation. Further in depth discussion always seemed to steer them toward indifference, since the first one failed to perform an ablation. Dr. Tucker, after some consultation with other colleague around the country came back with the idiopathic VT diagnosis, declared that my risk of SCD is almost as low as the general population. I know Lidocaine worked twice and Verapomil worked once. I usually can tell when one of these episode takes place and my blood pressure stayed well within acceptable range. I guess I am seeking for your opinions.
Thanks
Thai
Hello,
Check out this site.
http://www.lhsc.on.ca./uwodoc/pages/vt.htm
Scroll down the page , you will see it is a idoipathic Vt that responds to verapamil.
Your doctor is probably correct your risks of sudden death is about the same as the general population, no one is without risk, though it very small or minute.
good luck, i don't want to elaborate anymore, hope this gives you some insights.
flip(Lyn)
I was given a perscription of Covera hs (varapimil long lasting) I am afraid to take it because the last time the doc changed my meds, my heart rthyme worsened. I also read the side effects and O my, should not have done that.
Anyway I have bigeminy that last for hours also. These bigeminy just started a few months ago. I have had irregular skipped beats for over 30 years but nothing like this. They started with a change of medication i believe.
Also it has been quiet awhile since I had an echo test. Do you know if varapamil is less safe than similar drugs if one has not had an echo in since a change of rythme? Doc ordered it, so I GUESS it would be ok to try it. Just so scared to do ANYTHING that could make these irregular beats even worse.
I dont know what to do. I went to family doc a week ago today to get xanax. It seems to make me not notice the begeminy as much, but i still notice it. I get very tired when my heart beats like that for hours on end, and depressed.
MMDF, you said you took varapamil for 5 years.... then got cardiomiopathy(sp)?? Did you ever wonder if the verapimil might have caused it, or asked the doc if it could have?
To all, I am so upset with all this heart stuff..Meds, irregular beats, not being able to communicate with busy doc etc...I have found this forum very interesting and educational.... I would love for any of you that have similar problems to email me at ***@****. I Guess it would just feel good to "talk" to someone that is going through or has gone through the same fears & concerns.
rikku aka hopenprayers