Help with Echo Results - Cardiomyopathy or not?

[horselover7562]

I'm currently 54 years old.  I was dxd with hypertrophic cardiomyopathy, hypotension, sick sinus syndrome and bradycardia in 1983.  Sick sinus syndrome and hypertrophic cardiomyopathy were confirmed by cardiac cath and biopsy of heart muscle.  Symptoms included SOB, chest pressure and pain, fatigue with exertion, fainting.  In 1987 I had a single atrial lead pacemaker implanted.  In 1995 after multiple episodes of complete heart block I had a dual lead pacemaker implanted.  It will finally be replaced this next month sometime.

About 3 years ago I said something about hypertrophic cardiomyopathy to a cardiologist while in the hospital (completely unrelated to my heart) and he said, you don't have HOCM.  I said, no, I know I don't have any obstruction but I've been told by each successive cardiologist that I have a classic case of non-obstructive hypertrophic cardiomyopathy.  He said, no, you don't have it at all.  This same cardiologist told me a few weeks ago when I asked him about my latest echo results that there was no change between my current echo and my last echos.  I recently obtained a copy of the last two echo results and would like your opinions on whether or not there IS a change and if there is any indication of hypertrophic cardiomyopathy.  

I see my cardiologist (not the same one) June 3rd and I'm going to go over the reports with him at that time. I still have the same symptoms but the pacemaker does help with the fainting.  Have recently developed a cough that doesn't go away.

02/2007 Echo

Interpretation Summary:
Left ventricular systolic function is low normal
Ejection Fraction - 45%-55%
Septal appearance markedly hypokinetic

Left Ventricle:  The left ventricle is normal in size.  Normal left ventricular wall thickness.  Left ventricular systolic function is low normal.  Stage 1 diastolic dysfunction is present.  Severe septal hypokinesis.  Septum appears markedly hypokinetic.  There is no thrombus.

Right Ventricle:  Right ventricle is normal in size and function.

Atria:  Both atria appear normal in size and function.

Mitral Valve:  The mitral valve is normal.  There is trace mitral regurgitation.

Tricuspid Valve:  The tricuspid valve is normal.  There is trace tricuspid regurgitation.  Systolic PA pressure (by peak velocity of TR jet plus RAP) was 25-36 mmHg.

Aortic Valve: Probably bicuspid aortic valve.  No aortic stenosis.  No aortic regurgitation.

Pulmonic Valve:  There is no pulmonic valvular regurgitation.

Great Vessels:  The aortic root is normal size.  There inferior vena cava appeared normal.

Pericardium/Pleural:  Pericardium appeared normal with no pericardial effusion present.

Measurements with Normals:

IVSd: 1.1 cm (0.6-1.1 cm)
LVIDd: 4.7 cm (3.7-5.7 cm)
LVPWd: 0.90 cm (0.6-1.1 cm)
LVIDs: 3.5 cm (2.5-4.0 cm)
Ao root diam 2.0 cm (2.0-3.7 cm)
LA dimension 3.5 cm (1.9-4.0 cm)

MMode/2D Measurements & Calculations:

FS: 26%
LVOT diam:  1.9 cm

Doppler Measurements & Calculations:

MV E max vel: 77 cm/sec
MV A max vel: 81 cm/sec
MV E/A: 0.94
LV IVRT: 0.13 sec
MV dec time: 0.18 sec
Ao V2 max: 128 cm/sec
Ao max PG: 7.0 mmHg
AVA(V,D): 1.8 cm
LV V1 max: 81 cm/sec
LV max PG: 3.0 mmHg
TV V2 max: 195 cm/sec
TV max PG: 15 mmHg
PA acc time: 0.13 sec
PA pr (Accel): 22 mmHg
Pulm A Revs Vel: 22 cm/sec

02/2010 Echo

Interpretation Summary:

Left ventricular systolic function is reduced.
Ejection Fraction: 40-50%
Regional wall motion abnormalities as noted.
Premature ventricular contractions noted during study.

Left Ventricle:  Left ventricle is normal size.  Left ventricular systolic function is reduced.  Ejection Fraction - 40-50%.  Stage II diastolic dysfunction was present.  There is septal akinesis.  Moderate global hypokinesis of the left ventricle.  There are regional wall motion abnormalities.  There is moderate anteroseptal wall hypokinesis.

Right Ventricle: The right ventricle is normal in size and function.

Atria:  Borderline left atrial enlargement.  Right atrial size is normal.

Mitral Valve:  The mitral valve is normal in structure and function.  There is trace mitral regurgitation.

Tricuspid Valve:  The tricuspid valve is normal in structure and function.  The is trace tricuspid regurgitation.

Aortic Valve:  The aortic valve is normal in structure and function.  The aortic valve opens well.  No aortic stenosis.  No aortic regurgitation is present.

Pulmonic Valve:  The pulmonic valve is not well seen but is grossly normal.

Great Vessels:  The aortic root is normal size.  The proximal ascending aorta appeared grossly normal.  The inferior vena cava appeared normal and decreased > 50% with respiration (RAP 5-10 mmHg).

Pericardium/Pleural:  Pericardium appeared normal with no pericardial effusion present.

Measurements with Normals:

IVSd: 0.9 cm (0.6-1.1 cm)
LVPWd: 1.4 cm (0.6-1.1 cm)
LVIDd: 4.5 cm (3.7-5.7 cm)
LVIDs: 3.5 cm (2.5-4.0 cm)
Ao root diam: 2.9 cm (2.0-3.7 cm)
LA dimension: 3.8 cm (1.9-4.0 cm)

MMode/2D Measurements & Calculations:

FS: 22.2%
EF (MOD-sp4): 45.0%
LVLd ap2: 7.3 cm
LVLs ap2:5.7 cm
EF (MOD-sp2): 34.4%
SV (MOD-sp4): 36.0 ml
SV(MOD-sp2): 21.0 ml

Doppler Measurements & Calculations;

MV E max vel: 64.8 cm/sec
MV A max vel: 80.6 cm/sec
MV E/A: 0.80
PA acc time: 0.14 sec
MV dec time: 0.19 sec
TR max vel: 118.0 cm/sec
TR max PG: 5.6 mmHg
Ao V2 max: 139.0 cm/sec
Ao max PG: 7.7 mmHg
PA pr (accel): 15.5 mHG
LV V1 max PG: 2.5 mmHg
LV V1 max: 79.7 cm/sec
Pulm A Revs Vel: 27.0 cm/sec

Does anyone see anything that I should specifically ask my cardiologist about?  Some intelligent sounding questions would be good.  

I would particularly like to know (if anyone knows) what the difference is between an ejection fraction of 40-50% is and then in the MMode/2D Measurements section is says EF (MOD-sp4) is 45.0% and EF(MOD-sp2) is 34.4%.

Thanks for any help you can give me.

[horselover7562]

Thanks for responding.  Good luck on your echo on Thursday.  Let us know how it goes.

Not all normal.  There is hypokinesis and akinesis of the septum and (I think) left ventricle.  Plus my ejection fraction has dropped (altho it still isn't very bad) .  Left ventricle systolic function is reduced, stage II disastolic dysfunction, etc.

Anyway, hopefully someone will be able to tell me something.  If not, then like I said, I see my cardio on June 3rd.

[heartfluttersflyawayplz]

not sure how to read but it says all normal. am having one thursday hope mine normal. hope someone can tell you all about it