How Do I Proceed?

[JRLRN]

How do I proceed?

Greetings! I am an RN. I was assessing an old stethoscope, and, while listening to my own heart sounds, I found a murmur (some people hear it, and some don't). I don't have chest pain, per se (I have an old shoulder injury that flares up from time to time), and I don't have any shortness of breath.

I am in grad school, which makes it a bit difficult to focus on a super-healthy lifestyle, but I do run as much as I can (4 miles maybe 3-4 times a week), and I am conscious of my diet and stress levels.

Let's just say, I was expecting everthing on my echo to read "normal," but instead, things look enlarged, thickened, regurgitated (trace to mild), with an EF of 45%-50%.

I have not had my echo "interpretation" with my primary care provider yet (just had the echo on Friday, and today is Monday). AM I DYING? IS THIS MYOPATHY (something to worry about?) OR IS IT ATHLETIC HEART SYNDROME?

My heart rate is in the 50s. No hypertension. I have some ^cholesterol, but got it early, got it while it was still in the low upper limits, and started Crestor pretty quickly.

I feel really discouraged...like I might as well be smoking, drinking excessively, and throwing caution to the wind (I know better though).

Can you advise?

JRLRN

[kenkeith]

You are welcome and thanks for the question.

[JRLRN]

Thank you so much for your response! Interestingly, you talked about "global cardiac remodeling," and per the echo result, the LV has "mild concentric left ventricular hypertrophy," LA is "mildly dilated," RA is "upper lilmits of normal," and RV is "mildly enlarged." And, of course, as you mentioned, there is mild to trace valve leakage, which is often benign.  

When I research athletic heart syndrome, the findings sound so much like my own echo (as far as I can tell), only an interpretation & diagnosis have not been established by a physician yet (as a matter of fact, my primary care provider still has not called me...no news is good news?).

I thank you for going into EF for me, and then explaining the margin of error --good point!

kenkeith, I greatly appreciate this dialogue!

Sincerely,
JRLRN

[kenkeith]

The ejection fraction is an estimate, and it isn't a static parameter...it varies as does the blood pressure and heart rate.  That an other copmpensitory factors maintain a balance of blood flow from left side to right side. There is a margin of error of about 7%. and that would put you in the normal range (50 to 70%). Your resting heart rate is below 50 at rest and that may indicate an athletes well  conditioned heart.

Chamber size, wall dimensions may be a distiquishing factor.  With the athlete"s  LV, physiologic left ventricular cavity enlargement is associated with enlargement of the right ventricular and atrial chambers, as an expression of a global cardiac remodeling. In  athletes, the maximum left ventricular end-diastolic cavity dimension does not exceed 7.0 cm, that likely represents the upper limit of physiologic left ventricular enlargement.

For some insight: "In patients with dilated cardiomyopathy, on the other hand, dilatation of both ventricles is common, but left ventricular enlargement usually predominates and may be substantial, as an expression of primary myocardial disease. The enlarged left ventricular cavity in athletes maintains the normal ellipsoid shape, while LV cavity in patients with dilated cardiomyopathy usually achieves a more spherical shape, in association with impaired contractility and deterioration of the clinical status. Indeed, in dilated cardiomyopathy, mitral regurgitation is common, due to dilatation and distortion of the mitral ring. Left ventricular wall thickness may be within normal range in both instances, but relative wall thickness is usually (mildly) increased only in the athlete’s heart".

Mild/ trace etc. for valve leakage is not considered medically significant.
Hope this helps you for an informal self -appraisial and a perpective for consultation with your doctor.  Take care.