Is left atrial enlargement serious?

[luckymucamow]

My boyfriend woke up in the middle of the night las night with chest pains. It felt as if he had pulled a muscle in his chest and it hurt in his est when he swalloed. That night he went in to the ER and had an EKG done. The cardiologist said it looks like it may be "left atrial enlargement." This pain in his chest only lasted for 2 days and now he feels 100% better but the doctor recommended an echo.
Does this sound serious?  And what can be the cause?

Thank you, I'm so worried I can't sleep.

[Cjt1610]

Curious to know what they found. I had something similar happen to me and they told me it was my esophagus. Did a Ct scan of the chest and everything was fine. Thanks for your helo

[torontoafibguy]

I have aFib and my left atrium has enlarged to 60mm. Started TIKOSYN and now in Normal Sinus Rhythm.  Blood pressure now totally under control as well.  Size after a year and change? 55mm.  Asked if it will shrink further and cardiologist shrugged.  Said "you are in NSR and your ejection fraction is 60% (that of a 30 year old in good health) - stick to the program and perhaps we will see further shrinkage but it will take a long time.

[Bob007]

I have just been diagnosed with AF. I had several years of periodical irregular heart beat but my medical providers overseas did not paid much attention to it because it was not life threatening. Now that I became elligible for medicare coverage, my cardiologist put me on Coumadin immediately and said after my INR stablises, he will do a Cardioversion on me. My ecogram shows my left atrial size has enlarged to 5.4 which is much larger than the normal 4. My blood pressure has been controlled for the past 4 years. How dangerously large is my left atria? and will it size shrink back to normal after treatment.
Thanks,
Bob

[luckymucamow]

Thanks for the vote of confidence!

We're still waiting in the results of the echo. It's incredibly frustrating.

[kenkeith]

An EKG is not a reliable test for determining chamber dimensions and intra-chamber pressures that influence gradient pressures and valve insufficiencies.  An echocardiogram (doppler program) will evaluate the blood flow from the atrium down to the left ventrical and observe mitral valve integrity and if the mitral valve opening is narrow (stenosis...calicified or congenital), the gradient pressure will be higher than normal and the increased pressure causes the LA to dilate.  That could be a cause (worst case scenario), and if that is the cause the degree of stenosis determines the seriousness.  I'm on the side there is no problem!

[luckymucamow]

He went in and got an echo today but he has to wait a few days for a cardiologist to look at it.

Thank you for answering my questions, you're angels.

[erijon]

That is correct, an EKG is not a dependable tool for measuring chamber size. Unfortunately, an echo, while a better tool, is also not perfect when it comes to measuring the size of the atrium. The best way is to measure the volume of the chamber, which is almost never done,. mostly because an enlarged atrium may just be normal for the individual. It is considered a normal variant in many cases. An echo takes pictures of a "slice" of the heart. If the axis of the heart is off then the slice will be larger even though the size is normal. Here's an example, you take a banana and cut it at a perfect 90 degree angle, that slice will be smaller than if you cut it at a 45 degree angle, even though it's the same banana. I have an enlarged left atrium but the cardiologist says it is just normal for me and nothing to worry about, just something to watch every few years.

The real issue with an enlarged atrium is that it is a sign of an underlying problem, usually high blood pressure and can be more prone to afib which leads to a higher risk of stroke. He needs to find out what is causing the enlargment if real and deal with that issue first.

Hope this helps,

Jon

[madjlp]

EKG is a great gatekeeping test but it is not particularly accurate for determining things like atrial size, so an echo is probably the right move (very accurate for measuring the chambers of the heart).  The most common cause of atrial enlargement is high blood pressure and can be treated in a variety of ways that often allow the atrium to return to a normal size.  Given the details of the pain you describe (I'm also assuming the ran blood tests in the ER) it seems most likely that the ekg variation is an incidental finding and the pain was unrelated to the heart but it is always best to be cautious and have a Dr. check him over - get the echo done for your own piece of mind.  Hopefully sleep will find you soon.  Good luck.