Thank you so much for taking my question. I am 35 female 135 lbs, non smoker and non drinker. Have weird symptoms for the past ten years ie (hair loss at times, achy body, muscle twitching, weight loss episodes of about 15 pounds). On a colonoscopy I had in July of 2007 a 1 cm. ulcer in my illeum which is getting better, doctor thought it was due to a positive C. diff test and/or possible inflammatory bowel disease. Antibiotics cleared up the infection. My thyroid has been fully evaluated and is fine, also negative lupus panel. For the past two years I always have daily palpitations (PVC's) and racing upon exertion followed by pvc's. Sometimes my heart will race and palpitate during a whole walk and then the next week I feel fine. I occasionally feel chest pressure with these episodes and like I can't get a deep cleansing breath. I especially notice the heart racing in the mornings upon rising out of bed or when I take a shower. When I do exercise the palpitations are usually in the beginning when my heart speeds up and in the end especially when my heart tries to slow down. I rarely have any problems when I am sitting, sleeping, or not exerting myself. Here are a couple of specific examples of what happens: I went on a bike ride today and my heart palpiated the whole time and then when I sat down to rest it palpitated for a few more minutes and then turned to normal after about ten minutes. Yesterday when I was driving to work my heart was fine and then I walked a block or so to my office got there and slowed down and my heart thumped and skipped a few beats several times and then returned to normal. Sometimes I feel chest pressure with these episodes and sometimes I don't. This problem makes my daily life a struggle which concerns me there is something really wrong with me. My recent echo revealed:
left atrium 30 mm
aortic root 28 mm
1. Normal left ventricular size, wall thickness, wall mothion and systolic function, estimated left bentriuclar efection fraction is 55-60%
2. Normal right ventricular size and systolic function.
3. Normal atrial sizes. Left atrial area is 16 cm2, left atrial volume 34 ml, right atrial area 12 cm2, right atrial volume 27 ml. normal inferiro vena cava asize with normal respiratory changes is consistent with normal right atrial pressure.
4.Trileaflet aortic valve. Peak aortic valve velocity is approximately 1.0m/sec. no aortic regurgitation.
5. Normal mitral valve morphology and motion. Mitral valve E velocity is 75 cm/sec: E' velocity is 24 cm/sec; peak mitral valve A velocity is 44 cm/sec. A' is 14cm/sec; E/E' is 3, consistent with normal left atrial pressure. Mitral valve isovolumic relaxation time is 92 msec. Mitral valve deceleration time of 222 msec is within normal limits. Pulmonary vein profile reveals co-dominance consistent with normal left atrial pressure. No mitral regurgitation.
6.Trace Tricuspid regurgitatoin. Tricuspid regurgitation velocity is 2.2 m/sec. Estimated right ventricular systolic pressure is 29mmHg (if right atrial pressure is 10 mmHg) which is consistent with normal pulmonary artery pressure.
7.No pulmonic valve regurgitation. time to peak velocity of right ventricular outflow tract is approximately 156 msec which is consistent with normal pulmonary artery pressure.
1. Normal left ventricular size and ejection fraction
2. Trace tricuspid regurgitation (normal variant) with normal pulmonary artery pressure
My stress test revealed PVC's as well as my holter
My questions are:
1. what does "tricuspid regurgitant velocity is 2.2 msec. Estimated right ventricular systolic pressure is 29mmHg (if right atrial pressure is 10 mmHg) which is consistant with normal pulmonary artery pressure" mean? I have read that 29 is kind of high and don't understand the wordage of this statement.
2. In finding #3 above what does "respiratory changes" mean?
3. What does "pulmonary vein profile reveals co-dominance mean?
4. Do you see anything that I need to be worried about? I am specifically worried about pulmonary hypertension because I have had the relentless symptoms of it for at least two years.
5. Do you recommend or suggest any other kinds of testing I may need based on this echo and my history?
I apologize for this being so long and any advice would greatly be appreciated. Thank you so much.
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