LA Size

I have a couple questions about an enlarged left atrium. On my last echo, everything was normal with the exception of an enlarged LA at 4.9 CM. I was told that it was within the normal variant and that an echo is not necessarily always accurate, that the only accurate way is by a LA Volume test, but they are not commonly done in patients without symptoms as it is not usually diagnostically significant. She also told me that because I have lost some weight (60 + pounds) that the axis my heart is on may have shifted causing a reading that could be wrong. She ended by saying even if it is correct it may just be "normal for you" and that my echo was considered normal and my heart was structurally fine.

About me, I'm a 50 year old male, exercise 45 - 60 mins per day at 75% of max heart rate with appropriate BP and HR response, never have any cardiac symptoms, still about 50 pounds overweight and have had two normal nuclear stress tests in the past 4 years, only had them because I had some chest pain one evening, turned out to be a bad gallbladder that took 2 years to identify, had it removed and the pain went away. I have no other risk factors, don't smoke or drink, no family history, have controlled high blood pressure and great cholesterol numbers although tri's can run a little high.

My question is, at what point does an enlarged LA become problematic and what do you think about my cardiologist's comments?

Thanks!

[Cleveland Clinic]

If you have no risk factor such as high blood pressure, atrial fibrillation coronary artery disease or sleep apnea the likelihood that this is a normal variant is quite high.  If you have any of those factors then the atrium is probably enlarged pathologically.  She is right in that this measurement is not very accurate and that LA volume index is much more predictive of outcome.