. In 2004 I had an echo that said all was fine no LVH but this April I now have an echo report which says I have mild LVH at 13mm. All other parameters appear to be normal and the report describes my heart as within normal limits in structure and function. I have an ejection fraction of 74 per cent and nothing is dilated I am not tall, am male aged 48. about 68 KG and 5 feet 6 inches. I have various diagnosis, sometimes they say it is white coat hypertension, one doctor has said I am not hypertensive and the other that I am borderline but need not take medication. Typical ambulatory studies have produced results like 132/86 135.91 and I get averages around this on my home monitor, and low readings as well like 115. 72 My BP is not consistently raised However that was all before the latest echo. However, I have my ECG's over the years, and applying voltage criteria I do not reach LVH but all the relevant waves in the voltage criteria leads are the same height, both before and after the diagnosis of LVH, about 5 different ECG, all hospital and technician or nurse arranged.
1. I wonder whether the echo interpretation is reliable, given that no extra voltage has been required to penetrate the myocardium over the years
2. If there is LVH, my heavy duty exercise routine of fast cycling, hill walks and power walking, may be responsible for 'physiological' rather than pathological (hypertensive ) LVH I have a resting pulse between 50 and 55, a lower sternal edge (I think it was called) ejection murmur) no dilation on echo, normal diastolic and systolic function and EF of 74 per cent my 'untreated ' BP has been like it is since I was in my 20's as has my exercise routine I am now 48
Thanks for the reassurance, however, your reply isn't so useful for me because my questions are technical and really needs a doctors response, which I hope will arise.
BTW, 120/80 is normotensive in the UK and EU Obviously though I agree lower is generally better
Of course your exercise routine could be the cause of your mild LVH, on the other hand it probably isn't , its probably due to your mild hypertension over the years that is clearly now recognized as not desirable, some people get away with it some don't, that s what happened to me, it could also be a readers error, if in doubt get an another echo within 6months -1 year in the meantime , keep your BP controlled on the low side once you don't get symptoms, just my opinion of course!
Forgot to mention people with high end ejection fraction such as yours is often to a mid systolic murmur due to the high volume ejected, once again I think you can be reassured not worry ,just keep your BP under control , of course I'm no doctor just been down a similiar and worried myself silly
Hi Tickertock, Thanks again. I'm still hoping that a doc on here can have a look at my original post, however, I am going to list all the findings of my echo.
LVS thickness 13mm
LVID (d) 45.9mm
LVID (s) 26.1mm
posterior wall thickness 13.1 mm
LVEF (2D) 74 per cent
Left atrium diam PLAX 33.1mm
Right Ventricle TAPSE 20mm
Aortic Valve 122.cm/s
Max LV aorta gradient 6mm/hg
Pulmonary valve 111cm/s
Max RV-PA gradient 5mm/hg
E 65 cm/s
A 50 cm/s
mitral DTE 202 ms
The echo report also says
Left Ventricle Normal wall motion, non dilated LV, mild symmetric LVH, MAPSE 13mm Turbulent blood flow seen in LVOT
Left atrium non dilated
Non dilated right ventricle, normal systolic function
no aortic dilation, normal; aortic calve, no stenosis or regurtitation
normal mitral valve, no stenosis physiologic MR grade 0 to 1]
Tricuspic normal , Physiologic TR grade 0 to 1
same for pulmonary vavle
and no pericardial effusion
As for my ECG taken the same day, it was said to be noral.
The reason I wonder about whether the exercise as a cause is that I read an article in Maedica, an online clinical journal, in fact a paper about differentiating between physiological and pathological LVH, as well as some other materials I have read. Apparently, it cannot be assumed that LVH in a hypertensive is pathological, though often it is. If there is an intensive engagement in exercise it can have the same result of LVH developing. However, it is suggested that where there is no dilation, normal atrium etc and a low pulse rate as well as a certain type of ejection murmur, and normal systolic and diastolic function then these are findings more likely to be associated with physiologic LVH than hypertensive. The article suggests that tissue doppler imaging is a technique with potential to differentiate pathological from physiological and this is a technique feasible on most commercially available echo machines. Its hard for me to accept I have pathological LVH given my other echo findings and the fact that in the ecg leads relevant for LVH voltage criteria the voltages have not increased between my no LVH ech in 2004 and my LVH echo in 2011 and yet the percentage vof echo 'increase ' in ventricular wall thickening was not marginal between those times I am told it has gone from below 12 to 13 . My blood pressure has it seems been about the same for over 20 years
Why should one be concerned to know if it is pathological or physiological
Each carries a different risk and approach borderline hypertension and 'physiological ' LVH carries little risk compared to pathological hypertension. physiological
That said I do not fully understand all dimensions of my echo report, in particular the haemodynamic parameters. The doctor wouldn''t expand on these as he said it was too complicated
The echo btw, took only 10 minutes. My first one 7 years ago took almost half an hour.
Just measured the ECG's again, adding the S wave in V1 and the R wave in V5 I get a total of 32mm for the recent ECG which followed my echo detecting LVH and doing the same for the 2004 ECG, which was around the time I also had my echo then which showed no LVH, the voltage was in fact 34mm then and it is 32 mm now.
This is on the sokolow lyon voltage criteria. On this basis the ECG evidence suggests a reduction in left ventricular thickness over time, rather than it having hypertrophied
Maybe if one of the doctors that visit this forum and answer questions can also indicate whether a reduction in voltage produces grounds to query an echo report of ventricular wall thickening between those periods
You can't go by the ecg in diagnosing LVH, its usually wrong! When my IVS was 12mm , I had the minimal voltage criteria for LVH, when it measured 14mm, I had no voltage criteria at all for LVH, go figure!! Will be interesting to see the Doc response!
I agree with you, but I am only suggesting the ECG voltage pattern in my ECG's as a partial indicator that the echo finding may be lacking dependability given the physiological LVH features I described in my findings. I agree with you about ECG voltages, in fact
ECG fails to detect heart attack changes in a large number of cases even when it is happening ! BTW, 12mm LVS as in your case reaches the LVH diagnostic threshold but ECG usually misses 'mild' levels of LVH
I'm hoping a doc will review this thread and answer my questions and look over our discussion to see what clarification they can offer.
Have done a home blood pressure study since late afternoon yesterday to include first thing awakening and the first hour of being awake . Total 35 readings with a arm monitor a few months old with fresh batteries
averaged by totalling each and dividing by the number of readings
This depends on your age, nowadays ( February , 2014) the new guidelines on this matter suggest that the upper borderline for people 60 years plus is up to 150/90 and below 60 years, up to 140/90. The more they push for a lower blood pressure for everyone, the more patients on anti hypertensive drugs ( with all their side effects) and the more money to the coffers of the pharmaceutical manufacturers ( which is the true mover behind this craziness).
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