MI or Cardiomyopothay

Hello, I was wondering if someone could help me out. I was told by one Dr. I had a MI then told  by another doctor I may not have had an MI. Someone else mentioned Cardiomyopothy. If anyone has any ideas I would definetly appreciate it. I just had a echo stress test today, supposedly no restrictions. But of course I am worried and have no idea what is going on. Was told that the results of an ECG were abnormal, 40 BPM, Marked Sinus BradyCardia. The results of my echo were the following:

1.Left ventricle: normal left ventricular cavity size. Mild Concentric hypertrophy of the left ventricle. Severe Hypokinesis of the inferoseptal wall. EF Est. at 55-60%
2. Right Ventricle: Normal right ventricular size. Normal right ventricular global systolic function.
3. Left Atrium: Top normal left atrial size
4. Right Atrium: Normal right atrial size
5. Interatrial septum: no patent foramen ovale present by color doppler.
6. Mitral Valve: Structurally normal mitral valve. No mitral prolapse present. No mitral stenosis. Trace mitral regurgitation.
7. Aortic Valve: trileaflet aortic valve. no aortic stenosis. No aortic regurgitation noted.
8. Tricuspid Valve:  normally structured tricuspid valve. Trace tricuspid regurgitation noted.
9. Pulmonic Valve: Structurally normal pulmonic valve. No pulmonic stenosis. Trace pulmonary regurgitation.
10. Masses and Vegatations: no masses/vegatations noted.
11.  Aorta: Aortic root is normal size. Ascending aorta is normal in size.
12. Pericardium: No pericardium effusion

Measurements:
LV Diastolic Diameter PLAX 4.1cm
LV Systolic Diameter PLAX 2.7cm
LV Fractional Shortening PLAX 33.1&
Rv Internal DIM ED PLAX 3.4cm
IVS Diastolic Thickness 1.2cm
LVPW Diastolic Thickness 1.2cm
LA Systolic Diameter LX 4.1
Aorta at Sinuses Diameter 2.9cm
Aorta at Sinotubular Diameter 2.6cm
Ascending Aorta Diameter 2.8cm

[kenkeith]

QUOTE: Left ventricle: normal left ventricular cavity size. Mild Concentric hypertrophy of the
left ventricle. Severe Hypokinesis of the inferoseptal wall. EF Est. at 55-60%.

The severe hypokinesis (wall movement disorder) of the inferoseptal (lower portion of the septum).  This report indicates there is heart cell damage of the septum (wall that divides right and left chambers).  Usually, that condition idicates an infarct (heart attack) of the heart cells and this condition usually causes a lower than normal ejection fraction (normal EF is 55-70% and is the amount of blood pumped out of the left chamber with heartbeat).

The inferoseptal doesn't require much movement for tthe heart's contractions so that may explain a normal EF and the  inferoseptum hypokinesis.  However, if there was no infarct how does the cardiologist explain the hypokinesis?  Heart muscle disease?

EKG will report an abnormal result if the heart rate is above 100 or below 60.  The doctor evaluates whether or not that is a problem when viewed with history, medications, etc.

There are no other problems shown on the report.

[myron96]

Ken,
Thanks for the reply.  I def. appreciate it. I actually just got the results back of an Echo stress test and apparently nothing abnormal showed up and there were no defects. Im definetly relieved but of course still perplexed as to how the results of the first test were drawn...

[grendslori]

Myron, there is a lot that you need to understand about this. You have Hypertrophic Cardiomyopathy (HCM). Your EF% will be in the normal range, or even slightly higher than normal. Low EF%s are a result of Congestive Heart Failure (DCM, Dilated Cardiomyopathy) and run under the 50% range. Concentric means that the enlargement is all through the walls not just the septal wall. All of those findings would lead you to have a hypokinesis; that is where the contractability of the walls are impaired due to the thickened wall structure. When the walls of the heart become too thick, they lose the bloodflow to the walls and therefore you can have heart attacks throughout those walls all the time. I think my daughter had her first heart attack at 12. By the sounds of it, your disease process hasn't really hit the stage of that happening though. Your valves are okay which is a good sign. This form of heart failure is referred to as DIASTOLIC as opposed to SYSTOLIC which is the cause of CHF Systolic failure is referring to the pumping action of the heart not being good; diastolic is referring to the relaxation of the heart walls not being good. They are two different types of heart failure and the EF% are different in each case.; low in DCM, normal in HCM.

[kenkeith]

Gee, we must be reading different reports!

QUOTE: "1.Left ventricle: normal left ventricular cavity size. Mild Concentric hypertrophy of the left ventricle. Severe Hypokinesis of the inferoseptal wall. EF Est. at 55-60%
2. Right Ventricle: Normal right ventricular size. Normal right ventricular global systolic function.
3. Left Atrium: Top normal left atrial size
4. Right Atrium: Normal right atrial size ....."

ISSUE:  Mild Concentric hypertrophy:   Concentric LV geometry (geometry is normal) is the  condition associated with more severe hemodynamic (afterload...high blood pressure) and structural abnormalities and represents an unfavorable LV adaptation (EF is normal).

QUOTE: Severe Hypokinesis of the inferoseptal wall. EF Est. at 55-60% .  There is no wall impairment from a thick wall or septum according to the report.  The report states a myocardial infarct (MI), and that condition damages heart cells and causes hypokinesis (impaired wall movement).

No other problems noted other than EKG report and that appears to be insignificant.

[grendslori]

I guess we are reading different reports Ken. There is a huge difference between reading a report and living with HCM. Those numbers may not mean anything. (mild forms of this disease can cause severe symptoms in some patients while more severe forms of this disease can go unnoticed by others.) According to the report the IVS and the LVPW are both very slightly thickened, therefore he has a diagnoses of: Mild Concentric Hypertrophy. Even at those levels there can be hypokinesis. One doctor said he had a MI, the second doctor wasn't sure that was the case at all, so who do you believe? So are you saying this person had a heart attack? Heart attacks can cause this problem, but a heart attack is readily seen on the EKG, up to even several days after. Chamber sizes in HCM can certainly remain the normal size for a long time.

[kenkeith]

QUOTE:  "There is a huge difference between reading a report and living with HCM. Those numbers may not mean anything. (mild forms of this disease can cause severe symptoms in some patients while more severe forms of this disease can go unnoticed by others.)"

>>> It is maintaining the objectivity of the test report that is my position and what I am relating to.  We all know the subjectivity aspects of a medical condition, i.e. low EF feel healthy, normal EF unhealthy, etc, etc. and not relevant as symptoms have not been shown.


QUOTE: "According to the report the IVS and the LVPW are both very slightly thickened, therefore he has a diagnoses of: Mild Concentric Hypertrophy".

.>>>That inconsistent with the report of normal left ventricle cavity size.  An enlarged left ventricle posterior wall (diastolic) and enlarged intraventricular septum (diastolic) is inconsistent with the report of  "Mild Concentric hypertrophy of the left ventricle" as concentric hypertrophy reduces filling space and leads to diastolic heart failure...no evidence of that condition... LV cavity size is normal.

Also, chamber, wall, etc. dimensions with M-Mode by echo is an estimate and the dimensions reported are well within the margin of error and very possibly no basis for concentric hypertrophy.  There is a need to establish a basis and a series of tests to make a credible diagnosis.  Size can vary by body size, age, gender, etc.  M-mode echo criteria of LV hypertrophy performs too poorly to be clinically applicable.

I recognize as does Myron that there is a conflict and inconsistency of evidence so I'm not saying there was a prior MI or not (doctor should clarify).  Also, a normal EF does not support any heart wall movement.  If you understood how the EF calculation is made, you would not put any serious validity into the dx of hypokinesis.:)

Also, I see the EKG abnormality related to slow heart rate, <60 bpm, and I don't read into the EKG report anything else.