NEED ECHO INTERPRETATION PLEASE!!!!!

[scottwvu]

I am a 35 year old father of 2. I have NO history of high blood pressure. No previous heart attacks. The only problems I have had are about 6-10 pvc's a day. I have a history of panic/anxiety attacks.
I recently went to a local ER due to an anxiety attack. They did an ECG which came back abnormal. They admitted me, and gave me an echo. (The doctors around here have the WORST bedside manner EVER! I finally got an appointment with a very reputable cardiologist, but it is not until Dec. 22nd. I am full of anxiety. No one has ever sat down and explained anything to me). Please help!

My echo report states the following:

M-MODE AND 2-D DOPPLER ECHOCARDIOGRAM:

The aortic root size is normal at 3.22.5 cm> The aortic root wall is normal in thickness. The systolic seperation of the three-cusp aortic valve is normal at 1.9cm. At end systole, the three-cusp aortic valve normally closes at the midline.The left atrial size is normal at 3.5 cm.The mitral valve diastolic seperation is normal at 2.3 cm. There is no systolic anterior movement of the mitral valve. The posterior mitral leaflet movement revealed no systolic buckling. The LV end diastolic dimension is normal at 4.7cm. The LV end systolic dimension is normal at 3.2cm. The LV posterior wall thickness is mildly hypertrophic at 1.5 cm. The septal thickness is mildly hypertrophic at 1.2 cm. There is normal LV free wall/septal contractility in the resting state. The estimated LV ejection fraction is normal, in the range of 60%-65%. There is normal pericardial fluid. The RV cavity size is normal at 2.2 cm. There is no left atrial thrombus. There is no vegitation. The color-coded Doppler study revealed trivial tricuspid valvular regurgitation with a peak systolic flow velocity of 192 cm/sec. There is trivial mitral valvular regurgitation and a peak systolic flow velocity of 113 cm/sec. There is no shunting at the ventricular or atrioseptal level. The peak systolic flow velocity across the pulmonary arteryvalve is 139 cm/sec. The peak systolic flow velocity across the mitral valve is 74/75 cm/sec. E/A ratio of

The study shows:
1. The heart chamber sizes are within normal limits.
2. There is normal LV free wall/septal contractility in the resting state. This is suggestion of concentric left ventricular hypertrophy.
3. The estimated LV ejection fraction is normal, in the range of 60%-65%.
4. There is normal pericardial fluid.
5.The color-coded Doppler study revealed no signifigant valvular regurgitation. There is no shunting at the ventricular or atrioseptal level.
6. The myocardial texture is normal.
7. There is reduced LV compliance/ LV diastolic dysfunction.
8. The mitral valve and aortic valve areas are reduced.
9. The RV systolic pressure of 46.81 mmHg would suggest mild to moderate pulmonary hypertension.


Wow....I understand very little. PLEASE, walk me through it. Also please answer these questions....
1. What lifestyle changes do I need to make? (I own a landscaping company and I ride dirtbikes and ATV's. The docs here told me not to change anything).
2. My heart has ALWAYS pounded hard after a meal. I ate a BIG one 25 minutes before the echo- could this matter at all?
3. Is there anything that can be done to fix whats wrong? Is there hope?

I have a 1-year old son and a daughter on the way. I love them both. More than words can describe. What are the chances of me being able to see them groe up?



THANK YOU in advance for any help,
                                                         Scott :)

[JRLRN]

Greetings! I am an RN. I was assessing an old stethoscope, and, while listening to my own heart sounds, I found a murmur (some people hear it, and some don't). I don't have chest pain, per se (I have an old shoulder injury that flares up from time to time), and I don't have any shortness of breath.

I am in grad school, which makes it a bit difficult to focus on a super-healthy lifestyle, but I do run as much as I can (4 miles maybe 3-4 times a week), and I am conscious of my diet and stress levels.

Let's just say, I was expecting everthing on my echo to read "normal," but instead, things look enlarged, thickened, regurgitated (trace to mild), with an EF of 45%-50%.

I have not had my echo "interpretation" with my primary care provider yet (just had the echo on Friday, and today is Monday). AM I DYING? IS THIS MYOPATHY (something to worry about?) OR IS IT ATHLETIC HEART SYNDROME?

My heart rate is in the 50s. No hypertension. I have some ^cholesterol, but got it early, got it while it was still in the low upper limits, and started Crestor pretty quickly.

I feel really discouraged...like I might as well be smoking, drinking excessively, and throwing caution to the wind (I know better though).

Can you advise?

JRL
***@****

[maggiemag]

Hmm, I wonder if your workload would work the same way as an athlete's heart.  An aerobic athlete can get some LVH.  When my son was a D 1 distance swimmer he did have a slightly enlarged heart with mild LVH.  Your 1.5 seems a tad too much for that though, imo.  And frankly, your workload wears me out just reading about it!  Sounds totally exhausting.  Take a vacation and enjoy those kids.  Hope you can get an appointment very soon.

[piepie]

Forgot to add I do have high BP but it's now normal on 5 mg of Bystolic. Back in 04 I had major major high BP because my run with anxiety then was nearly 2 years but this one has not lasted as long or been as bad. I have had three bad panic attacks but still have this weird rushes in my chest area (almost like electric shock sensations). My regular doc said this is not a symptom of PH and is probably just an adrenaline rush or my anxiety acting up. The PVCs bother me too. They are supposedly harmless but feel so scary when they happen.

[piepie]

Scott, boy can I relate. I am a 40 year old female. I was dx'd with panic disorder in 92 and have some on and off spells with panic attacks. In 2004 I had a bad attack and was in the ER with an abnormal EKG. I went on to have all the heart tests and the only abnormality was a PH reading of 52. My doc did a trans ech where they take the scope down and checked my pressure 6 times and it was normal. She wrote it off as a false reading and chucked my symptoms up to anxiety. This June I had another whopper panic attack and had another abnormal EKG so was put through all the tests again. All came back normal except again the PH pressure is now 38. Doc said not concerned at all and is not doing any futher testing. All other tests he did other parts of echo, cardiolite stress and holter were perfect. I am still having a lot of heart anxiety, skipped beat sensations, and all over anxiousnous and can't seem to get past the PH issue. They say they aren't concerned at all. Maggie, do echos really read PH falsely that often??? I was told they do not. Also I don't understand why a right heart cath was not done 4 years ago instead of a TEE. They say I need neither and I am fine. That my ejection fracture is perfect and heart is structurally sound and I walked for 15 mins on the treadmill and could have walked longer. Scott, keep us posted on what you find out and if you have insurance call them and complain about something called an "access issue" and ask them to help you get in with another cardio sooner. I work at a major health insurance company in the grievance dept so you can complain to try to get something sooner. Maggie I appreciated your response to Scott as well! Thanks.

[scottwvu]

Thank you sooooo much for your response! I can't tell you how much this means to me.

I am quite sure about the high blood pressure. Never had it, but will ask the cardiologist about this possibility for sure.

I work all the time. When landscaping, I work sometimes 12 hours or more in 90 degree heat. I can spread 3 dumptruck loads of mulch in a day. This is the first year I have ever worked THIS hard. I wonder if that has anything to do with the LVH?

Thanks again for your help! God bless!!!!!

[maggiemag]

Scott, I am sorry you weren't given more complete information.  Yes, the chances are great that you will be able to see your children grow up.  Your echo looks pretty good to  me, but remember we are not  physicians on this site.  I am just an RN, but with heart disease myself.  I doubt your large meal has anything to do with your echo.  It looks essentially normal except the DD and elevated pulmonary pressures.  I don't know how often you have had your BP checked in the past, but I suspect you may have had hypertension without knowing it.  That is the most likely cause for the left ventricular hypertrophy, as you seem to already know.  High blood pressure is also the most likely cause of the DD, which can lead to elevated pulmonary pressures.  However, an echo is only an estimate, and time and time again elevated pressures have been proven to be wrong on right heart cath.  You don't mention any symptoms like shortness of breath or passing out, that might be related to pulmonary hypertension.  The heart pounding after meals is probably nothing.  
Given your stated history of panic attacks, and the long wait til a cardio appointment, I would search around some more and find another cardio that you could see soon.  I doubt that a PH specialist would see you , given the lack of symptoms, and especially how inaccurate echo PA pressures are.  It is very doubtful that you have primary pulmonary hypertension, if that is what concerns you.  If a cardio finds you need a referral to a PH specialist, that would be great and could put your mind at ease.  But for right now, you need to be seen as soon as possible to help relieve your anxiety, as well as develop a treatment plan for the DD and LVH.  Hope this helps some!