I need someone to explain the severity of this Echo report that was dated back to 07/19/2005 this report was not brought to my attention until August 11, 2008. Now 3 yrs have gone by, and I just had an EKG/Echo done 08/11/08 at my Doctors office which has been faxed to the cardiologist. I have an appointment Monday with the cardiologist. My question is: after 3yrs from the date of this report without any advice or knowelege of the perticular report has (or) could cause more damage to the heart I can only think it has. I was told my doctors practitioner that I may need a Defibrillor implant. This has me worried to death. That my (EF) is at 30 - 40% this is not good. The percentages have to be less. I been diagnosed with cardiomyopathy, (AF), CHF), enlarged heart, type 2 diebeties, hi (BP) average (BP) rate 120/80 body weight 400lbs 6'3".
M-MODE DIMENSION PATIENT NORMAL
RIVD (ed) 2.2cm
LVID (ed) 3-5.3cm
LVID (es) var.
IVS (ed) 5-1.3cm
LVP WALL (ed) 0.8-1.2cm
LVP WALL (es) 0.8-1.2cm
AO Valve opening >1.8cm
AO (ed) 4.0 2-3.8cm
LA (es) 6.0 2-4cm
Mitral Valve Slope ( E-F) > 7.0cm/sec
Excursion > 1.5cm
M mode, 2-D M and Doppler wave study were performed. Left ventricular systolic dysfunction. Ejection fraction 30 - 40%. Anterior and anteroseptal hypokinesis. Mildly dilated right ventical
Moderately dilated left atrium. Borderline size of aortic root at 4 cm.
There is no pericardial effusion or intracardiac thrombi.
No structural valvular pathology is seen.
Dpller wave interrogation reveals the presence of mild mitral and moderate tricuspid regurgitation. Mild pulmonary hypertension at 40mmHg
Conclusion: 1. Technically difficult study with poor window.
2. Left ventricular systolic dysfunction. Ejection fraction 30 - 40%
3. Anterior and anteroseptal hyokinesis
4. Mildly dilated right ventrical.
5. Moderately dilated atrium
6. Borderline size of the aortic root at 4 cm
7. Mild mitral and moderate tricuspid regurgitation.
8. Mild pulmonary hypertention at 40 mmHG.
There was a "technically difficult window" meaning the estimates are not very reliable. I haven't ever seen a report that is gives a range of 10% between two estimates for an EF. Normal EF is 55 to 75%.
Hypokinesis is an impairment of wall movements at the location described. That would be consistant with a lower than normal EF. Regurgitation that is mild is considered medically insignificant, moderate regurg should be closely monitored.
Pulmonary hypertention is the resistance the right side of the heart has to pump against and probably is the cause of the enlarged right ventricle
thanks for the info,
Do you think, (or) can anyone tell me if I should have had an MRI (or) a cardiac catheterization test done as to the results of this echo report above? and also! would I be looking at having a Defibrillator implanted. What are the guarantees if a decision is made by my cardiologist to have one implanted. I've been reading bad things on the internet and the two thing that stand out most of all is
"Patients with low (EF) are significantly more likely to suffer sudden cardiac death within two years than patients with normal (EF)"
Defibrillator: These are used primarily as "bridge to transplant" meaning that they help patients with a low (EF) while they await a heart transplant. this is what has me scared to death. I haven't had an MRI (or) a cardiac catheterization test done in 8 -9yrs ago. My only treatment are med's:
Gee, why didn't anyone give you the results of the echo? To tell you the truth, since it was so long ago, it would probably be irrelevant now, and you would need it redone. Since you are on the right meds, the results COULD be better. The target dose of the Carvedilol is 50 mg. twice a day for someone your weight, and your bp is not low so they could raise that med. If a repeat echo would show an EF of less than 35%, you could very well be a candidate for an ICD. But it could save your life! So it would be a good thing and you will adjust I'm sure. But for now, I would take it just one step at a time and get another echo. For what you want, it would be more accurate than the MRI, and you probably don't need a cath. But I am not a doctor and I would get to a very good cardiologist and have the echo at a place with high volume. Ok, I see now that you have already had a repeat echo, so forget what I said about getting one again! Good luck.
Thanks, No Idea why I wasn't told of the echo results, the practitioner who is a new member of my MD's staff couldn't answer me either she is the one who brought this echo result from 2005 to my attention. But! I'll be seeing the cardiologist on Monday the 18th, this is the cardiologist that tended to my needs when hospitalized less then a year ago, with (CHF) and (AF) they drained about 60 lbs of fluids out of me, and nothing was ever mentioned about my (EF). since my last discharge from the hospital I haven't felt good at all. the past 6 times when discharged I felt like a new person, and I've made many complaints as to how I feel, weak, tired, shortness of breath getting worse, slight dizziness, no fainting though, thank God.
I had CHF more than 4 years ago (EF 13-29%) Furosemide was discontinued after several months once my heart recovered and EF was strong enough to pump the oxygenated blood from the lungs. With your EF range you may not need the diuretic if you cut back on salt (sodium) intake.
Medications that reduce your heart's workload include ACE inhibitors (enalapril) dilates your vessels and reduces the heart's workload (that continues). Beta Blocker (coreg/carvedilol) lessens the heart's workload (that contiues). Isosorbide is a slow acting nitrate that helps prevent angin (chest pain)...now I take only prior to going to the gym).
Digitalis may be prescribed to increase the muscle contraction of the heart (not needed as my EF is now 59%). I take an aspirin daily not warfaran (warafran while in the hospital).
You haven't indicated any EKG abnormalities so its not clear why an ICD is recommended. It is often the treatment for irregular heartbeats, and if there are damaged cells of the heart wall, that condition can interfere with the electrical pathways to myocyte cells (repolarized myocyte cells contract chambers), also enlarged chambers can obstruct pathways. That would be the issues addressed (hypokinesis and enlargement) for an implanted device and whether or not you need such a devise.
The ICD was recommended because I have an irregular heart beat (AF) and had it since diagnosed with (CHF) and an enlarged heart since 1998. I was at the cardiologist monday the 18th, he stopped these med's: FUROSEMIDE, KLOR, ENALAPRIL, ISOSORBIDE.
new med's and dose change,
change in dosage:
COREG 80mg 1- daily.
SPIRONOLACTONE 25mg 1- daily.
METOLAZONE 2.5mg 1 - take on Mon, Tue, and Wed.
New added med's: as of Aug 18, 2008
Linonopril 5mg 1 tab at bed time.
Torsemide 20mg twice daily.
I also went and had a Corotic (spelling?) ultrasound done on Tuesday the 19th the tech said I had nothing to worry about, that sounds good to me.
tomorrow I'm having a nuclear stress test done and more blood work due to the change in med's. no results yet as to the EKG/Echo that was done on Aug, 11th my today's visit with my MD. He couldn't pull it up on the computer it was only in transcript form so He, wasn't able to give the results. Which I think is "BS" so as we stand all result are up in the air now, until my next visit to my MD on Sept 3rd and the cardiologist on the 5th.
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