Regarding Dilated LV and Hypokinesia of Apex,ivs and anterior wall

[rajanrishi]

Hi Doctor,

Recent my father got an mild heart attack Here is an ECO and colour doppler report of him.

M-MODE             Normal value        
IVSed     : 1.0 cm    (0.6-1.1 cm)         Arota   : 3.8 cm
LVed      : 5.4  cm   (3.6-5.2 cm)         LA       : 3.8 cm
LVPWed :1.1 cm    (0.7-1.2 cm)         LVEF by M-mode 40 %
IVSes      :1.1 cm    (0.7-1.4 cm)         LVEF  by 2D echo 35 -40%
LVes       :4.3 cm    (2.3-3.9 cm)         RV ant. wall :Normal
LVPWes : 1.5 cm   (1.0 -1.4 cm)        IAS -IAS -Intact IVS Intact

Chambers:                                       Valves:
RA : Normal                                     Tricusid Valve: Normal
RV : Normal                                     Pulmonary Valve:Normal
LA : Normal                                      Mitral Valve:       Normal
LV : Dilated                                       Arotic Valve : Normal

Color doppler:
Mitral valve E: 0.63 m/s                 PV value : 0.96 m/s
Mitral valve A: 0.41 m/s                AV velocity : 0.79 m/s

Mitral  regurgation - Absent          pulmonary  regurgation - Absent
Tricuspid  regurgation - Absent    Aortic regurgation - Absent


Final Impression
Dilated LV
No left ventricular hypertrophy
hypokinesia of apex,IVS and anterior wall
Moderate LV systolic dysfunction
LVEF 35-40%
Normal valves

Father is also suffering from constipation and gas related problem but no drinking and no smoking : AGE is 57 and weight is 58 kg height is 5.6
my questions are:

Is LVEF value 35-40 % is critically less ?
Is the drug therepy enough?
Is he in any imminent danger?
Any other thing he can do?

[kenkeith]

Angiography can be with a cathode that takes a vessel route to the heart, and ct scan angiography uses images to diagnose vessel blockage.  The new 258 slice ct scan may be better as it images vessels in 3 dimensions as well as the flow of blood.  Other than the new technology (more slice scans) with ct the cath is usually considered the best.

With a scan there are no tubes, but an IV for injection of anxiety reducing agent, and a cathode is inserted in the arm or agrion into the femur vessel.  CT scan is better for a fast within an hour diagnoses in an emergency situation. A cath may take hours or even a day for results.

[rajanrishi]

Hi,

My next questions are regarding Angiography test .

is Angiography  test is nessecary to know the blockage conditions any other test for same?
is  Angiography  test involves insertion of tubes in patient body?

[kenkeith]

QUOTE: Is LVEF value 35-40 % is critically less ?

>>>>>There is hypokinesia (heart wall movement impairment) disorder of apex,IVS (Impairment is the wall (septum) that separates the left and right ventricular chambers and anterior wall due to a prior heart attack.  This impairment reduces the heart's ability to pump normally.  Normal is an ejection fraction (EF) 50 to 70%...amount of blood pumped with each heartbeat.  The reduced LVEF (left ventricle EF) is due to mild heart attack, and not critically low as many people perform daily activities without symptoms at less than normal EF.  Heart failure range is less than 30%, and many people begin to experience chest pain, shortness of breath, fatigue, etc. at that level, but some individuals experience problems with less than normal EF. It depends on the individual's system to effectively compensate, and the general health, etc.

Little more than 6 years ago, I was hospitalized with congested heart failure, LVEF of 12 to 29%, enlarged heart, moderate to severe mitral valve regurgitation, blocked coronary vessels.  A stent was implanted and another 72% blockage not stented, and I have been treated successfully with medication,  Currently, my heart is normal size, LVEF is 59%, MVR remains, but I have no symptoms and feel well.

QUOTE: "Is the drug therepy enough?"

>>>>It may depend on the underlying cause.  If your father's heart attack was due to ischemia (lack of blood flow), and if medication successfully treats the ischemia (dilate vessels with an ACE inhibitor and Coreg, etc) medication can return the heart to normal functionality.  The hypokinesis can be corrected with a good supply of blood (stent or medication) to the heart cells in question, and as a result there can be revitalized heart cells, stronger contractions, and the EF will increase.

QUOTE: "Is he in any imminent danger?"
>>>>>Based on the information posted there is not any imminent danger.

QUOTE: "Any other thing he can do?"
At the proper time with doctor's permission, aerobic exercise 3 times week for about a half an hour (minimum), proper diet, moderate life style, etc.

Hope this helps give you a perspective of your father's heart condition, and if you have any followup questions feel free to ask.  Thanks for sharing your father's experience and hope it goes well for your father and helps reduce any stress that you may have. Take care.