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Heart Disease (Expert Forum)
Right sided structures at top limits of normal - help!
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Right sided structures at top limits of normal - help!
by CGTMHI, Sep 12, 2000 12:00AM
, Sep 12, 2000 12:00AM
I am a 57 year old woman who has had numerous cardiac tests done within the past month. The results are as follows:
7/5/2000 - Exercise Treadmill Test
Results: The patient exercised on a Bruce protocol for 4 minutes reaching a heart rate of 178 which is 109% of maximum predicted heart rate. There was some shortness of breath and chest pain. This was noted to go away when she rested. There were some ST and T wave changes seen. These came fairly early within the first minute at a heart rate of less than 100.
7/14/2000 - Angiography
Selective Coronary Arteriography
The main coronary artery was normal & gave rise to an LAD and circumflex. The circumflex found to have 30% irregularity in its proximal portion. It was otherwise unremarkable. The LAD was unremarkable. The right coronary artery was a dominant vessel and free of angiographically significant disease.
Left Ventriculography
Left ventriculography was performed in the single RAO projection. This revealed excellent left ventricular function. The EF was 55%. There was no mitral regurgitation.
Impressions: Minimal coronary disease in the circumflex
Comments: The patient's abnormal EKG with stress testing is not explained on this study and is deemed to be a false negative finding. Her current symptoms of dyspnea with exertion and atypical chest pain do not seem to be on the basis of left vetricular dysfuction or coronary artery disease. Vigorous and aggressive risk factor modification and cholesterol management is indicated
8/10/2000
24-Hour Holter Monitor
The basic rhythm is sinus with heart rate varying from 155 to 62 bpm. Rare PVC's and PAC's were present. Nor runs were identified. The patient described chest pain without changes on the EKG. The patient described shortness of breath, again, without changes in the ECG. She did complain of shortness of breath and palpitations after she climbed the stairs and this was associated with sinus tachycardia at a rate of 110 to 120 bpm.
Impressions: No high grade arrhythmia identified
8/14/2000
Adult Echocardiogram Report
Indications: chest pain & palpitations
Left Ventricle:
End Diastole: 5.1 cm
End Systole: 3.7 cm
EF: 45-50
Outflow Tract: mm
Right Ventricle:
End Diastole: 2.2 cm
Ratio IVS/PLVW :1
Left Atrium:
Diameter: 3.5 cm
Aortic Root:
Diameter (D 2.9 cm
Ratio: LA/AR: :1
Interventricular Septum:
Thickness (D): 1.1 cm
Paradox: No Yes
Posterior Left Ventricular Wall:
Thickness (D) .9 cm
Mitral Valve:
D E Excursion mm (20-35)
E-F Slope mm (>80)
E Point to Septum mm (0-10)
Aortic Valve:
Opening: 1.5 mm
PROCEDURE:
M-mode and two-dimensional echocardiogram performed. The quality of the study was reasonable. The patient appeared to be in sinus rhythm.
The patient exhibited concentric left ventricular hypertrophy. The overall systolic function was reasonable. The mitral apparatus was reasonably intact. The aortic valve appeared trileaflet and opened well. The right-sided structures appeared to be at the top limits of normal. Pericardial effusion, clots or vegetations not seen. Doppler interrogration revealed mild to moderate MR and tricuspid insufficiency used to estimated right ventricular systolic pressure of 40.
My questions are:
1) What would cause my right-sided structures to be at the top limits of "normal"?
2) What are ST segment changes?
3) Do I need further testing?
4) If so, which tests would you recommend?
5) What else could be causing chest pain and shortness of breath? I've had a pulmonary function test and my lungs are fine.
Thank you all for this wonderful forum!!!
Lynne
7/5/2000 - Exercise Treadmill Test
Results: The patient exercised on a Bruce protocol for 4 minutes reaching a heart rate of 178 which is 109% of maximum predicted heart rate. There was some shortness of breath and chest pain. This was noted to go away when she rested. There were some ST and T wave changes seen. These came fairly early within the first minute at a heart rate of less than 100.
7/14/2000 - Angiography
Selective Coronary Arteriography
The main coronary artery was normal & gave rise to an LAD and circumflex. The circumflex found to have 30% irregularity in its proximal portion. It was otherwise unremarkable. The LAD was unremarkable. The right coronary artery was a dominant vessel and free of angiographically significant disease.
Left Ventriculography
Left ventriculography was performed in the single RAO projection. This revealed excellent left ventricular function. The EF was 55%. There was no mitral regurgitation.
Impressions: Minimal coronary disease in the circumflex
Comments: The patient's abnormal EKG with stress testing is not explained on this study and is deemed to be a false negative finding. Her current symptoms of dyspnea with exertion and atypical chest pain do not seem to be on the basis of left vetricular dysfuction or coronary artery disease. Vigorous and aggressive risk factor modification and cholesterol management is indicated
8/10/2000
24-Hour Holter Monitor
The basic rhythm is sinus with heart rate varying from 155 to 62 bpm. Rare PVC's and PAC's were present. Nor runs were identified. The patient described chest pain without changes on the EKG. The patient described shortness of breath, again, without changes in the ECG. She did complain of shortness of breath and palpitations after she climbed the stairs and this was associated with sinus tachycardia at a rate of 110 to 120 bpm.
Impressions: No high grade arrhythmia identified
8/14/2000
Adult Echocardiogram Report
Indications: chest pain & palpitations
Left Ventricle:
End Diastole: 5.1 cm
End Systole: 3.7 cm
EF: 45-50
Outflow Tract: mm
Right Ventricle:
End Diastole: 2.2 cm
Ratio IVS/PLVW :1
Left Atrium:
Diameter: 3.5 cm
Aortic Root:
Diameter (D 2.9 cm
Ratio: LA/AR: :1
Interventricular Septum:
Thickness (D): 1.1 cm
Paradox: No Yes
Posterior Left Ventricular Wall:
Thickness (D) .9 cm
Mitral Valve:
D E Excursion mm (20-35)
E-F Slope mm (>80)
E Point to Septum mm (0-10)
Aortic Valve:
Opening: 1.5 mm
PROCEDURE:
M-mode and two-dimensional echocardiogram performed. The quality of the study was reasonable. The patient appeared to be in sinus rhythm.
The patient exhibited concentric left ventricular hypertrophy. The overall systolic function was reasonable. The mitral apparatus was reasonably intact. The aortic valve appeared trileaflet and opened well. The right-sided structures appeared to be at the top limits of normal. Pericardial effusion, clots or vegetations not seen. Doppler interrogration revealed mild to moderate MR and tricuspid insufficiency used to estimated right ventricular systolic pressure of 40.
My questions are:
1) What would cause my right-sided structures to be at the top limits of "normal"?
2) What are ST segment changes?
3) Do I need further testing?
4) If so, which tests would you recommend?
5) What else could be causing chest pain and shortness of breath? I've had a pulmonary function test and my lungs are fine.
Thank you all for this wonderful forum!!!
Lynne
Doctor's Answer
by Cleveland Clinic, MD, Sep 12, 2000 12:00AM
, Sep 12, 2000 12:00AM
1) What would cause my right-sided structures to be at the top limits of "normal"?
A: Hard to say for sure. Top limits of normal is still normal so I wouldn't worry too much about it.
2) What are ST segment changes?
A: A change on the EKG that may indicate blockages. In your case it was wrong.
3) Do I need further testing?
4) If so, which tests would you recommend?
A: These would be up to your doctor.
5) What else could be causing chest pain and shortness of breath? I've had a pulmonary function test and my lungs
are fine.
A:There are many causes of chest pain. The one that doctors worry about the most is cardiac because it has the potential to be life-threatening. Once this is ruled out the work-up can proceed at a more leisurely pace.
Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack and coronary artery spasm), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.
Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.
Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.
Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).
Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.
As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause. A good Internal Medicine doctor should be able to work through the potential causes of your symptoms.
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies.
A: Hard to say for sure. Top limits of normal is still normal so I wouldn't worry too much about it.
2) What are ST segment changes?
A: A change on the EKG that may indicate blockages. In your case it was wrong.
3) Do I need further testing?
4) If so, which tests would you recommend?
A: These would be up to your doctor.
5) What else could be causing chest pain and shortness of breath? I've had a pulmonary function test and my lungs
are fine.
A:There are many causes of chest pain. The one that doctors worry about the most is cardiac because it has the potential to be life-threatening. Once this is ruled out the work-up can proceed at a more leisurely pace.
Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack and coronary artery spasm), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.
Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.
Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.
Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).
Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.
As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause. A good Internal Medicine doctor should be able to work through the potential causes of your symptoms.
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies.
