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Heart Disease (Expert Forum)
TTE and Stroke
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
TTE and Stroke
by JenLB, May 29, 2004 12:00AM
I'm 33 years old and had an ischemic stroke in Dec 04 (an arterial occlusion). I have had an MRI/MRA/MRV, blood tests, lumbar puncture, TTE & a 2nd TTE/TEE. All were normal. I have a few questions about my TTE.
InitialIy, I had a TTE with a bubble test, & although the test results were normal, I did have bubbles return to my heart from my lungs after 4 heartbeats. My 1st cardiologist (a pediatric--initially, they thought I had a PFO) said that he thought I might have PAVMs & sent me for a lung MRI. The lung MRI was normal. The 1st cardiologist wants me to go to a catheter lab to look at my lungs for a PAVM.
My 2nd cardiologist (a pediatric--again, this was my second opinion, because initially, they thought I had a PFO) looked at the TTE & said that it looked normal and that the bubbles coming back to my heart were normal (after 3 heartbeats, he said was normal). The 2nd cardiologist also showed my TTE to two other cardiologists (their echo guy and an adult cardiologist); both said that the TTE looked normal to them too (no PAVM). Finally, I also had a 2nd TTE (same bubbles came back) and TEE just to be sure that I did not for sure have a PFO (No PFO), & those cardiologists also told me that the bubbles coming back to my heart from my lungs were normal.
q1: What is the difference between "normal" bubbles coming back to my heart & "PAVM" bubbles coming back to my heart?
q2: I am, for now, not going to the catheter lab (4 docs told me the bubbles coming back were normal). But, I am still confused about why one doc said I might have PAVMs & the others say that I am fine.
InitialIy, I had a TTE with a bubble test, & although the test results were normal, I did have bubbles return to my heart from my lungs after 4 heartbeats. My 1st cardiologist (a pediatric--initially, they thought I had a PFO) said that he thought I might have PAVMs & sent me for a lung MRI. The lung MRI was normal. The 1st cardiologist wants me to go to a catheter lab to look at my lungs for a PAVM.
My 2nd cardiologist (a pediatric--again, this was my second opinion, because initially, they thought I had a PFO) looked at the TTE & said that it looked normal and that the bubbles coming back to my heart were normal (after 3 heartbeats, he said was normal). The 2nd cardiologist also showed my TTE to two other cardiologists (their echo guy and an adult cardiologist); both said that the TTE looked normal to them too (no PAVM). Finally, I also had a 2nd TTE (same bubbles came back) and TEE just to be sure that I did not for sure have a PFO (No PFO), & those cardiologists also told me that the bubbles coming back to my heart from my lungs were normal.
q1: What is the difference between "normal" bubbles coming back to my heart & "PAVM" bubbles coming back to my heart?
q2: I am, for now, not going to the catheter lab (4 docs told me the bubbles coming back were normal). But, I am still confused about why one doc said I might have PAVMs & the others say that I am fine.
Doctor's Answer
by CCF-M.D.-RCJ, May 29, 2004 12:00AM
JenLB,
Thanks for the post.
Q:"What is the difference between "normal" bubbles coming back to my heart & "PAVM" bubbles coming back to my heart?"
We often see bubbles in the left chambers of the heart after 3-4 heartbeats, and we consider this normal. I am not aware of any echo-bubble criteria for diagnosing PAVM. If the bubbles returned after 2 to 3 beats, and were in large quantity, then a PAVM might be suggested, but PAVM are so uncommonly encountered that no set "guidelines" exist.
Q:"But, I am still confused about why one doc said I might have PAVMs & the others say that I am fine."
PAVM are rarely diagnosed. Whenever a rare diagnosis is being entertained, less data is available. Thus the Art of medicine becomes more important in deciding how to manage the patient. Obviously, each doctor has a different opinion (or Art), and so disagreements may arise.
Hope that helps.
Thanks for the post.
Q:"What is the difference between "normal" bubbles coming back to my heart & "PAVM" bubbles coming back to my heart?"
We often see bubbles in the left chambers of the heart after 3-4 heartbeats, and we consider this normal. I am not aware of any echo-bubble criteria for diagnosing PAVM. If the bubbles returned after 2 to 3 beats, and were in large quantity, then a PAVM might be suggested, but PAVM are so uncommonly encountered that no set "guidelines" exist.
Q:"But, I am still confused about why one doc said I might have PAVMs & the others say that I am fine."
PAVM are rarely diagnosed. Whenever a rare diagnosis is being entertained, less data is available. Thus the Art of medicine becomes more important in deciding how to manage the patient. Obviously, each doctor has a different opinion (or Art), and so disagreements may arise.
Hope that helps.
