What is this?

[line]

Hello Dr.

I Just had my 7th early echo done. I am a 65 year old female with a life long heart murmuur.

interpretations:

>>left and right ventricles are normal in size and function.

>>borderline left atrial enlargement

>>mitral valve is normal-- trace of mitral rguritation

>>triscupid is normal -- mild regurgitation

>>aortic valve is normal-- is not heavily calcified, no vegetatration.

EF>55, the tech said 63-65

I understand the report fairly well but it states cannot rule out chordal SAM. I tried calling the DR. concering this but she is on vacation. I was told the echo was fine.

These measurement I do not understand and have no idea if they are within normal limits.

mv e point: 81.4 cm/s
mv a: 82.6 cm/s
mv dec slope: 307 cm/2s
mv dec time: 0.263 sec
mr max vel: 266 cm/s
max pg mr: 28.3 mmhg
mv e/a: 0.986

max vel(tr)- 222 cm/s
ra press- 10.0 mm hg
rvsp (tr) 29.6 mm hg.

Could you please tell if the report is within normal range and especally what does chordal SAM mean.

THANK YOU FOR YOUR TIME, Line

[Forum-M.D.-MJM]

Hi Line,

My first questions is why are you getting seven echo's if you have a completely normal echo. Unless you have a change in symptoms or start having significant symptoms, you do not need anymore echo's.  

Don't worry about all the numbers -- we don't even use those numbers unless there is something abnormal and based on this reading, there is not.

Even the questions of chordal sam only matters in a context concerning for outflow tract obstruction or hypertrophic cardiomyopathy -- which your echo does not show.
SAM means systolic anterior motion of the mitral valve -- the mitral valve can in rare circumstances move forward and obstruct the aortic outflow tract.  Cordal SAM is when the cords of the mitral valve move into the outflow tract and cause obstruction.  I don't think you need to worry about this based on the above reading, but it is still worth asking your doctor incase that is what she was looking for -- clinical context means a lot in interpretting studies.

I hope this helps.  Thanks for posting.

[Brothabill]

Your test was normal is what it means.
Chordal SAM, is systolic anterior motion of the chordal structure that tether the mitral valve.
It really means nothing. It can in certain individuals cause outflow tract obstruction with exercise as not only the chordal apparatus gets suck into the outflow tract (the last narrowing before it leaves the last valve of the heart heart called the aortic valve) but also a mitral valve leaflet does as well.
It would not be something to worry about especially since it just cant be ruled out, does not mean you have it. Means you may just have poor images and it cant be clearly ruled out.

Your ejection fracion is normal if it is over 55%. A normal heart range is 55-70% and ejection fractions are notoriously unmeasurable. So just saying it's over 55% is code for saying it's normal which is whats most important.

Your other values are normal for your age.

Your valvular leakage is normal and physiological because your heart valves are made of tissue and not in a factory (even the factory made ones leak called cleaning jets). But with the technology as good as it is today, having a trivial, physiological mitral valve leak is quite common. And for buddha's sake, everyone has tricuspid regurgitation, over 75% do, and over 85% have a leaky valve that is observable. And when technology gets even better, the percentage will be near 100%.
So if you have a leaky valve of mild or less on any valve, do not worry at all, it's just technology progressing making it visible. People with moderate valve leaks can progress though and echos should be done periodically to make sure.

Now, also, bloodpressure can affect mitral regurgitation, but you already know to do everything possible to make sure your blood pressure is normal already, right? And I've never met a blood pressure I couldnt treat, so don't let a doctor not get you sorted out with that and dont let yourself not get sorted out with it. If you get high blood pressure, you can increase left atrial size as well as get an irregular heartbeat called atrial fibrillation which stretches it out even more.

BUT, I digress, your heart test is just about as flat normal as can be. The caveat is that it was NOT a stress test so it has no predictive value in terms of your risk stratification of a cardiac event.
They looked at the structure of your heart, but an echocardiogram cannot see the plumbing or the arteries of the heart.
So, I would be happy with your test results, although I at your age would push for a stress test. Which is debatable if you do not have chest symptoms.

But if you fail a stress test, it tells everyone that you should be taking the four drugs that prevent heart attacks

[line]

Brothbil, I know I spelled your name wrong, sorry, but it is late and I am  sleepy.

I was searching the net when the email came in from the site. The more I searched, the more frightened I became, you both have put my mind at ease and I thank you.

I know in my heart that if my DR. thought anything serious was going on I would be flying to a cardio, she is very pro-active when it comes to health care, but still when you read something you do not understand it boggles your mind.

I myself wondered why I need a echo done every year, but the machine is owned by my DR. so I guess that is why.  I have no high b/p and no family history of heart desease.

My husband had a nuclear stress done and wthin two weeks had a heart attack after passing the test with flying colors. He had two stents, less than a year later a stent threw a clot and he had by- pass and a small stroke. A week before this last heart attack he had a stress done, passed again, but has a known 60% blockage was seen through the cath which did not show up. I really have no faith in the stress test. But certainly if I have problems I would have one done.

Thank you so much for you help and God bless, Line

[Brothabill]

Well Line,
I am sorry you are having distress.
The thing is, is that for the most part, the heart does not change from region to region. My fiance is in Australia and we Indian-leg-wrestle on who moves where because she is an attorney there.
I can change locales as, her reasoning is, that the heart is the same no matter where you go. Damn lawyers!

But not always the case, but we fair better than learning a whole new legal system so it looks like Sydney here I come.

As far as stress tests my dear, they are good at saying Yes or NO, that you have  blockage restricting flow.
The most important issues are what next, the Gold Standard is an Angiogram where *after* a stress test says you have a problem, then what the best treatment, where in the arteries they are, or if in fact you had a false positve stress test.

An angiogram is an invade your body procedure, its the best, a half hour xray test, more expensive, so when Joe Blow walks in says I have CHest pain. We dont rush them into an angiogram. Just doesnt make sense.
So when they fail a stress test, they get the 10,000 dollar test or 20,000 test, I forget the cost nowaways.

Well a stress test is 1/20 the cost with echo and no complications of invading your body. Meaning no infection or no nothing.

When I was in school years ago 'learning' this stuff. There was a fellow student who brought her father in for an 'echo' because he was having chest pain. His echo was normal and died of a massive heart attack that weekend.
Echos have no predictive value as demonstrated by that event, period.

A stress can, if you follow logic, can stratify YOUR RISK, (NOT EXCLUDE IT) as low, medium or high to having a cardiac event in the next five years.
In medicine, no one can say nuttin' about who will or wont have a heart attack. That is a fool's errand.

There are four drugs that prevent heart attacks. If someone who has the history to take them, they should, but thats between you and your cardiologist.
Otherwise, recent evidence shows that angioplasty with stents is only symptom relief except in acute settings.
Otherwise, drugs are better.

And alot of times, heart attacks are not from major blockages, they are from vulnerable plaques whose friable outer covering is swept away from a blood pressure surge causing a platelet surge clotting off a major coronary artery.
Daily exercise and blood pressure control along with an aspirin can prevent that type of heart attack as well.

[line]

Bet I mis-spelled your name again, but age has its priveledges as forgetting and making boo boo's.

You sound like you are in the health feild and a asset to the board. do you go on the member heart site, a lot of people there with ??, it is hard to post to the DR.

Maybe you could sue the love of your life for allienation of affection and force her to move to where ever you are. Lots of luck. I do wish you both luck and happiness.

My husbands cardio says as soon as the new heart scan is perfected it is going to be very valuable, but so far is not perfected and still keeps cardio's guessing.

What are the four drugs you advise to prevent heart attacks? My hsband is on toprol, lisinipril, 81 mgs aspirin. and coumadine. He was on plavix for one year after his stents.

I have been taking aspirin for at least 15 years, our old dr. who is old, 78 and still practicing and doing surgery advised us a long time ago to start aspirin therapy I did my husband did not. He has a strong family history of heart attacks and strokes. The surgeon who did my husbands by-pass told both our sons to start on aspirin every day, they both have high b/p and are on meds.

What is your opnion on folic acid for heart health. My Homocysteine level was a little elevated my Dr. put me on foltx, it came down in half, but my good chol. went up and my bad came down, I am thinking the foltx did that because I did not watch my diet. I read on a a few sites that they are still using this  in some places to prevent reinstenoses. My Dr. said now they say the homocystine level is nothing to worry about and I can stop the pill but if I want to take it that if fine, it will not hurt me.

I have fibromyalgis and costochondritis so get lots of chest soreness but it that type of soreness that clothing even bothers me and hurts more with movement.

Here is my medical advice, don't get old because you get pain in parts of your body that you did not even know had before the aging process.

Again I thank you, line