What's the use of getting echo(s)

[jan]

Dear Dr.,

History: 46 f,IST,NCS, brain lesion (stroke or MS), seizures due to lesion, Factor V Leiden.  Mom died of CHF (had a mitral replacement), her sis had "weak heart" died of "milk arm" at 30, her brother died of stroke at 42.
I am on atenolol and verapamil (sm doses), Trileptal for seiz

I have had 3 echos.

1st shows thicken'g of anterior mitral leaflet,normal excursion and coaption. no prolapse, mild regurg.w/posteriorly directed jet

2nd, done just months later, shows mvp (anterior) with mild MR and mild TR.

3rd shows MVP with myxomatous appear'g mitral valve and trace regurg.

Yesterday I had a TEE to see if heart could've led to stroke. It showed I have a little prolapse ,I don't have myxomatous chgs, I have trace regurg.

My cardio/ep had just reiterated to my primary and my dentist about my need for antibiotic prophylaxis, because of the 3rd echo (which was done just last July). When I referred to the results of TEE and asked cardio about the need for antibiotics prophy., he said I don't need it.

It is so frustrating and confusing, that that good news almost isn't received as such. I don't know if you can understand that.  

I know in time there is the possibility of getting another reg. echo, but why?  What's the use, with all the diff interpretations?! And to top it off they could all be wrong, but w/o a TEE the patient and dr. would never know.  (I don't think I would ever get another TEE)

Thank you for your time.

[CCF-M.D.-KE]

Dear Jan,

The results of the 3 different echocardiograms are not markedly dissimilar. The transesophageal echocardiogram (TEE) is capable of detecting subtle differences not fully appreciated by the surface tranthoracic echocardiogram(TTE). I think in a situation such as yours, the surface regular echocardiogram (TTE)  would be warranted if there were any change in your level of symptoms. This approach would allow you to be evaluated using the less invasive test, TTE. In the event any significant changes are found on TTE, a more invasive study could be performed. Hope this answers your concerns.  

Thanks for your question,


CCF-ME-KE

[jan]

I didn't want to know the purpose of echos, I wanted to say they seem misleading and if so, then ...
  The 3 reg echos seemed to show something that wasn't there.  The TEE showed I really don't have much of a prolapse and only a little regurg, no longer enough to warrant antibiotics proph as orig thought.  AND no myxomatous changes!  So, if you ask me the reg echos are misleading and now seem like a waste of time.  That is my point. (Maybe they need to get new guidelines).

[papaley]

Not an exact science, that's for sure. I have been followed for 26 years for rheumatic heart disease.  I have mitral stenosis and aortic regurgitation and the measurements of the diameters of the valves and chambers are always different. Mitral valve, from less than 1cm sq to 2cm sq.  At one point I was sent for a valvuloplasty because the valve was < than one cm sq.  I saw the valve opening with my own eyes as the tech measured the valve and it was indeed very small.  When I went to the cath lab three weeks later it measured 1.9 (normal is 4-6) so they did not perform the valvuloplasty.  Now it is measured at 1.3 ( twice in 6 months) so they are going to go in again.  My point is, is that every echo seems to be different with wide variences, so to your point, how do they know which results are accurate?
fdeg

[jan]

And because of the echos, actions were taken and then the decision reversed.  Antibiotic prophyl isn't a big deal, mind you, but it makes me leary and uncomfortable going off now.  (Doesn't help that my cousin died at 37 because of infection in heart).  The stress of the TEE is another story!  If the echos were more accurate I wouldn't have had to endure the TEE.
If I had to be sched on and off for valvuloplasty that would make me very concerned and stressed, even more so!

[jan]

oops *blushing*  I got carried away. LOL  I had to have TEE to check for hole(s) or clot(s).

[Jacci4]

Your experience seems so similar to mine.  I, too had a mild stroke and a TIA.  I was sent for echos, both TTE and TEE.  The first one said everything was excellent.  The next one (done by a different doctor) said there were numerous abnormalities including Mitral Valve Prolapse.  The unfortunate thing is that nothing was ever explained to me.  The doctor that performed the echo left the test without going over the results with me.  The  neurologist who ordered the test said the heart is not his speciality.  No one has told me one way or the other whether I should take antibiotics prior to dental treatments or not.  Believe me you are not alone.

[jan]

Jacci,

What about scheduling a follow up with the cardio who did the 2nd test?  Somebody, certainly, should've gone over the results with you!
I have to get EEG's done annually (hoping to get off meds) and I don't see my neuro for follow up, I go directly to the epileptologist who read it.  I can read a report, but I want to know what he thinks, what his opinion is (besides the fact that neuro is leaning on him for decisions).  Try to do the same.

Good luck!

Wouldn't you think if you were in my cardios place it would be a bit embarrassing?  As I mentioned, he just dictated 2 letters recently, telling about my valvular disease and that I needed prophalactic antibiotics, now...  (Don't get me wrong, I love the guy. LOL).  But we, as the patients, are left scratching our heads and have more concern now, because of the diff results of tests!
Fortunately, mine is nothing and I can just go on and forget about it, but if a next time comes up...