Yesterday I had an appointment with an electrophysiologist whom I'd been referred to by a general cardiologist. I have a history of severe, chronic lightheadedness, with a few faints (one in 2011, another in 2017), and waves of scary-feeling palpitations. The cardiac MRI I took in Jan 2018 showed dilation of all four chambers. The diameter of all four chambers was abnormal, as was the volume in each chamber. I do not have heart failure, because my systolic function is completely normal. I have an EF of 61%, FS of 33%, and a resting stroke volume of 123mL. The MRI showed no late gandolinium enhancement, normal rest perfusion, and no regional or global wall motion abnormalities. I have a massive exercise capacity, as I run about 60 miles a week at roughly 7 flat mile pace, and can race a 5k in the 17 minute range. So, my heart seems to be functioning quite well, and is free of fibrosis and ischemic issues, but I still believe there are concerning issues.
Yet, the electrophysiologist was unconcerned. He said that echos and MRI's are essentially useless, highly variable, subjective estimates. He said that the technology used to measure chamber size and volume is very imprecise, and furthermore that there is much variation on a month to month, year to year basis, and that different technicians would all get different numbers when measuring from the same images. In other words, that any echo/MRI value is just an imprecise estimate, that the actual values would be quite different over time, and that ten different people measuring the same echo/MRI would get ten different results. Thus, he said there's no point in trying to compare my 2018 numbers to the 2012 numbers, and that the numbers on this 2018 MRI may or may not even be accurate, but that even if they were, that's probably just "my normal," and given my normal systolic function the degree of dilation and volume overload I have is not indicative of any pathological process.
I find a lot of this difficult to accept. The degree of variation between my 2012 and 2018 numbers seems far too large to be due to mere normal undulating variation in the values and/or differences in how two different technicians measure. The degree to which values are outside of the normal range seems far too great to merely be "normal for me," rather than the start of some disease process. The fact that my symptoms are now worse, and other findings seem to suggest cardiac dysfunction (pericardial effusion, valve regurgitation, prolonged sinus pauses, documented arrhythmias, etc) is further suspicious to me. Anyways, I'm going to list below my the pieces of evidence that are concerning to me. I appreciate any feedback as to whether or not I should continue to pursue this, as all this guy gave me was a prescription for motion sickness pads and no further referrals to other doctors, nor for further testing.
CONCERNING PIECES OF EVIDENCE
1.) My cardiac MRI in 2018 is far different from my echo in 2012 when I was experiencing severe palpitations. Back in 2012 there was no chamber dilation and the volumes were all normal. So, it appears remodeling has taken place.
2.) I have prolonged sinus pauses on my Holter monitors. They've caught 5 separate pauses of 3-5s on the two Holter's I've worn, which suggests some sort of electrical problem, a problem with the SA node, or a problem with autonomic nervous system.
3.) The MRI revealed mild pericardial and pleural effusions, which seem to suggest that there is some sort of fluid overload beginning to take place.
4.) On my EKG's my QTc interval is usually in the 450-460ms range, which would seem to predispose me to afterdepolarizations that could trigger problematic arrhythmias
5.) My Holter picked up a PVC couplet, which suggests that beyond enhanced automacitity triggering single premature beats there is some sort of structural or functional barrier that enabled reentry, even if only for that one extra beat.
6.) An echo in 2012 showed a prolonged mitral valve deceleration time, possibly suggestive of impaired LV relaxation
7.) My recent MRI showed tricuspid and pulmonary regurgitation, which might suggest the beginning of functional deterioration.
8.) My LV wall and the intraventricular septum have both thinned/stretched out since 2012, going from 1.1cm each to 0.5cm each, suggesting that the dilation remodeling is possibly causing the LV to weaken and/or strain.
9.) I was recently found to have an enlarged liver (I had abdominal pain and elevated enzymes so they took an ultrasound), which can happen when cardiac dysfunction is present.
10.) I've had a chronic cough for the past few years that might correspond with the effusions which may be indicative of cardiac dysfunction
11.) I have other various signs of poor circulation that have developed over the past few years, such as slow healing minor cuts that leave scars, an inability to get an erection, frequent nocturnal urination, etc.