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Heart Disease (Expert Forum)
Worried about Echo and HCM
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Worried about Echo and HCM
by Noxx, Jun 19, 2007 12:00AM
Hi!
A few months ago I had a 2D guided M-mode echo, because of PVCs (about 200 per day). This echo showed a septal thickness of 13 mm, and a very slightly enlarged left atrium. Everything else normal (posterior wall 9 mm, LVIDd 54 mm). Since I've been worried about HCM, I asked the cardiologist about that, but he just said that he sees a septal thickness of 13 mm in almost half of his patients. He said that depended on where on septum one meassures and discarded the question about HCM.
However, since I was worried, I was scheduled for a second echo, which I did today. This echo showed a normal septal thickness of 10 mm, but still a slightly enlarged left atrium. Posterior wall 9,5 mm and LVEDd 57 mm.
1. Could the first meassure have been a false-meassure, or is it true that septum is 13 mm in nearly half of normal people depending on where one meassures? Sounds strange. I know echocardiography isn't highly accurate but could it differ in 3 mm between meassurements?
2. What are my chances of having HCM? Is there something else I can do to have this issue (which is driving me nuts) finally cleared out?
3. I had an exercise test which was "generally normal" with an excericse capacity of 125 % of normal. Does that add any information?
Best regards,
Noxx, 25 y old male
A few months ago I had a 2D guided M-mode echo, because of PVCs (about 200 per day). This echo showed a septal thickness of 13 mm, and a very slightly enlarged left atrium. Everything else normal (posterior wall 9 mm, LVIDd 54 mm). Since I've been worried about HCM, I asked the cardiologist about that, but he just said that he sees a septal thickness of 13 mm in almost half of his patients. He said that depended on where on septum one meassures and discarded the question about HCM.
However, since I was worried, I was scheduled for a second echo, which I did today. This echo showed a normal septal thickness of 10 mm, but still a slightly enlarged left atrium. Posterior wall 9,5 mm and LVEDd 57 mm.
1. Could the first meassure have been a false-meassure, or is it true that septum is 13 mm in nearly half of normal people depending on where one meassures? Sounds strange. I know echocardiography isn't highly accurate but could it differ in 3 mm between meassurements?
2. What are my chances of having HCM? Is there something else I can do to have this issue (which is driving me nuts) finally cleared out?
3. I had an exercise test which was "generally normal" with an excericse capacity of 125 % of normal. Does that add any information?
Best regards,
Noxx, 25 y old male
Doctor's Answer
by Forum-M.D.-MJM, Jun 19, 2007 12:00AM
Hello,
1. Could the first meassure have been a false-meassure, or is it true that septum is 13 mm in nearly half of normal people depending on where one meassures?
The only way to answer the question is to see the tape or recording. It is possible to catch a view in an off angle and incorrectly measure the septum. The distance may very a little depending on where you measure. In general, a septum greater than 12 mm (1.2 cm) is consider abnormal but by no means is equal to a diagnosis of HCM. The most common cause is uncontrolled high blood pressure. If you have a family history of sudden death, hypertrophic cardiomyopathy, or the appropriate physical exam findings of HCM, that would be a different story.
2. What are my chances of having HCM? Is there something else I can do to have this issue (which is driving me nuts) finally cleared out?
Unless you have the above mentioned risk factors, your chance of having HCM are very low. Other things like age or and how often you exercise are important. It is possible to have physiologic hypertrophy with exercise and young person with a septum of 13 is more concerning that a 70 year old with the same finding. It is true that is something to consider in people with hypertrophy, but true severe hypertrophy usually has the physical exam features and the septum is much thicker than 13. You coud always seek a second opinion but there is no definitive test. Nothing that you mentioned speaks to high or even moderate risk.
3. I had an exercise test which was 'generally normal' with an excericse capacity of 125 % of normal.
The typical exercise stress test finding of high risk HCM is a drop in blood pressure with exercise. Otherwise it does not help that much.
It sounds like you need a second opinion for your own peace of mind.
I hope this helps. Thanks for posting.
1. Could the first meassure have been a false-meassure, or is it true that septum is 13 mm in nearly half of normal people depending on where one meassures?
The only way to answer the question is to see the tape or recording. It is possible to catch a view in an off angle and incorrectly measure the septum. The distance may very a little depending on where you measure. In general, a septum greater than 12 mm (1.2 cm) is consider abnormal but by no means is equal to a diagnosis of HCM. The most common cause is uncontrolled high blood pressure. If you have a family history of sudden death, hypertrophic cardiomyopathy, or the appropriate physical exam findings of HCM, that would be a different story.
2. What are my chances of having HCM? Is there something else I can do to have this issue (which is driving me nuts) finally cleared out?
Unless you have the above mentioned risk factors, your chance of having HCM are very low. Other things like age or and how often you exercise are important. It is possible to have physiologic hypertrophy with exercise and young person with a septum of 13 is more concerning that a 70 year old with the same finding. It is true that is something to consider in people with hypertrophy, but true severe hypertrophy usually has the physical exam features and the septum is much thicker than 13. You coud always seek a second opinion but there is no definitive test. Nothing that you mentioned speaks to high or even moderate risk.
3. I had an exercise test which was 'generally normal' with an excericse capacity of 125 % of normal.
The typical exercise stress test finding of high risk HCM is a drop in blood pressure with exercise. Otherwise it does not help that much.
It sounds like you need a second opinion for your own peace of mind.
I hope this helps. Thanks for posting.
I've talked to the cardiologist very bried thorugh phone, he said it was "meassured a little bit too far to the left". Could the septum be visualized as thick as 13 mm, even though the real thickness is 10mm? He said they meassured in the parasternal long axis view.