echo changes

50 yo female, 20 year history of asymptomatic mild MVP w/ trace MR, treated with nadolol 40 qd, 6 week episode of unifocal RVOT PVCs starting 4/04, switched to verapamil SA 180 bid in 5/04. Last cholesterol was 126 in 2/04. BP 120/65 normally, as high as 150/80 under emotional stress.

Echo 3/05: LVPW 0.8 ; LVID Dd = 4.7, Ds = 2.1 ; Septum 0.7 ; Aortic root 2.9 ; Aortic valve open 2.0 ; LA 2.9 ; LVEF 55% ; Conclusions: normal LV chamber volume w/ good contractility ; thickened mitral valve leaflets with flattened systolic motion ; trace MR and TR ; mitral annular calcification ; mild aortic valvular sclerosis ; minimal A and P pericardial effusion ; LV relaxation abnormality ; estimated PAH 30mm Hg.

Echo 4/04: LVEF 60%, no other measurements given. All valves reported as normal, no effusions seen. Conclusions: normal LV size and systolic function ; borderline LVH ; slightly dilated LA ; mild MR and TR.

Echo 5/03: LVPW thcknss 0.9 ; LVID Dd = 4.1, Ds = 3.2 ; Septum 1.1 ; Aortic root 2.6 ; Aortic valve open 2.0 ; LA 3.0 ; LVEF 54%. Conclusions: LV normal in size and function, good contractility of all wall segments ; mild MVP with minimal MR ; all other valves normal.

These echoes were all done at different labs. My cardiologist says that the latest echo results are normal for my age and history and do not represent significant changes over the previous echoes. Any comments would be appreciated, thanks.

[CCF-M.D.-MJM]

I agree with your cardiologist.  There are no significant changes based on the typed report.  Seeing the actual images always helps though.  There is always variation from lab to lab.

The one question I would ask is if you have no significant mitral regurgitation and no symptoms (?), why are you getting yearly echo's?

I would not worry about these echo findings.  

Good luck.

[fizzixgal]

To correct a typo in the echo results from 3/05: should have been estimated PAP 30mm Hg (pulmonary artery pressure).

Also, sorry for the condensed format but I was up against the 1600 char limit. I had specific questions as well, hope it's okay to ask them here.

1). Does "thickened mitral valve leaflets" indicate myxomatous degeneration?

2). Are MAC and mild AV sclerosis common at age 50? They were not reported before, can I assume they were simply not considered significant to report previously, or can one conclude that they have truly developed over the past year?

3). Of what significance is "LV relaxation abnormality"? It was not quantified on the report, does this merit further workup?

4). I know that a PAP of 30mm Hg is borderline high, but is an estimate based on a trace tricuspid "jet" reliable?

5). My cardio says the "minimal pericardial effusion" is of no significance, could you comment?

6). What further workup, if any, would you recommend? I had a sestamibi treadmill test to 98% maximal HR and a cardiac MRI in 5/04,  both negative for any abnormalities. The stress test report specifically said no LVH observed.

Thanks in advance for any advice you can give me.

[pms_barbie]

I hope things are going well with you.  The only thing I can note on the echo is this.  I have had many echos and no two are ever exactly a like...lol Or at least in my case they havnt been.  A lot just depends on the person viewing the echo.  I hope your pvcs have calmed down.  If your dr says the echo is ok try and believe him  ( as long as you trust him.lol)  Best wishes