echo question

[Pam]

Hi.  I am a 36 yr old female with mild mitral valve prolapse.  I had my 3rd echo last winter at my general practitioner's office. 2 weeks ago I went in for a check up and the PA pulled out the report and told me that some of the numbers were off, and that I needed to be seen by a cardiologist.  I have an appointment for next week, and do feel I understand most of the report.  In the meantime, would you mind explaining one of the numbers under the Mitral Vlave section called "EPSS"?  My number is higher than the normal value (which the report says should be less than 4).  Other than that, my left atrium is out of normal range by .4 cm, and the report summary says my ejection fraction is 47, and I have marginal diastolic disfunction.  Should I panic about any of this?  I am 35 pounds overweight (5'9" - 190 lbs) and do binge drink a couple times a week.  Is my party lifestyle causing some of this, or is it all related to MVP?  Thank you so much for your time and input.   Pam

[Bob to Echo Tech]

Thank you for replying.  I realize that you need to be careful not to give medical advice.

I didn't get to see the echo output, as my GP gave it to a cardiologist for interpretation.  What I was told was as follows:  I was at 1.1sqcm.  The chambers were normal in size, and the pressures were not abnormally high (I'm not sure how that can be if the valve is at 1.1).  They didn't comment about whether it was a bicuspid valve, so I don't know if they could tell.  I'm 47, so it's a fair possibility.  There was no mention of regurgitation.  My blood pressure bounces around some, but stays <150/<90.  

Sounds like you have high confidence in sonography.  Too bad it doesn't overestimate an AS problem.  I'm finally getting referred to a cardiologist, so I should be able to get more info about the next echo, and a deeper interpretation.

[MelissaA]

I have a question regarding and echo I have had. I have had three echos since 1/98, First one was normal, I don't have any measurements on.  I had an Echo in the fall of last year that was  a little abnormal.  My LVOT was listed as 1.77 (I am not sure what that means) IVSd was listed at 1.31 and IVSs was listed as 1.66.  I was told this was in the margin of error.  My Left Posterior Wall LVPWd was 1.07 and LVPWs 1.60.  My doctor wrote that my Right Ventricle is upper limit normal measured at 2.74. and my RSVP was 32 mmHg.  They also used the term Hyperdynamic FX, and I have no idea what that means.  I was told after that echo I needed to take it easy.  I had a Cardiac Cath a couple weeks later and that was normal. I then had another echo in January of this year and the Conclusion was Normal Cardiac Structure and Function.  My measurements on this one were LVIDD 3.7, that changed from first one which was 4.36.  IVSD 1.1 LVPWD 1.2 Aortic Root 2.3  Left Atrium 2.9.  I am concerned because now I got the okay to excersise again.  Are my measurments something to be concerned about or are they okay?  I was concerned of Hypertrophic Cardiomyopathy?  Which he had mentioned before as well as Restrictive Constrictive Disease.  Should I push it any further or let it go?  I don't know if I need to get a second opinion.  My cath was normal and from what I understand that test is acurate.  Would it pick up Cardiomyopathy?

Thanks

[Bob to Echo Tech]

A cardiologist (not mine) told me that echocardiograms are "notoriously inaccurate" when it comes to measuring the size of the aortic valve opening, particularly if it's bicuspid, or if there's regurgitation.  I have aortic stenosis, and want to avoid having a cardiac cath as long as possible.  I haven't been told I need a cath yet, so this isn't an  avoidance thing, but I don't want to wind up getting one just to satisfy a doctor's curiosity.  Some doctors take the cath procedure very seriously, others seem to feel it's no big deal and should be done as a minor procedure.  I think it's something to have done when you need to, but not to be taken lightly.  

What's your opinion of the accuracy of an echocardiogram for estimating the extent of AS?  Please note, I said opinion.  I know there may not be a "correct" answer.

[lee to cindy]

now that's what i call a good answer to question!!  pam got what she was looking for and we all got a little education.  thankyou.

[Echo Tech]

EPSS stands for e point septal separation.  All this means is that when your mitral valve opens there is that much distance between your anterior leaflet and you ventricular septum ( the wall dividing your ventricles)  EPSS dosen't tell us anything about the mitral valve it self.  It is meant as an additional assessment of the size of your left ventricle.  Your EF (ejection fraction) does sound on the low side but that is something you should talk to your cardiologist about.  Sometimes patients who drink to much alcohol can have an enlargening of the heart called a cardiomyopathy.  As far as you MVP you should just be sure tell your dentist you have this condition so the can give you antibiotics to prevent any infectins on the valve.

[BEWARE]

Please be careful when going to other sites. Dr. Singh is no doctor. He is P2K, alias Parmi, alias, Singh 2000, alias Singh45, alias Dr. Singh.

[jennileigh222]

A related discussion, Response to EPSS Question was started.

[MelissaA]

I think I should have put that the LVOT was 1.77 cm this was under the measurements of Aortic Root & Valve.  Under the doppler max velocities it was 1.2 which was slightly higher than the normal reference values (.7-1.1 m/sec).  My cardio said I have a good strong heart.  What would cause the Hyperdynamic Heart?  Is that bad to have?  Would having fast heart rates cause something like that.  I also had another question.  If your heartrate drops during a echo report could it be possible that the electrode was not connected properly, it dropped about 70 bpm to 27 during the test while in a position and I didn't feel any symptoms.  Doc said the echo didn't show that the heart rate dropped.  Is that a possibility on the machine it was showing 27-35 while in that position once I moved again it went right back to where it was before it dropped because a electrode was getting pulled?  Is enlarged septums like the measurments I said something that is seen a lot.  I was told now that Sinus Tach can cause some enlargement and it may not be Hypertrophic Cardiomyopathy?

Thanks Again

[cardiac sonographer]

A cath can pick up any kind of pressure gradients in the heart and usually echo measurements are relatively close to that obtained in the cath lab.  The LVOT velocity is 1.77 m/sec  (that's how fast the blood is moving at that particular point) that is higher that normal but that is probably due to it being hyperdynamic.  Hyperdynamic means your heart is squeezing harder than usual.  So the blood move faster because of that extra squeeze.  As far as you measurement differences, when we measure we only measure a slice of your heart.  The second time they could have been cutting the heart at a different angle and that could account for the difference in measurement.  As far as the Cardiomyopathy goes...to have a hypertrophic CM several things need to be present.  I am not sure if a cath could pick it up but they would have been able to tell you by echo if you did have one.

[cardiac sonographer]

When ever there is a congenital abnormality of any valve the measurements of opening are more dificult.  I work at a very well known University Medical Center in California.  In our lab the quality and accuracy of our tests are outstanding.  In my opinion  quantifiying the severity of any valvular disease by echo is accurate as long as the technician performing the exam has had good training and they are registered.  The liscence given is RDCS (registered diagnostic cardiac sonographer) This means the tech has competency in the physics and anatomy of the heart as well as ultrasound physics and pathology.  However a echo can never over estimate the severity of the AS.  You can underestimate if the machine isn't good or it good pictures are not obtained or if good Doppler is not obtained.  In our lab we are trained to know what we are seeing and why it is happening, we are more than just picture takers.  A cardiologist should always review the echo and make the final call on severity of anything.  Do you know your valve area or how severe the AS is?  Is there associated regurgitation?  Do you have left ventricular hypertrophy or LVH and if yes how severe?  How about high blood pressure?  All these things come into account when estimating the severity of AS.  Hope this helped out a little.

[Jamie]

Anybody know why we can't post new questions to this forum? I keep getting a message that the limit for today has been reached- and this for two days! I even tried posting at exactly 12:05 Eastern time, then again at 1:05 and 2:05 Eastern time, same results. There has only been one new message posted today 4/29, and only three yesterday, so what's up?

[Charlotte]

I can't answer your questions, but as a MVP sufferer myself I wanted to tell you to try not to panic about it. I would avoid alcohol all together, though, because I think it's considered a stimulant...as well as caffeine & sugar.

[Cleveland Clinic, MD]

Hi Pam,

EPSS is not a standard abbreviation so I don't really know what it is referring to.  If you can give me the full name I may be able to tell you what it is referring to.  In general however none of the things you mentioned are general cause for concern.