how to read echocardiogram

Question

I received the preliminary report of my echocardiogram CPT 93307, 93320, 93325 and need help to understand it: 

CEREBROVASCULAR                                                 CODE 
AAA(Thoracic Aneurysm)                                              441.1 
Carotid stenosis w/o CVA                                              433.10 
Carotid stenosis w/ CVA                                              433.11 
Carotid bruit                                                                  785.9 
Claudication                                                                  443.9 
TIA                                                                               435.9 
Amaurosis fugax                                                            362.34 
Syncope                                                                        780.2 
Aphasia                                                                         784.3 
Slurred Speech                                                               784.5 
Hemiplegia, unspecified                                                   342.9 

VENOUS 
Cellulitis                                                                        682.9 
DVT (Deep Vein Thrombosis)                                          453.8 
DVT Femoral                                                                 451.11 
DVT Pop/Tibial                                                               451.19 
Edema                                                                          782.3 
Pain in limb                                                                    729.5 
Post phlebitic syndrom w/o complications                         459.1 
pulmonary embolism/infraction, other                                415.19 
superficial phlebitis GSV                                                  451 
varicose veins w/ulcer and inflamation                               454.2 
varicose veins w/ulcer                                                       454 

Can some one tell me what's wrong?  My family doctor suspects that i have pulmonary hypertension.  I'm terrified.

chely22 · Answer

I think what you need is a CT scan of your heart, not a body scan because your main concern and pain is on you chest. I know it must be frustrated to have pain and all exams turn out to be normal, I have the same problem....chest pain and all these exams and nothing, but I just had a nuclear stress test...let's see what the results are going to be.

Hope you get better and keep telling your doctors about your chest pain, they have to find out what is causing your chest to hurt.

PAITON2010 · Answer

I was going in for a surgery and had to get an EKG and blood work, there was a abnormal reading on it so my PCP sent me for a Echo Stress test and that came back reading low likely hood, and when my PCP received that she would not okay my surgery and is now sending me to a Cardiologist. After my test I was a bit light headed and a bit of tightening in my chest. But I have also been having numbness and tingleing in my feet, I will go as far as my right toe turns purple. I am 45 years of age and can not understand what they are looking for, could someone maybe have some info to help me understand this better.

kenkeith · Answer

Thanks for your response. Enjoy your vacation and stay well.

long73 · Answer

Thanks Ken...i'll take the meds and how if they'll help...i'm taking one week vacation and will be back in 10 days...hopefully, everything will be better...will post when i get back...thanks again for your replies

kenkeith · Answer

QUOTE:.  "What does "sinus rhythm with early repolarization but no significant ST or T wave changes" mean?"

>>>>>When there is an irregular rhythm the source can be the sinus node (individuals natural pacemaker), sometimes there is an irregular rhythm from an abnormal source. Your sinus rhythm has an occasional out of sync. electrical impulse...not unusual circumstance we all have an extra or skipped heartbeat.

Q: " Does the tape record every actions the tech did (how he measured, what parameters he input...).

>>>>generally, when there is a tech involved in testing, there can be subjectivity.  With an EKG, there can be improper placement of leads, lead not conducting properly, etc. 

You have been given good news regarding your health, and the probability of a correct analysis is high.  That is an outstanding result with the CT scan.  I have a scan about a year ago, and total score was over 1000.  All 4 coronary arteries had some soft plaque!

long73 · Answer

Thanks, i'm planning to take the medications this weekend to see if they help.  Here's the exact wordings from the cardiologist report:"
    His electrocardiogram today reveals sinus rhythm with early repolarization but no significant ST or T wave changes.  As a part of the workup for his recent symtoms he underwent a treadmill stress test which revealed ST segment depression.  Two days later he underwent a stress echocardiogram which revealed no evidence for ischemia.  There was a question of left ventricular hypertrophy on his electrocardiogram at the time therefore he underwent a standard resting echocardiogram which was essentially normal.  The technician's note of right ventricular systolic pressure of 41mmHg was an overestimation and the patient likely does not have any significant pulmonary hypertentention.
    ECG: Normal sinus rythm.  Within normal limits.
   ASSESSMENT: Patient's physical examination, recent cardiac testing and atypical symptoms suggest that he has no significant underlying cardiac pathology to be concerned about.  I reassured the patient about this as he appeared quite anxious of the results of his recent diagnostic testing.  No further cardiac testing is required at this time"

Questions:
1.  What does "sinus rhythm with early repolarization but no significant ST or T wave changes" mean?
2.  Does the tape record every actions the tech did (how he measured, what parameters he input...)

Since i'm still having symptoms, i'll take the medication and if they don't help, i'll either ask my PCP to see what else he can do or ask for second opinion.

PS.  I did have a full body scan a few days ago (after seeing the cardio and the PCP) and it showed everything normal (no calcium build up, i.e, score of 0).

kenkeith · Answer

If your right ventricle is normal size, that would be some evidence there is no a serious problem for any length of time. Pulmonologist would be more decisive and in my opinion more trustworthy for PAH diagnosis.

You are correct a cath is better to determine pressure.  I believe PAH with an echo involves an algorithm measurement from blood velocity and not very accurate.

Follow your doctor's advice and take the medication, and if the problem continues you may wnat to get a second opinion.  I believe the tech input parameters and the echo software does the calculation. A review of the tape, my echo is on dvd, can provide information for a second opinion.  I have my disc from the latest echo, and I viewed the images.

long73 · Answer

I saw the cardiologist.  When he asked how i was doing since it was the first time we met (he had been reading my echo but we had never met), i said "Terrible".  He asked "Why?".  I told him "Because I am having pulmonary hypertension."  
He told me:" You don't have PH"
I said:"But the primary doctor wrote that down after he received the preliminary report of the echo where it said my pa was 41mmgHg"
The cardiologist shook his head:"I told those primary care physician not to tell patients anything before I talked to them first"

He went on and said that i don't have PH.  The 41mmgHg was an overestimation because the technician who performed the echo on me did it wrong.  He also said that the machines are often wrong.  To prove that point, he said that the ECG he just performed on me (not the echo the tech did) showed that i was wearing a pace maker.  He then went on and asked me questions about my health history.  After i told him that i played soccer twice a week and dont have symtoms; and that my dad has "enlarged" heart but still alive and healthy at 70.  Mom has no health issue.  He listened to my lungs and heart.  He then concluded that i had no heart disease, including PH.  A few days later, i met up with my PCP and he showed me the official report from the cardiologist which stated that no further cardiac testing is required at this time since I have nothing significant

The report does not have any numbers.  Should I get a second opinion from another doctor?  I'm still having these questions:

1.  I know the right heart catherization (RHC) is the "gold standard" test to determine if someone has PH.  I also understand that is a very dangerous procedure.  What would trigger the doctor to order a RHC?  Is it the echo?
2.  If it is the echo, what pulmonary artery pressure the echo has to have to trigger the RHC?  I believe 25mmgHg is the upper limit for PH, but this 25mmgHg is measured by RHC, not echo.
3.  The echo was done on my by a tech and was recorded on VHS tape (i believe so as i saw him put a blank tape labeled my name in the machine).  Can the cardiologist tell that the tech was measuring wrong just by looking at the tape? (The cardiologist was not there when the echo was done)
4.  In terms of patient right, can I ask for a copy of that tape and a report with numbers (size of my heart, wall thickness, ejection fraction, pressure..)?


I'm still feeling tired and some chest tightness here and there...the PCP concluded that it must be the stress, sleep deprivation and the anxiety that cause my fatigue and chest tightness because the cardiologist saw no cardiac problem, all the blood work came back normal (except for low vitamin D)...so he prescriped me antidepression and sleeping pills and vitamine D

Should I push for more testings???

kenkeith · Answer

A cath takes a few to several hours and you are given medication that reduces anxiety.  I was awake during the procedure, and felt very good (effects if the injection) :).  Unless there are unusual circumstances you should be able to go home the same day. 

Unable to comment on the medication dosage, possible side effects, etc.  PH can be primary and genetic, and the underlying cause may not be known.  Or the PH can be secondary, and successful treatment of the underlying cause may help.

long73 · Answer

Thank you Ken.  your answers are very helpful.

More questions:  
1.  Right heart catherization (RHC) is a very invasive procedure.  How long do I have to stay in the hospital?
2.  Should I get the RHC done as soon as possible?  I'm asking this stupid question (my instint tells me yes, the sooner i start the treatment, the better) because my family doctor has been taking a long time.  Usually, he asks me to come back 10 days the previous test.  Also, since my family already booked our vacation in mid May, I want to know if we can still take the vacation
3.  Since you said that the doctor can administer medicine while the cather is still inside the heart, how many medication can he try?
4.  I know that there is currently no cure for PH. but if the underlying problem (say, i have sleep disorder) is fixed, will the secondary PH go away?

kenkeith · Answer

Before effective therapy for PH, the condition should be determined if PH is primary or caused by another underlying cause (secondary PH).  Secondary pulmonary hypertension is much more common than primary pulmonary hypertension.

A newer classification of this condition is based on the main underlying cause of pulmonary hypertension. This system classifies the condition based on whether it is due to: •left sided heart disease, •lung disease, •blood clots, •constriction of arteries due to any reasons (including primary pulmonary hypertension), and •obstruction from outside of blood vessel (for example from diseases of the chest wall compressing the blood vessels). 

Pulmonary hypertension can be caused by diseases of the heart and the lungs, such as:
•chronic obstructive pulmonary disease (COPD), •emphysema, •failure of the left heart ventricle, •recurrent pulmonary embolism (blood clots traveling from the legs or pelvic veins obstructing the pulmonary arteries or chronic thromboembolic pulmonary hypertension), etc.
 
The best procedure is a right heart catheterization; the response to certain medication to treat pulmonary hypertension can be assessed. This is done by administering medications for pulmonary hypertension while the patients still has the catheter placed in heart. Then pulmonary blood pressure is monitored and the response to treatment is compared to no treatment. This can give the physicians a clue as to if an individual is a candidate for a certain therapy and also what dosage of the medicine may be appropriate.

For some insight: "Pulmonary hypertension is defined as the mean pulmonary artery blood pressure greater than 25 millimeter of mercury (mmHg) measured by right heart catheterization. The pressures can be much higher than 25 mmHg in some people. Therefore, the pulmonary hypertension can be labeled as mild, moderate, or severe based on the pressures. Mean arterial pressure is two-thirds of the difference between systolic and diastolic blood pressure (systolic is the upper number and diastolic is the lower number in measuring blood pressure). As explained above, the pulmonary blood pressure is much lower than the systemic blood pressure. 
Other tests available for diagnosing pulmonary hypertension include electrocardiogram (ECG), chest x-ray, and echocardiogram. An ECG may show some abnormalities that may be suggestive of right heart failure. Chest x-ray may also show enlargement of the chambers of the right heart. And echocardiogram (ultrasound of the heart) shows ultrasound images of the heart and can detect evidence of right heart failure and pressures in the pulmonary artery can be estimated. These tests, in the right clinical setting, are very useful in diagnosing pulmonary hypertension.

Other tests may be useful in evaluating the conditions leading to secondary pulmonary hypertension. For example, a ventilation-perfusion scan (V/Q scan) can detect blood clots in the pulmonary arteries suggesting chronic thromboembolic pulmonary hypertension. A pulmonary function test can be useful in diagnosing chronic obstructive pulmonary disease (COPD)."

long73 · Answer

since my pa reading is 41mgHg, i am terrified to learn that i do have pulmonary hypertention.  Do i really need the right heart catherization procedure?  Can the doctor just start prescribe medication for me since 41mgHg is much higher than the normal value of 25mgHg?

If I respond the the medication, how long can I live?  I've read from some websites that 3 years are max if the body does not respond the the drug.  Other website said that some PH patients who have had the disease for 20 years and still living.  Is there any statistics on how succesful these drugs are in treating this disease?

In terms of diet, what do I need to do from now?

My family doctor said I could still play soccer twice a week.  Should I?

kenkeith · Answer

After you've had an echocardiogram, the most effective and appropriate test for pulmonary hypertension is a right heart catheterization. This test is often the most reliable way of diagnosing pulmonary hypertension. During the procedure, a cardiologist places a thin, flexible tube (catheter) into a vein in your neck or groin. The catheter is then threaded into your right ventricle and pulmonary artery. Right heart catheterization allows your doctor to directly measure the pressure in the main pulmonary arteries and right ventricle. It's also used to see what effect different medications may have on your pulmonary hypertension.

long73 · Answer

Thanks for all your response.  Unfortunately, this medical group is not prompt when it comes to test results.  I had my EKG (on Apr 2nd), stress echo (Apr 9), then echo (Apr 21) done for a while, and still, they only provide me with "preliminary" report (with the numbers I listed above);

I'm thinking about getting the full body scan done to find out what causes my chest pain (dull pain that experience here and there for less than 1 minute when i'm not having physical activities) and fatigue.  Do you think the full body scan can detect PH?

kenkeith · Answer

RadioAstronomyObserver is correct.  You will need a cross refererence, but usually the report provides information regarding results. 

I can tell by the test protocol that there is an evaluation regarding a possible TIA (minor stroke, etc) and the appropriate vessels were looked at for any blockage. 

Pulmonary hypertension involves the measurements related to the VENUS section. If you doctor suspects PH, then (s)he may have ruled out the other portion of the test.