left atrial enlargement

I am 46 yrs old (female)and recently had an ekg. I was having chest pains and a fast heart beat with extreme fatigue. The ekg report stated it was abnormal with a possible left atrial enlargement, left axis deviation, left bundlebranch block and normal sinus rythm. My family doctor says there is nothing to worry about but I continually have dull chest pain with rapid heart beat. I have tried motrin to control the pain but it doesnt help at all. The only thing that helps a little but not completely is Alprazolan 0.5 3 times a day. It just takes the edge off of the pain. Do I need to see a cardiologist for a second opinion?

[Yvette BG]

I would see a cardiologist.

[rkrhome]

TY Yvette

[erijon]

An EKG is NOT accurate for diagnosing an enlarged left atrium. Normally this is found during an echo and even then the only true way to know is by a volume test. Most cardiologists won't do this as an enlarged atrium is usually of no significance. Normally doctors will try to find the underlying cause like high blood pressure and treat that. The possibility of a left axis shift just means your heart may not be oriented on a normal axis, which is usually the case with people that have lost weight. I have the same thing and my cardiologist says it is a normal variant and not to worry as well.

Good luck!

Jon

[rkrhome]

Thank you for that info Jon. I have looked everywhere on the web for information that would explain it the way you just did.

[erijon]

You are welcome. To help a little more, here's how it was explained to me;

You have to understand the limitations of echocardiography in assessing left atrial size: although they are telling you that it is dilated at 4.9 cm, and the upper limit of normal is 4 cm, it may actually not be dilated at all. This 4.9 cm was most likely obtained on a single 'slice' of the atrium and may not be representative of actual left atrial size. For instance if you slice a banana perpendicular to its long axis you may get a small value, but if you cut it at a 45 degree angle you may get a larger value: simply because you were not perpendicular to its main axis. Often patients, especially patients who may have been heavier in the past ( you mention that you lost 60 pounds) does not have the standard  orientation in the chest and may be rotated to the left, causing the standard echocqardiographic views to be off axis and the consequent inaccuracies in measurements. The most accurate way to measure the left atrial size is to report atrial volumes,  but this is difficult to assess in most patients, and in general has very little prognostic value in most patients. The exception are patient with atrial fibrillation whose likelihood of responding to treatment depends on the left atrial size.

Hope this helps!

Jon