Abnormal Echo with breathing problems and chest pain

30 yr old/male.  Have had some shortness of breath for about 3-4 months now (at rest or exercising) as well as varying chest pain/discomfort on the left side near the sternum, better breathing ability while lying down but with some deep noise that can only be heard while lying on my back and some slights bouts of dizzyness every once in a while.  I have been seeing a pulminologist who after normal chest x-rays, CT scans of the chest, VQ scan, EKG and mildly low PFT results that suggested asthma, had me get an echocardiogram (my father died of a heart attack at 55) which had the following results:

LV end diastolic volume, wall thickness and contractility normal.  MV leaflet thickness, opening, excursion closure normal.  AV systoliv opening normal.  MV leaflet diastolic opening insertion normal.  No prolapse.  RV normal.  No pericardial effusion.

Left ventricular ejection fraction is 70%

Cardiac Doppler Study:Intracardiac flows were assessed by color and pulsed doppler techniques.  Mitral valve flow profile suggests diminished left ventricular compliance.  There is trace mitral insufficiency.  Aortic peak velocity is normal.  Tricuspid flow is physiological.  There is no pulminary hypertension.

Normal left ventricular systolic function
Diminished left ventricular diastolic compliance
Trace mitral insufficiency

The last blood test I had back in Feb of this year had the following measurements:
mg/dl:  
Cholesterol:  189
HDL:  68
LDL: 109
Triglycerides: 62
Blood Pressure: 120/80

I am getting a stress test done in a few weeks as requested by the cardiologist.  Should I be alarmed at all from the abnormal echo and the symptoms I am suffering from?  Will a normal result from my stress test in addition to the results I listed above be enough to rule out heart problems being the cause of my symptoms?

[Michael J. McWilliams, M.D.]

Hello,

Should I be alarmed at all from the abnormal echo and the symptoms I am suffering from?  

The echo does not sound that abnormal.  They mentioned decreased compliance in the ventricle.  this can cause shortness of breath, but it depends on how extensive the decreased compliance is.  There is a grading system for decreased compliance (diastolic function) from 0-4.  You should ask your doctor how significant your diastolic dysfunction is.


Will a normal result from my stress test in addition to the results I listed above be enough to rule out heart problems being the cause of my symptoms?

Shortness of breath can be caused by diastolic dysfunction but it depends on how bad this dysfunction is -- if it is grade 0-1 (most common), it is unlikely to causes symptoms.  I can't really answer the questions without knowing how bad the diastolic dysfunction is.

The most important thing for you to do is write down your questions before you meet with your cardiologist and then make sure he answers your quetsions.

I hope this helps.  Thanks for posting.

[ducksfan]

When I called radiology they said anything not on the result page I described, the doctor would have to call and obtain.  I assume this will be difficult since the cardiologist didn't mention anything regarding the diastolic function grade after he looked at this result and examined me.  Is there any mathematical formula I can use to derive the diastolic function grade from the numerical results I have?  I have:  aortic root, lv end systole, aortic cusp opening, lv end diastole, interventricular septum, left atrium, lv posterior wall, rv internal diameter, lv ejection fraction.  The only result falling outside of the normals was aortic cusp opening which was 1.6cm, normals 2-4cm.  Thanks.

[Michael J. McWilliams, M.D.]

nope.  it is a Doppler measurement.

[ducksfan]

I'm finding it quite frustrating that if this is a Doppler measurement that should have been included on a report, why it was not.  I told my pulminologist basically what was stated here about finding out the severity of diastolic dysfunction and they said they would call radiology.  So I hear back today from them that they don't believe my breathing is related to the diastolic dysfunction, when I inquire about seeing the rest of the results they say that they spoke to the cardiologist and that it is not related.  I should probably find out what extent the dysfunction is if for nothing else than my own personal knowledge but I can't seem to get this information from anyone.  I have been having intermittent chest pain and go for a cardio-pulmonary stress test and a methacholine challenge test in 2 weeks.  Hopefully there will be more information available to me after that.