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Does this sound like a "Structurally Normal Heart"?
Hello, I knows that when a person has PAC's PSVT's, etc, the doctor say there is nothing to worry about in a structurally normal heart. Well, I just had an echo, it looks good, but I was wondering what you folks thought. Here it is:
Cardiac Measurements:
Left Atrium Diameter: 36 mm (normal is 27 to 41)
Aortic Root Diameter: 30 mm (normal is 23 to 35)
Left Ventricle Diastole: 37 mm (normal 40 to 51) I know, I have a small left ventricle, that was discovered on my very first echo.
Left Ventricle Systole: 22mm (normal 22 to 34)
LV Septum: Diastole: 10 mm (normal 9 to 12)
LV Posterior Wall, Diastole: 10 mm (normal 9 to 12)
Cardiac Measurements:
Right Ventricle Diameter: 30 mm (normal 22 to 44)
LV Outflow Tract Diameter: 20 mm (Normal 19 to 27)
Calculated Values:
LV Fractional Shortening: 41% (normal 28 to 44)
Cardiac Structures:
Aortic Root: Normal size
Left Atrium: Normal size
Right Atrium: Normal size
Left Ventricle: Small size
Right Ventricle: Normal Size
Percicardium: No pericardium effusion
Regional Left ventgricular wall motion:
Anterospetial Wall: Normal for Apical, Mid and Basal
Anterosuperior Wall: Normal for Apical, Mid and Basal
Posterolateral Wall: Normal for Apical, Mid and Basal
Inferior Wall: Normal for Apical, Mid and Basal
Value motion and morphology:
Aortic Valve: Native valve,
Mitral Valve: Native valve
Tricuspid Valve: Native valve
Pulmonic Valve: Normal
Doppler flows:
Aortic: Peak velocity is 1.543 m/s, no aortic stenosis, no aortic regurgitation
Mitral: No mitral stenosis. No mitral regurgitation
Tricuspid: No tricuspid stenosis
Pulmonic Valve: No pulmonic stenosis. Normal, physiologi8c pulmonic regurgitation
PA Pressure: Normal, mean pulmonary artery pressure.
Conclusions:
Small Left Ventricular size with normal, left ventricular global systolic function.
Grossly normal RT and LT heart size and function.
It then said "Technically difficult study" Well, it looks good to me. When I asked 2 doctors about that, they both said that due to the faster heart rate of 94, and my body size being I have a very short torso, the tech wrote it that way, they said my heart is perfectly normal for me and doing its job very well. The tech did not figure out my EF, but one of the docs said it was more than likely in the mid 60's. He said the LV shortening Fraction was great and that was another way of doing the EF.
Anyway, what do you think? I am pretty happy with it, I am a constant worrier, so, I still worry when I have the PAC's and PSVT's, but that is my nature.
Thanks for looking at this.
Susie
Cardiac Measurements:
Left Atrium Diameter: 36 mm (normal is 27 to 41)
Aortic Root Diameter: 30 mm (normal is 23 to 35)
Left Ventricle Diastole: 37 mm (normal 40 to 51) I know, I have a small left ventricle, that was discovered on my very first echo.
Left Ventricle Systole: 22mm (normal 22 to 34)
LV Septum: Diastole: 10 mm (normal 9 to 12)
LV Posterior Wall, Diastole: 10 mm (normal 9 to 12)
Cardiac Measurements:
Right Ventricle Diameter: 30 mm (normal 22 to 44)
LV Outflow Tract Diameter: 20 mm (Normal 19 to 27)
Calculated Values:
LV Fractional Shortening: 41% (normal 28 to 44)
Cardiac Structures:
Aortic Root: Normal size
Left Atrium: Normal size
Right Atrium: Normal size
Left Ventricle: Small size
Right Ventricle: Normal Size
Percicardium: No pericardium effusion
Regional Left ventgricular wall motion:
Anterospetial Wall: Normal for Apical, Mid and Basal
Anterosuperior Wall: Normal for Apical, Mid and Basal
Posterolateral Wall: Normal for Apical, Mid and Basal
Inferior Wall: Normal for Apical, Mid and Basal
Value motion and morphology:
Aortic Valve: Native valve,
Mitral Valve: Native valve
Tricuspid Valve: Native valve
Pulmonic Valve: Normal
Doppler flows:
Aortic: Peak velocity is 1.543 m/s, no aortic stenosis, no aortic regurgitation
Mitral: No mitral stenosis. No mitral regurgitation
Tricuspid: No tricuspid stenosis
Pulmonic Valve: No pulmonic stenosis. Normal, physiologi8c pulmonic regurgitation
PA Pressure: Normal, mean pulmonary artery pressure.
Conclusions:
Small Left Ventricular size with normal, left ventricular global systolic function.
Grossly normal RT and LT heart size and function.
It then said "Technically difficult study" Well, it looks good to me. When I asked 2 doctors about that, they both said that due to the faster heart rate of 94, and my body size being I have a very short torso, the tech wrote it that way, they said my heart is perfectly normal for me and doing its job very well. The tech did not figure out my EF, but one of the docs said it was more than likely in the mid 60's. He said the LV shortening Fraction was great and that was another way of doing the EF.
Anyway, what do you think? I am pretty happy with it, I am a constant worrier, so, I still worry when I have the PAC's and PSVT's, but that is my nature.
Thanks for looking at this.
Susie
Best Answer
Hi!
I'm not familiar with Thickening fraction, I think it means how much the walls thicken as the heart contracts. Anyway, when the doctor wrote "grossly normal echo" you'll have to trust that. I know it's difficult when you (like me) suffer from health anxiety. Every echo measurement, like blood velocity, EF, FS, end diastolic diameter, end systolic diameter, wall movement, etc, will change from moment to moment, just like your blood pressure and your heart rate. We are not operated by a CPU, we are humans. You can't compare two results and find one "better" or "worse" when the conditions are different.
Concerning the shortening fraction: Ejection fraction can't be measured directly with echo (invasive procedures are needed) so it is estimated through different formulas. One of them is EF = FS x 2. This one is not correct when the FS is high, though. Say you had a shortening fraction of 60% (50 mm diastolic diameter, 20 mm systolic diameter) your EF would be 120% which is impossible. And it would be less than 100% because there would still be blood in the heart at end-systole.
Regarding the Holter, yes, PACs will be far more annoying and occur more often when we are afraid. PVCs on the other hand, can also be provoked by adrenalin and anxiety, but the ventricles are less sensitive to adrenalin than the atria. People suffering from PACs may often get "flare-ups" with cascades of PACs during anxiety attacks or major stress. PACs may occur in singles, couplets or runs. The fact that an atrial focus takes over the function as pacemaker for some seconds is not dangerous and in fact quite common. I have that "problem" too sometimes.
Atrial runs are according to the textbook PSVT, but then again, even sinus tachycardia is SVT according to the textbook. PSVT is usually AVNRT or AVRT. Even my PCP misunderstands this and that is highly annoying..
I'm not familiar with Thickening fraction, I think it means how much the walls thicken as the heart contracts. Anyway, when the doctor wrote "grossly normal echo" you'll have to trust that. I know it's difficult when you (like me) suffer from health anxiety. Every echo measurement, like blood velocity, EF, FS, end diastolic diameter, end systolic diameter, wall movement, etc, will change from moment to moment, just like your blood pressure and your heart rate. We are not operated by a CPU, we are humans. You can't compare two results and find one "better" or "worse" when the conditions are different.
Concerning the shortening fraction: Ejection fraction can't be measured directly with echo (invasive procedures are needed) so it is estimated through different formulas. One of them is EF = FS x 2. This one is not correct when the FS is high, though. Say you had a shortening fraction of 60% (50 mm diastolic diameter, 20 mm systolic diameter) your EF would be 120% which is impossible. And it would be less than 100% because there would still be blood in the heart at end-systole.
Regarding the Holter, yes, PACs will be far more annoying and occur more often when we are afraid. PVCs on the other hand, can also be provoked by adrenalin and anxiety, but the ventricles are less sensitive to adrenalin than the atria. People suffering from PACs may often get "flare-ups" with cascades of PACs during anxiety attacks or major stress. PACs may occur in singles, couplets or runs. The fact that an atrial focus takes over the function as pacemaker for some seconds is not dangerous and in fact quite common. I have that "problem" too sometimes.
Atrial runs are according to the textbook PSVT, but then again, even sinus tachycardia is SVT according to the textbook. PSVT is usually AVNRT or AVRT. Even my PCP misunderstands this and that is highly annoying..
I forgot to add some things. First, on the Echo. Under "Calculated Values" It says IVS Thickening Fraction: 17% (normal is 30 to 65) on my last echo, the one that they took more time with in 2008, it was 24%.
LVPW Thickening Fraction: 17% (normal is 30 to 65) Again, last one in 2008 was 48%.
I am concerned about the difference, not one doctor will answer me on this. One did say that because my heart was 94 bpm and I was nervous, those readings would be hard to get, these numbers are in the same catagory as the "left blank" EF number.
I think the tech went too fast, it only took 20 minutes and she was finished. Gesh, it was such a "technically difficulte study" then why did she go so fast and why the good comments at the end. Sure is a mystery.
My holter did not say PSVT's, it said I had atrial runs, are they the same?
It also said it was a very good reading.
Thanks again for your help, I appreciate it.
LVPW Thickening Fraction: 17% (normal is 30 to 65) Again, last one in 2008 was 48%.
I am concerned about the difference, not one doctor will answer me on this. One did say that because my heart was 94 bpm and I was nervous, those readings would be hard to get, these numbers are in the same catagory as the "left blank" EF number.
I think the tech went too fast, it only took 20 minutes and she was finished. Gesh, it was such a "technically difficulte study" then why did she go so fast and why the good comments at the end. Sure is a mystery.
My holter did not say PSVT's, it said I had atrial runs, are they the same?
It also said it was a very good reading.
Thanks again for your help, I appreciate it.
Thanks for your reply, it really helped.
You know, that old formulae could be right, you see, the first echo, the fractional shortening was 37, and then they did have an EF number which was 75, they called it hyperdynamic systolic function, so, maybe it is still close to that.
I also agree, I thought PSVT's were faster, but, my "runs" are always right after the PAC, then the pause, the fast beats, then pause, then back to normal. I am very blessed that they are not worse.
I admit, they do scare me, but the more scared I am, the more they act up.
Thanks again for your comment, it meant alot.
Susie
You know, that old formulae could be right, you see, the first echo, the fractional shortening was 37, and then they did have an EF number which was 75, they called it hyperdynamic systolic function, so, maybe it is still close to that.
I also agree, I thought PSVT's were faster, but, my "runs" are always right after the PAC, then the pause, the fast beats, then pause, then back to normal. I am very blessed that they are not worse.
I admit, they do scare me, but the more scared I am, the more they act up.
Thanks again for your comment, it meant alot.
Susie
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I'll comment both your posts here.
Both your echo and your Holter are perfect. Your results are quite like mine, my Holter also revealed some PACs (less than 50) and sometimes I get a few of them in a row. I wouldn't say this is PSVT, it's just PACs. Technically, more than three premature beats is tachycardia, but as my cardiologist said, use common sense. You have PACs. The one wide complex beat ("pvc") on your Holter is possibly a PAC too.
When I think of PSVT, I think about those reentry variats when you have to use Valsalva or splashing water in your face to terminate them. That don't seem to be the case with you. Your ectopic tachycardias also seem very slow, at 100 and 130 BPM (the first one is barely a tachycardia, more an "atrial rhythm" and the second is no more dangerous than a sinus tachycardia at 130 BPM.)
Your echo is excellent. Regarding the EF, an old formula did roughly estimate EF to FS (fractional shortening) x 2 which in your case would be 82%, but this formula is overestimating EF at high FS (like we have, mine is 40). My EF was estimated to 70%+ Some of us have large hearts and some of us have small hearts. Nothing to worry about.
It wouldn't be surprising if it is your health anxiety that maintains the PACs (though we all have PACs during 24 hours so you never make them go completely away). But if we are afraid, the PACs can narrow in on the previous beat and feel much more uncomfortable (what you feel in the throat is the atrial contraction towards a closed tricuspid valve, so the blood is pumped backwards - benign but uncomfortable). We all have PACs, most of us have more than you do. Most of us also have PVCs.. you don't.
Take care :)