LVH and Diastolic Dysfuntion on Echo

I have posted a couple of times in the past couple of months but would like to clarify a couple of things.

I had an Echo which one cardiologst read as normal, and one read as Mild to Moderate of LVH with possible diastolic dysfunction, EF, wall motion, and chamber sizes were normal. With trivial to mild insuffiency in both the mitral and tricuspid valve.

My EKGs have never shown LVH or anything really abnormal other than LAD, IRBBB, and Short PR syndrome depending upon who did the test (I assume a lead placement issue)

My questions are:

1. Does LVH look different on Echo when commpated to HCM?
2. Would mild or moderate LVH cause an increase in SCD?
3. Why would many EKGs miss the LVH if it is actually there?
4. Could technician error cause a false Echo report?
5. I was on Vallium (for stress) for a while and notice my airway would sometimes close up while lying on my back when I would be in the transition period between sleep and awakness, can vallium cause these apnea like symptoms or increase them?
6. I have been able to convince myself I do not have many of the rare heart conditions, but something like Idiopathic VF concerns me. What info could you give me on this condition, and does it differ from Brugada, and would the newly discovered Short QT syndrome be included in the Idiopathic VF cases?

Thank You for your time.

[Michael J. McWilliams, M.D.]

I notice from your post that you are worried about the rarest medical conditions.  Be careful not to read too much on the internet, it can really scare you if you aren't careful.

1. Does LVH look different on Echo when compared to HCM?

They can look similar, but HCM that is associated with higher risks of cardiac events is usually pretty thick.  HCM is usually localized to the interventricular septum, LVH is usually around the entire left ventricular chamber.  HCM is often so thick that it obstructs the outflow tract and creates a pressure gradient between the LV chamber and the aorta.  It often cause the mitral valve to move anterior during contraction (SAM) and can cause the mitral valve to leak.  If I read mild/moderate LVH on an echo, this implies that it is symmetrical around the heart muscle and not localized.  The whole picture must be considered to determine if this could be HCM or if it is just LVH.

2. Would mild or moderate LVH cause an increase in SCD?

Any structural heart disease signifies an increased risk of cardiac events -- but this is not a yes or no answer, there is a gradient of risk.  The risk would be greater if there was either severe LVH or if there was severe diastolic dysfunction.  Your echo read does not sound like it is high risk or even moderate risk.

3. Why would many EKGs miss the LVH if it is actually there?

It is a surrogate marker for LVH.  LVH is really an echocardiogram diagnosis. EKGs often over or under call LVH.

4. Could technician error cause a false Echo report?

Not usually for LVH.

5. I was on Vallium (for stress) for a while and notice my airway would sometimes close up while lying on my back when I would be in the transition period between sleep and awakness, can vallium cause these apnea like symptoms or increase them?

It could if you took too much or if you were very sensitive to it.  I think what you are describing is a more common phenomenon that many people occasional have -- I have had it myself when I am very tired.  Usually nothing to worry about unless you think you have sleep apnea.

6. I have been able to convince myself I do not have many of the rare heart conditions, but something like Idiopathic VF concerns me. What info could you give me on this condition, and does it differ from Brugada, and would the newly discovered Short QT syndrome be included in the Idiopathic VF cases?

In general, idiopathic VF has no warning.  If you or I have that, there isn't much you can do.  It is very rare.  Brugada  syndrome is much different and is also a very rare condition.  The explanation of both conditions is not easy to understand or explain.  The joke about short QT syndrome is that there are more researchers studying it than there are people in the world that actually have it - it is very rare.  Idiopathic VF patients have VF for no apparent reason (we don't know the reason yet), the other syndromes have a clear genetic and pathophysiologic explanation.

I hope this helps.  Don't worry about this rare stuff.  Work on the reversible risk factors like diet, exercise, no smoking, and close management of diabetes, cholesterol and hypertension.

[LukeL]

Thank you for your reply, the reason I read into the rare conditions is that I have neurfibromatosis, with cherubism/fibroys dysplasia and have had rhabdomyosarcoma so I tend to look into the rare medical conditions instead of the common ones.

[Michael J. McWilliams, M.D.]

Guess I can't argue with that--those are pretty rare.

[tickertock]

I also have been diagnosed with mild hypertrophy of the IVS it is only abnormality noted on my echo, I was assured not to worry about it and that I don't have HCM, I was told it was caused by HTN, but my BP has been controlled now for years ranging in the average of around 105/65. I have ankylosing spondylitis and I often wonder if there is some link to my LVH and ankylosing spondylitis and it is not caused by HTN in my case.I know that AS has been linked to some heart problems with the aortic valve and conduction sysytem of the heart.Do you know the dimension of your heart? My IVS was at 10mm to 12mm diastole is 2001 and my IVS in 2005 was read at 14mm, did by the same same cardio on the same echo machine. I was due for an echo this year but it will have to wait til next year, I try not worry about it but sometimes I find myself straying and thinking about it.All the Best for the New Year and try to keep your mind off those rare things it can drive nuts if you keep researching, you can convince yourself that you have every disease in the book if you keep reading about them, I know I've been there it's not a good place to be.Take care.

[LukeL]

I just got a brief echo report that listed what was normal and what wasn't. Just said mild to moderate LVH with possible evidence of Diastolic dysfunction and trivial insuffiencies in the mitral and tricuspid valves. All other things normal including EF and wall motion.

[tickertock]

I posted a question on the heart disease forum today concerning my hypertrophy, I'm awaiting the doctors reply , you might want to check it out.