Pediatric Heart Expert Forum
Letter from consultant which make no sense
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Letter from consultant which make no sense

Our 2 year old daughter went for her 6 mth check up she has tricuspid atresia, with vsd and asd va concordance with normally related great arteries she went through the glenn shunt in 2007.  Her sats are mid 70's and we are concerned about her so relayed this to her doctor.  Our letter back has parts which are double dutch to us, we have had many in the past like this and not followed up what they mean.  So if anyone can help in telling us what a sinus rhythm with an axis of 5* and left atrial hypertrophy on ECG with dominant left ventricular forces. any help on this would be appreaciated.  we do understand her underlying symptoms etc.
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Dear Lisamarie,

I can’t be sure, but it sounds as if you may have received a copy of the clinic letter for your daughter’s last visit.  My very first recommendation is that you follow this information up with your primary cardiologist, since he or she will know your daughter’s anatomy and physiology much better than I will, having never seen her and having only minimal information.  What you are describing on the ECG is several different aspects of this study.  Sinus rhythm is the normal rhythm that originates in the natural pacemaker of the heart, the sinus node.  The axis is the electrical axis of the heart, which is the direction that the combination of electrical forces generated by the heart travel.  The normal range of axis for your daughter’s age is between 5-100o.  Left atrial hypertrophy suggests that the left atrium, the receiving chamber on the left side, is thickened.  Without seeing your child or her studies, I am not sure exactly why this is so.  However, I will say that ECGs are good for rhythm but only okay at estimating chamber size, so we do see a lot of false positive findings when assessing the size of the chambers.  Lastly, the concept of dominant left ventricular forces goes along with tricuspid atresia.  The tricuspid valve and part of the right ventricle did not completely form, and thus the left ventricular forces show up more.  Do remember that an ECG is just a test, and should be interpreted both by itself as well as in the context of your child’s heart condition.

Finally, please make sure that you are communicating your concerns and questions to your cardiologist, and make sure that you are happy with how your questions are getting answered.  It is important that you are comfortable with this.  If you are not getting the information that you feel that you need, it is certainly reasonable to obtain a second opinion.
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