You are within what is considered a normal variant. The actual numbers are as follows;
30 - 40 Normal
41 - 46 Mildly abnormal
47 - 52 Moderate abnormal
> 52 Severely abnormal
Also, an echo is not the most accurate way to measure the atrium. Remember, and echo is a single slice view of the atrium. Imagine a banana, if you cut it on a 90 degree angle it will look smaller than if you slice it at a 45 degree angle, this is the issue with echos and diagnosing atrial enlargement. Much depends on the angle of the slice and the axis of the heart. The best way is to measure atrial volume, but this is rarely done as an enlarged atrium is normally not a significant finding. The biggest issue is an increased risk for blood pooling in the atrium which can form a clot which may induce a stroke. When mine was diagnosed to be enlarged, my cardio said it may just be normal for me.
I hope this helps,
I should add that your doctor should work with you to find the underlying cause of the enlargement. It could be something as simple as high BP, but it should be dealt with. Once the underlying cause is resolved, the atrium can remodel itself back down to a normal size.
You haven't mentioned the PVC issue. That could be an underlying cause..also the size of any chamber is not static because the intra chamber pressures change constantly. You can probably safely apply a marginal error of 5-7% higher or lower. With the banana theory aside the measurement of any chamber is difficult because the shape of any of the 4 chambers are not spherical meaning from any fixed point the distance to other points is not equidistant. The margin of error will give a ballpark estimate.
I am providing a link that may help give you a perspective and yes a dilated left atrium could cause palpitations and PVCs. The treatment depends on the cause. It may be due to high blood pressure. Do you have high blood pressure? If I understand, are the results of an echo you provide a year old, and you are having a heart rhythm issue currently?
Thanks for your question, and if you have any further questions or comments you are invited to respond. Take care and I wish you well going forward.
You don't like the banana theory? Would it help if you knew it came from one of the MH docs here in a response to a question I asked? Here's their exact quote;
" 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 representatitive 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 degreee 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 innacuracies 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 likelyhood of responding to treatment depends on the left atrial size."
Hope this clears up the banana theory for you Ken :)
Thank you very much all for your comments. I have been taking metropolol 25 mg morning, 25 mg evening for about six years now to treat pvc's. These pvc's went away up until a few weeks ago. My BP is excellent 118/120 over 78/80 most times. Last night was terrible, the pvc's only start around 7pm. I was having one every 2-3 beats for about an hour. I was petrified so I went to bed. The only thing that has changed for me was going south in April taking Advil for a sore ear for 7 day straight (about 5 per day). I normally do not take Advil. When I got home I had severe stomach issues which they diagnosed as gastritis. Prescribed stomach pill. My GP says the stomach issue could trigger the pvc's. He also has me on a list for a holter monitor. I am scared to death which I am sure doesnt help things..
First off benign PVC's will not kill you even though they feel like they will. Yes, stomach irritation can trigger PVC's as well as anxiety. My doc put me on OTC Prilosec for 14 days and that helped me. metoprolol really doesn't treat PVC's. See if you can get an event recorder...since your PVC's are intermittent...this allows you to record the PVC's when you feel them.
I get my PVC's mid-day (not every day) and they can last for minutes or hours...the ones that occur every other beat are the worst for me. Relax, easy to say, and avoid NSAIDs.