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Echo says my R. side heart is at upper limits of normal?

I get an echo every 6 months since being diagnosed with an ascending aneurysm almost 11 years ago at Mayo Clinic in Jacksonville, FL.  I have all records of my previous echoes dated all the way back to 2005 at Mayo and they always measured my R. side heart at normal size.  I live in another state in a small town and I had a Ct scan here in 2009 and 2012 and they also showed my R. side heart as normal in size.  I have a few benign lung scars from possibly past infections or pleurisy...Never did smoke.  Now the echo I had a few weeks ago says my R. side heart is in the upper limits of normal...I asked my doc if having the scar tissue would make my right side heart work harder and make it larger?  She said, yes....but the scar tissue has remained the same since it was discovered back in 2005.  Located on top of both lungs and not very large....also have a 5 mm benign nodule on one lung as well..has not changed either.  So that is my history.  Now I AM WORRIED as to what is going on...or maybe  did the echo just mis-measure slightly and everything is really normal????  Very scared here....I also have cats and have for years taken care of their litter boxes and have breathed in cat litter dust I would imagine from time to time....I can take clear long breaths.....with no pain...no coughing, etc.  Hard to get back in with my Cardio doc to show her my past medical records, scan results and echo results.  I would have to wait another 4 months...Small town and lack of doctors...make it hard to get in...Wondering if I should see a Pulmonary doc???  Or, should I wait for my next echo in 6 months like the Cardio doc said to do when I left her office.  After all my research, now I know what I should have asked her, but, cannot get in to see her...WHAT DO I DO IN THE MEANTIME?  Thank you....
2 Responses
11548417 tn?1506080564
The right side of the heart can become enlarged from several different causes. Some of them are relatively "easy" to solve (anemia, hemochromatosis).

The question however is much more whether the right side of your heart is really enlarged, compared to 6 months ago.
In my experience, the measurement of heart sizes is often way off with echo doppler.

I understand from your posting here, that you discussed this measured right heart size with your cardiologist and that it did not really worry her?
Often, we stare ourselves blind on one single measurement, while the cardiologist overlooks the whole situation and bases his/her conclusions on that.
If your cardiologist was not worried, I would not be too worried either.
1 Comments
Thank you Ger57 for the reply.  I got in with my Cardio doc and she ordered a contrast study with intravenous injection of agitated saline performed at rest with cough and valsalva maneuvers.  There was no evidence of positive or negative contrast to suggest intradcardiac shunt.  Also, stated again was that my R. Ventricle appears to be upper limits of normal.  The apical portion of the right ventricle appears minimally hypo kinetic as seen from the apical view.  There is mild to moderate left atrial enlargement and there is mild to moderate right atrial enlargement.  Also stated was the info about my Ascending aortic aneurysm which I am fully aware of.  It has not changed too much since being found back in June of 2005.  Left Ventricular size is normal.  Global left ventricular systolic function is normal with the ejection fraction estimated in the mid 60's.  Wall motion appears normal.  My next appt. is in July as I go in every 6 months for an echo to keep an eye on my aneurysm.  But, now I AM CONCERNED about both my Atria being mild to moderately enlarged  and my Right ventricle appearing to be upper limits of normal....Never did smoke and drank so minimally, not even worth mentioning.  Have had a LOT of stress and adversity along the way of life.  One being losing my son in 2004.  I have been on Beta Blockers since my Aneurysm was discovered at Mayo Clinic in Florida in 2005....JUST keep on wondering why my heart is changing?  Sometimes, I feel docs just wait and watch.....Now I have to wait until July for my next Echo....I WISH I KNEW WHY my heart is changing....??  Scares me to death.  Keep on wondering if I should get a second opinion.....I did get copies of past echo...one being Dec. of 2014...it was noted that my Atria were mildly enlarged at that time....but it was not noted that my R. Ventricle was at upper limits of normal.....but this echo was interpreted by my former Cardio doc who eventually left the practice .....I AM SO NERVOUS .....THANKS AHEAD....
11548417 tn?1506080564
I can understand that you are worried, but remember that you are still in the normal range.

You are right, echo doppler measurements always have to be taken with a grain of salt. They once measured my right atrium as severely dilated and half a year later is was mildly dilated again. It so depends on the person that does the examination and on the quality of the images they get.

It is hard to give you advice. I would just wait for the next echo, but if you do not feel comfortable with that, you could contact your cardiologist and discuss your worries with her. Perhaps a phone call with her could ease your mind?





3 Comments
Thanks again, Ger57 for responding...What prompted my Cardio to do the contrast echo was the fact that I called after I got the echo report sent to me and saw that my R. Ventricle was at the upper limits of normal ... She could see I was nervous and worried, so, she did that.  But, then I get the newer results from the contrast and that shows the atria on both sides was mildly to moderately enlarged....I looked back on an echo result from 2014 and the atria enlargement was notated and this was from my previous Cardio doc, but, he never mentioned it to me....But, it stated that my R. Ventricle was normal....I keep thinking, what will the next echo show.  WOW, I bet that got your attention when they said your R. Atrium was SEVERELY dilated.....I know you breathed a sigh of relief when they said mildly after your next echo...Did they discuss your dilation in your R. Atrium with you at all??????  What would cause it and what could be done?  This Nervous Nellie is always on the internet trying to find out more and there really is nothing to find out....Are you on Beta Blockers as well?  THANKS SO MUCH for taking the time to discuss this with me....One always feels so alone with all this.....Christine
Thanks again, Ger57 for responding...What prompted my Cardio to do the contrast echo was the fact that I called after I got the echo report sent to me and saw that my R. Ventricle was at the upper limits of normal ... She could see I was nervous and worried, so, she did that.  But, then I get the newer results from the contrast and that shows the atria on both sides was mildly to moderately enlarged....I looked back on an echo result from 2014 and the atria enlargement was notated and this was from my previous Cardio doc, but, he never mentioned it to me....But, it stated that my R. Ventricle was normal....I keep thinking, what will the next echo show.  WOW, I bet that got your attention when they said your R. Atrium was SEVERELY dilated.....I know you breathed a sigh of relief when they said mildly after your next echo...Did they discuss your dilation in your R. Atrium with you at all??????  What would cause it and what could be done?  This Nervous Nellie is always on the internet trying to find out more and there really is nothing to find out....Are you on Beta Blockers as well?  THANKS SO MUCH for taking the time to discuss this with me....One always feels so alone with all this.....Christine
Hi Christine,

Well, my cardiologist did not discuss it with me either. He just said that everything was fine. :-s

I always ask for a copy of the echo report afterwards and noticed the  severe RA dilation, which really got me worried. I made a new appointment at which he said he was not concerned at all.
His interpretation of the echo images was different from that of the echo technician and he saw no reason for concern.  
I have quite some confidence in him, so I took him on his word although of course very curious what the next echo would show.

One year afterwards I had an echo again and it showed only mild dilation. pffft.  

So, for me, the important things to keep in mind are:
-take the echo report with a grain of salt, the measurements are not always trustworthy
-be sure you have confidence in your cardiologist.
A few quick searches we do on the internet can not compare with the many years of studying that our cardiologist has done. He/she oversees the whole situation and can interpret the results from tests much better than we, as he takes much more into account than just the result from 1 isolated echo report.

Take care and feel free to discuss.
Ger
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