Echo shows enlarged LA

[Toneman]

Need your thoughts, I received a copy of my echo from last week and everything looks good within normal range with the exception of my left atium which was enlarged to 4.9 cm. No one seemed concerned and explained it could just be due to my daily exercise program. Even the LVH that they made a point of telling me about on the phone was only borderline and not a problem. EF is 63%, normal wall motion throughout, all other chambers and walls within normal size and function, all valves good except trace leakage in my tricuspid valve, everything else normal. I am a 49 yearl old male, non smoker, no early onset CAD history in family, blood pressure and cholesterol controlled.

How big of a deal is an enlarged LA?

Thanks in advance for your input.

Tony

[Jack54]

Tony, I am so sorry to hear about the CAD or calcium buildup. I remember reading a good while back on what these scores did mean and did not mean to the cardiology folks. There was a lack of agreement on just how the overall calcium score applied to the disease of CAD. I think that the disagreement stemmed from the fact that all people build up high amounts of calcium in their arteries as they age.

I guess the "we all should be so lucky" thought that some cardiologist had didn't sit well with other cardiologist that were of the mindset that "these calcium scores represent CAD", and therefore need to be dealt with as CAD. I do know one thing, if they represent a blockage or resistance to blood flow, they are treated as CAD, and dealt with as such.

You have heard the term "heart of stone" I know. I read that this came form the ancient Greeks who were practicing forensics, lol, and they would pick up the heart and noticed it was like stone. The coronary arteries are epicardial or run in grooves on the outside of the heart, and the Geeks felt the stone inside the arteries. I wonder if Mick Jagger is working on "This Heart of Stone"?????

Whether it is plaque with a calcified covering (stable plaque) of soft plaque without a calcium covering (unstable plaque and subject to rupturing and causing an MI) is represents a blockage. The 64 slice ct angiogram that I had showed stable vs unstable plaque, and amazed me. I have the results here before me, and I do not believe I got an overall calcium score.

I do have non-cardiac chest informations, such as nodules in my lungs and signs of previous "granulomatous disease". Hain't got a clue there...

Seems to me if you have significant coronary artery blockages, they would be described on the CT report.

I have been deep into the "snake oil" industry... I have heard that IV Chelation (keelation) removes calcium from the arteries. Oral chelation is probably not good since it is barely absorbed. There is a clinical trial ongoing that started in 2002 and will end in 2010. The name of the trial is TACT or something like that. I have tried to find info, but not with much luck. Really I haven't had that much time.

Be well,

Jack

[va_tony]

Hello Pilgrim

I'm pleased to see that reports of your demise were greatly exagerated.

Sorry to hear about your high LVDEP and your continuing heart problems.  Life has a habit of throwing some real challenges at us at times. But you seem to be hanging tough. Wouldn't it be reasonable to assume that the high LCDEP been caused in some way by your CAD? Scar tissue perhaps?

In my case, my atria probably became enlarged as a result of 30 years of off and on afib. The more afib, the bigger it gets. The bigger it gets, the more afib I have.  Vicious cycle. Lately, though I'm more concerned about a recent diagnosis of CAD. I had a CT-A that showed a calcium score (CAC) of 739 and a few partial blocks.  I gather 739 is bad and indicates fairly high risk.  I really don't know much about CAD --- I previously concentrated my reading on arrhythmias. I need to do some serious studying.

Take care

Tony

[Momto3]

That's so funny that you noticed the "enlarged atrium" on your report.  That's what happened to me also....I was worried, but the doctor wasn't : )

Take care
connie

[Toneman]

Thanks for the info, you certainly have done some significant research. My LVEDP was reported as "normal" without any numbers. All my other chambers and walls show well within normal ranges so does my aortic root plus all valves look "structurally normal" and only my tricuspid valve shows trace leakage and my right ventricular systolic pressure is also normal. I guess all is well for now...........

[Jack54]

Very sorry to hear about your LA. I have been studying this with great interest since mine was above the normal limits at 4.1 cm on a recent echo. I read a rather profound statement that really applies to me. It stated if the left atrium is enlarged, obviously it is due to the high pressures below it. My left ventricular end diastolic fill pressure is 24 mmHg. Normal is like 5 mmHg to 8 mmHg.

I read for hours last night on what could cause this high of an LVDEP. It is either the muscle fibers, contractile ability, or damaged myocardium of the LV from long term CAD or a heart attack. I have really over simplified this to the max. There are so many terms used to describe the muscle of the  myocardium (LV specifically) and what can go wrong.

I have many other dimensions that are borderline high that I haven't had the time to try to put it all together, in order to form a picture of where I am headed.

I meant to say that >20mmHg is considered diastolic heart failure. This pressure is a sign that the LV never relaxes after the systolic phase, I even thought about taking a muscle relaxer after reading this, lol. But really it read like anxious individuals might be bothered by this, or maybe I wanted it to seem that simple.

The LVEDP is measured during a cath. I did not notice it on my echo report. I had this cath 2.5 months ago. I checked earlier cath reports ( I have 9, lol) and mine LVDEP was 9 mmHg on one. I need to look at some more.

Another dimension I am high on is the aortic root. The limit is 3.7 and mine is 3.5 cm. I am trying to figure out how this and my aortic valve may effect my LVDEP, especially since I have no aortic valve leakage. I wonder if they measure the leakage both ways?

For now I am trying to keep my blood volume as low as I can within limits of course. I read last nigh that when a heart goes in to failure, it causes the body to retain salt and thereby water in order to increase the blood volume to the max. I am really restricting my salt at all cost before it is too late. I am also watching my fluid intake. I take lasix so that it really not a problem, unless you drink lots of fluids after you have peed them all out. I read somewhere that Lasix was good in helping to lower the LVDEP.

Another thing we or I need to watch for if my LVEDP continues to stay high is high pulmonary artery and pulmonary vein pressure, better known as pulmonary hypertension. The extremely high LV pressure is transmitted through the mitral valve on into the pulmonary vein. The pulmonary artery is always the same pressure as the pulmonary vein (I read this and it makes sense). I do have mild mitral valve leakage (MVR) so I no that my left atrium is exposed to this high LVEDP.

Well Va. Tony is an expert in this area...Glad to have your brain Tony. I didn't know your left atrium was enlarged, and I am very sorry to hear it. It sounds like you are dealing with it just fine.

Tony if I find anymore hair raising info on this subject, I will let you know. Ha ha ha.

Jack

[Toneman]

Thanks for the comments, when my doctor went over the results he was not concerned about the enlarged left atrium either, he did not even mention it, I pointed it out on the summary of the report. The only issue he brought up was mild LVH at 1.2 cm which is where hey draw the line, otherwise the heart was healthy. I just could not get the enlarged left atrium out of my mind, it was also mentioned on my last echo from 1 1/2 years ago and he did not tell me about it, I went back and read it, no measurements though.

Thanks, makes me feel better.

Tony

[Momto3]

Hi Tony,

I think I was told that a report of an enlarged atrium is something that must be clinically correlated to an individual.  If memory serves me (and sometimes it doesn't....lol), I've  think I've also had reports indicating an enlarged right atrium, but other than being watched now and again, it didn't seem to be indicative of a bigger problem.  

You're right.  When the ventricle started to shows signs of enlarging, all bets were off and it was time for treatment.

Hope you are enjoying the summer and that the a-fib episodes are not too bothersome.

Connie

[va_tony]

An enlarged atria is relatively benign, certainly in comparison to an enlarged ventricle. My advice is to keep an eye on the size possibly creeping up with time.  So write the current number down and compare to any future echo numbers you may have. The main problem with an enlarged atrium is that it almost inevitably leads to afib at some point, which although also relatively benign, may turn out to be a major inconvenience. The main problem with afib is possible stroke as the blood tends to pool in the enlarged atria (in the left atrial appendage, actually)..... so that may lead to taking coumadin for life (another royal pain).

My own LA has been edging upwards with time.  I'm 65 and it's now 5.4 cm.  I'm in chronic afib and take 225 mg rythmol 3 times daily.  Even so, the afib breaks through on occasion and I have episodes from a few hours to two weeks in duration. I'm on coumadin.  Still, I feel very healthy if that's any consolation.

I have never heard that exercise will lead to enlarged LA.  I was under the impression that it would not.  Exercise tends to enlarge the ventricles (atheletes heart).

Regards

(also) Tony