Help me to understand

[Melisa41]

I have been diagnosed with MILD HCM. My septum was 15mm with no obstruction and no pooling. My Dr. says not to worry. I should die of old age. What is the prognosis for someone with a mild form of HCM.

[kenkeith]

The left atrium (4.4) slightly high, "normal" is 1.9 - 4.0.
Posterior wall (1.4) *normal" 0.6 - 1.1 cm.
All other dimensions are within the normal range.

The enlarged dimensions could be an athlete's heart...meaning there is no pathology associated with the abnormal dimensions.  Reducing or stopping your exercise regimen would/should reduce the dimensions.  If you have an athlete's heart your heart rate should be below 60 at rest, indicating your heart is pumping efficiency and requires fewer heartbeats to meet system's demand for oxygen.  Is your heart rate below 60 bpm.

If your condition was/is pathological, an increase in size will almost always at some point in time reduce your EF if not treated. EKG reads is hypertrophic cardiomyopathy, is characterized by the thickening of the heart's walls. For some statistics a genetic disorder is found in 1 out of 500 Americans and is responsible for thousands of sudden death cases every year. Of all sudden death cases, only about 8% are exercise related. So you want to make the correct assessment.

The following table shows distinguishing characteristics of the two conditions.

Feature                                     Athletic Heart syndrome           Cardiomyopathy

Left ventricular hypertrophy             less than 1.3 cm             > 1.5 cm
Left ventricular end-diastolic diameter       7.0 cm
Diastolic function Normal                        (E:A ratio > 1)       Abnormal (E:A ratio < 1)
Septal hypertrophy                       Symmetric                     Asymmetric (HCM)
Family history                              None                              May be present
BP response to exercise               Normal   Normal or reduced systolic BP response
Deconditioning            LV hypertrophy regression    No LV  hypertrophy regression

Your post indicates E:A ratio 0.70 less than one indicates cardiomyoathy
LV diastolic 5.2 less than 6.0 cm indicates athelete's heart.

I am not able to make a conclusion based on the information you have posted.  The
above chart should/does provide distinquishing characteristics so the doctor should be able to make a dx.  LA enlargement can be secondary to A-fib, and A-fib can be secondary to LAE.

With A-fib regardless of underlying cause, when first exercising heart rate tends to be very rapid.  Also, A fib reduces your overall capacity to exercise because the heart is not pumping properly.  Not to exercise probably is the best advice, to avoid A-fib.

[Melisa41]

Thank you for the post on my previous question. Could you reveiw the following info and give me an idea as to whether it is HCM or AHS ? I am a 42 year old male no family history of HCM. Very athletic his entire life. Had 2 episodes of afib 1 month apart 147 and 170 both for approx. 4 hours. Went in for testing. Nuc Stress test and echo. Results as follows.
Aortic Root 3.4 cm - Aortic cusp sep 2.4 cm  - left atrium 4.4 cm  - RV end diastole 2.6 cm  - Septum 1.5 cm  - Posterior wall 1.4 cm  - LV end diastole 5.2  - LV end Systole 3.1- EF 66%  - Fract short 40%  -  LA vol BSA 27.4ml  - LA Volume 27.4ml  - LA Pressure 6.82mm  - LV Mass/ bsa 158g  - LVED vol 70ml  - LVES vol 24ml MITRAL VALVE - E Velocity 48cm  - E/A ratio 0.70 ( 48:69) E/e ratio 3.93 ( 48:12.2)  Nuclear Stress test conclusion - Gated LVEF 57% Normal rest and exercise myocardial perfusion study  - There is no evidence of ischemia  - LV systolic function is normal.

Do these results sound like HCM or Athletic Heart Syndrome? I have been told both. I live a very active life and have been told to hold off on all strenuous activity for 60 days by one Dr. and another tells me I have HCM and not to restrici myself from any activity. I am so confused. How do I know what I really have and should I stop exercising?

[kenkeith]

The septum is the wall that separates the chambers of the heart.  Normal is .6 to 11 mm so the ESTIMATE is slightly higher than normal...but it can be normal for you.

The problem  develops if and when the septum's increased size restricts the capacity for the chamber to fill with blood and as a consequence the cardiac output is reduced.  Also, and enlarged wall can reduce flexibility and contractions to pump blood is reduced.  The septum normally has less flexibilty, it is the outer walls that requires more flexibility so that may not be an issue with the septum.