Aa
LV global wall hypokinesis
I recently had a Nuclear Stress Test which revealed severe abnormalities with a large
septal apical inferior defect with mild reversibility on perfusion images. (What does mild
reversiblity mean in the context used here?)
The left ventricle was severely globally hypokinetic with more prominent septal wall
hypokinesis with EF of only 24%. (What does this mean in layman's terms?)
Echocardiogram matched the nuclear strudy, and the EF was only 15-20%.
There is mild left ventricular enlargement, mild left atrial enlargement, diastolic
dysfunction, and aortic sclerosis. (Here again what does this mean in layman's
terms?)
Finally, what are the procedures for treating the above conditions?
Thank you
Marlin in Florida
Hypokinesia of infero posterior wall and lateral wall,
mildly dialated LV
mild MR/TR with PAH
Moderate LV dysfunction
no pericardial effusion
ef -39%
my age is 46yrs and had mi three months back and the echo reports shows the above defects -will i be able to lead a normal life --how is my heart condition
from vinay raaj
mildly dialated LV
mild MR/TR with PAH
Moderate LV dysfunction
no pericardial effusion
ef -39%
my age is 46yrs and had mi three months back and the echo reports shows the above defects -will i be able to lead a normal life --how is my heart condition
from vinay raaj
Hypokinesia of infero posterior wall and lateral wall,
mildly dialated LV
mild MR/TR with PAH
Moderate LV dysfunction
no pericardial effusion
ef -39%
my age is 46yrs and had mi three months back and the echo reports shows the above defects -will i be able to lead a normal life --how is my heart condition
from vinay raaj
mildly dialated LV
mild MR/TR with PAH
Moderate LV dysfunction
no pericardial effusion
ef -39%
my age is 46yrs and had mi three months back and the echo reports shows the above defects -will i be able to lead a normal life --how is my heart condition
from vinay raaj
QUOTE: He had a severe MI two years back and afterwards never recovered fully. He is 63 and had been very active. Now life is physically and psychologically very difficult for us in the family.
>>>Your father is relatively young and should be able to make a complete recovery by revitalizing heart cells with the stents and by-pass. If hypokinesis is a new condition to another location, your doctor should be able to give you a diagnosis related to the underlyhing cause (occlusion!?) for a lack of blood flow to the location in question. Has there been a restenosis of the stented implants? Have the by-pass vessels become occluded, etc.
Sometimes medication may be the root of the psychological and physical distress.
>>>Your father is relatively young and should be able to make a complete recovery by revitalizing heart cells with the stents and by-pass. If hypokinesis is a new condition to another location, your doctor should be able to give you a diagnosis related to the underlyhing cause (occlusion!?) for a lack of blood flow to the location in question. Has there been a restenosis of the stented implants? Have the by-pass vessels become occluded, etc.
Sometimes medication may be the root of the psychological and physical distress.
Dear Kenkeith, I am really facinated to read your comments on question related to heart diseases. I am from India and very much concerned about my father's severe heart disease. He had a severe MI two years back and afterwards never recovered fully. He is 63 and had been very active. Now life is physically and psychologically very difficult for us in the family.
My father is somehow stable (a-symptomatic) but has severe systolic dysfunction EF 30% Grade 1-2 Dystolic dysfunction. He has undergone CABG and has 4 stents. In his latest echo a new thing is added that is other walls are hypokinetic, earlier other walls were contracting normally. Though it seems that his other parameters LV End systolic and dystolic diamterers improved. Apart from this my father has mild MR (with a MR clipping done in Germany) and now the echo report is saying there is some calcification.
All other valves are normal. My father does not have an ICD. But his holter monitorig shows 0.5% PVC without arythmia. Despite all he remains generally a-symptomatic and goes to office and all.
Being the only child staying away from home, I am always very concerned and afraid. Could you please tell me what course of action shall we take. The cardiologist does not stay much and only says that he is stable, this is not adequate for me to understand the situation. Almost 2.5 years have passed since MI of my father and we are trying our best to cope with it. Your advice will be highly appreciated.
best wishes
Ujjaini
My father is somehow stable (a-symptomatic) but has severe systolic dysfunction EF 30% Grade 1-2 Dystolic dysfunction. He has undergone CABG and has 4 stents. In his latest echo a new thing is added that is other walls are hypokinetic, earlier other walls were contracting normally. Though it seems that his other parameters LV End systolic and dystolic diamterers improved. Apart from this my father has mild MR (with a MR clipping done in Germany) and now the echo report is saying there is some calcification.
All other valves are normal. My father does not have an ICD. But his holter monitorig shows 0.5% PVC without arythmia. Despite all he remains generally a-symptomatic and goes to office and all.
Being the only child staying away from home, I am always very concerned and afraid. Could you please tell me what course of action shall we take. The cardiologist does not stay much and only says that he is stable, this is not adequate for me to understand the situation. Almost 2.5 years have passed since MI of my father and we are trying our best to cope with it. Your advice will be highly appreciated.
best wishes
Ujjaini
Many many thanks for this useful information. This gives me more clarity on what I should be doing in terms of exercise. I will also take my doctors opinion beforing resorting to any particular regime.
Unfortunately, in India(where I live) we do not have this concept of rehabilitation and that is the reason why so much confusion and questions. Doctors are more interested in new and serious cases and do not devote much time or attention to questions similar to mine.
I will keep this forum posted on my experience of treatment and recovery. Thanks once again.
Unfortunately, in India(where I live) we do not have this concept of rehabilitation and that is the reason why so much confusion and questions. Doctors are more interested in new and serious cases and do not devote much time or attention to questions similar to mine.
I will keep this forum posted on my experience of treatment and recovery. Thanks once again.
For many years, exercise (aerobic) was not recommended, but studies have changed that opinion and now exercise is recommended.
There should be cardiac rehabilitation program asociated with the hospital for heart patients, or instructions regarding a program specifically for you. Yes, beta blockers can cause muscle fatigue. I have found resistance training for the legs have reduced the fatique...I failed the stress test after 3 minutes about 3 years ago...less than 7 METs. I do have a resistance training program as well as the aeorbic.
To give you a frame of reference, to walk at a leisurely to average pace, one mile every 25 to 30 minutes, three times a week is 3 to 2.5 METs each time or a total of 7.5 (one mile every 30 minutes) or 9.0 (one mile every 25 minutes) MET-hours a week. That may reduce risk of heart attack, especially in persons over 65 years of age.
The least healthy situation appears to be that of being sedentary, and that appear to be more true for older age groups (over age 65). So, do what you can, taking into account your age, time constraints, and any underlying conditions. The rule of thumb for heart rate maximum with exercise is subtract your age from 220 and some people subtact 10 from that parameter...220-48=172-10=162 would be your target rate.
The standard metabolic equivalent, or MET, level. This unit is used to estimate the amount of oxygen used by the body during physical activity.
1 MET = the energy (oxygen) used by the body as you sit quietly, perhaps while talking on the phone or reading a book.
The harder your body works during the activity, the higher the MET.
Any activity that burns 3 to 6 METs is considered moderate-intensity physical activity.
Any activity that burns > 6 METs is considered vigorous-intensity physical activity.
Take care
There should be cardiac rehabilitation program asociated with the hospital for heart patients, or instructions regarding a program specifically for you. Yes, beta blockers can cause muscle fatigue. I have found resistance training for the legs have reduced the fatique...I failed the stress test after 3 minutes about 3 years ago...less than 7 METs. I do have a resistance training program as well as the aeorbic.
To give you a frame of reference, to walk at a leisurely to average pace, one mile every 25 to 30 minutes, three times a week is 3 to 2.5 METs each time or a total of 7.5 (one mile every 30 minutes) or 9.0 (one mile every 25 minutes) MET-hours a week. That may reduce risk of heart attack, especially in persons over 65 years of age.
The least healthy situation appears to be that of being sedentary, and that appear to be more true for older age groups (over age 65). So, do what you can, taking into account your age, time constraints, and any underlying conditions. The rule of thumb for heart rate maximum with exercise is subtract your age from 220 and some people subtact 10 from that parameter...220-48=172-10=162 would be your target rate.
The standard metabolic equivalent, or MET, level. This unit is used to estimate the amount of oxygen used by the body during physical activity.
1 MET = the energy (oxygen) used by the body as you sit quietly, perhaps while talking on the phone or reading a book.
The harder your body works during the activity, the higher the MET.
Any activity that burns 3 to 6 METs is considered moderate-intensity physical activity.
Any activity that burns > 6 METs is considered vigorous-intensity physical activity.
Take care
Many thanks for prompt reply. I feel a bit relieved knowing that in my condition it may be possible to continue with life with medications, exercise and lifestyle considering that you started with more or less similar conditions. I hope I will continue to get encouragement from someone who is 4 years senior to me in this fighting with this disease and doing well.
As regard my MI, I had throat pains during my walks starting three months before MI. But doctors whom I approached took it for throat problem. Luckily, on the day of attack, my physiscian measured my BP and suspected MI and I could get required medical support within 1.5 hrs of starting of severe throat pain. Interestingly I had gone through treadmill test just ten days prior to attack(as my routine medical checkup) but I did not have any throat pain even after 10 minutes of test duration and I could complete the test.
Kenkeith, could you please guide me in respect of walking required in my case. From january(after ICD) until march this year I was able to do 1.5 miles(35 minutes) in morning and same distance in evening(Before ICD I was doing even better). During same time I increased my carvidilol from 12.5x2(my dose since after MI) to 18.75x2(spread over a period of three weeks). By march end I started feeling tired during walking. I had strange sensation in the region of my throat and upper part extending upto forehead. I had to cut down on my speed and distance. Now I am able to do 1.25 miles in 35 minutes(only in mornings) and I feel somewhat tired after walk but not breathless. Could this be because of carvidilol(beta blocker)?. Will these symptoms disappear as my body gets used to this drug? Or do I need to reduce the drug.
Because, now I am a bit confused whether I should walk more or less. On one hand I need to keep my hear rate low to ensure lower workload by taking drugs. But when I walk I increase my heart rate putting more burden on my heart(could lead to further dilation of my LV?). So my queation is how much and at what speed I should walk? What should be the guiding parameters(pulse rate?, getting tired? or something else). Is it necessary to reduse drugs(beta blockers) to be able to walk more? What is the real purpose of walking? Is it exercise of heart muscles or make the heart do higher level of work from time to time so that it remains used to it. I am a bit surprised to note that you walk only thrice a week. I always thought that more I walk,better it will be for my heart?
You should know that your reply will be very important for me, as to many others on this forum. Thanks you so much
As regard my MI, I had throat pains during my walks starting three months before MI. But doctors whom I approached took it for throat problem. Luckily, on the day of attack, my physiscian measured my BP and suspected MI and I could get required medical support within 1.5 hrs of starting of severe throat pain. Interestingly I had gone through treadmill test just ten days prior to attack(as my routine medical checkup) but I did not have any throat pain even after 10 minutes of test duration and I could complete the test.
Kenkeith, could you please guide me in respect of walking required in my case. From january(after ICD) until march this year I was able to do 1.5 miles(35 minutes) in morning and same distance in evening(Before ICD I was doing even better). During same time I increased my carvidilol from 12.5x2(my dose since after MI) to 18.75x2(spread over a period of three weeks). By march end I started feeling tired during walking. I had strange sensation in the region of my throat and upper part extending upto forehead. I had to cut down on my speed and distance. Now I am able to do 1.25 miles in 35 minutes(only in mornings) and I feel somewhat tired after walk but not breathless. Could this be because of carvidilol(beta blocker)?. Will these symptoms disappear as my body gets used to this drug? Or do I need to reduce the drug.
Because, now I am a bit confused whether I should walk more or less. On one hand I need to keep my hear rate low to ensure lower workload by taking drugs. But when I walk I increase my heart rate putting more burden on my heart(could lead to further dilation of my LV?). So my queation is how much and at what speed I should walk? What should be the guiding parameters(pulse rate?, getting tired? or something else). Is it necessary to reduse drugs(beta blockers) to be able to walk more? What is the real purpose of walking? Is it exercise of heart muscles or make the heart do higher level of work from time to time so that it remains used to it. I am a bit surprised to note that you walk only thrice a week. I always thought that more I walk,better it will be for my heart?
You should know that your reply will be very important for me, as to many others on this forum. Thanks you so much
I'm assuming you had an ischemic MI, and the lack of blood flow has been treated with the intervention of a stent implant and medication. You are receiving the same medication as my perscription 4 years ago after congested heart failure. Currently, I am taking 25 twice daily of coreg and I only take a nitrate prior to working out 3 times a week (treadmill 7.0 METs which is about 4 miles an hour) without a problem. I cut back on a nitrate daily.
You may have some concern regarding the syncope event. The cause can be a temporary drop of blood supply to the brain due to obstructing of blood flow from the heart, severe aortic stenosis, or if there is a heart attack (I had had a silent heart attack and the only symptom was CHF). Apparently, those conditions were ruled out.
Syncope can occur when the automatic nervous system ( vaso-vagal, the part that deals with heart rate) goes awry. So an ICD is implanted and coreg (helps control heart rate) medically.
The M-Mode values appear to be normal except the left ventricle is dilated (estimated). If you have heart cell negrosis, there may be some impairment of contractions and degree of impairment and location is significant and an increase of EF may be limited. But medication can decrease the heart's afterload, and a weakened heart can provide adequate blood supply to meet demand and there should be no shortness of breath, pain, etc.
A dilated left ventricle will impair contractions. The Frank/Starling phenonomon effect, and that can be explained with an anology. If a hand-spring is stretched (the heart noprmally dilates to compensate), it will snap back with more force, but overstretch (over compensation) the spring it will lose its elasticity. The dilated LV will lose some of its elasticity (when over compensated), but reduce the size to normal will increase EF. An ACE inhibitor and coreg will decrease the heart's afterload, and this should help the heart to recover and reverse remodeling.
I had hypokinesis at the distal portion of the heart. I saw the wall impairment on the echo monitor during the test. There doesn't appear to be any impairment currently, or very little. Your other M-Mode values are better than mine were, so that is a plus, and even if the EF can't get to the normal range, that may not interfere with your lifestyle. There is an estimate that 26% of the heart disorder population has an EF 0f 29% (heart failure range) and are not aware of a heart problem!
You may have some concern regarding the syncope event. The cause can be a temporary drop of blood supply to the brain due to obstructing of blood flow from the heart, severe aortic stenosis, or if there is a heart attack (I had had a silent heart attack and the only symptom was CHF). Apparently, those conditions were ruled out.
Syncope can occur when the automatic nervous system ( vaso-vagal, the part that deals with heart rate) goes awry. So an ICD is implanted and coreg (helps control heart rate) medically.
The M-Mode values appear to be normal except the left ventricle is dilated (estimated). If you have heart cell negrosis, there may be some impairment of contractions and degree of impairment and location is significant and an increase of EF may be limited. But medication can decrease the heart's afterload, and a weakened heart can provide adequate blood supply to meet demand and there should be no shortness of breath, pain, etc.
A dilated left ventricle will impair contractions. The Frank/Starling phenonomon effect, and that can be explained with an anology. If a hand-spring is stretched (the heart noprmally dilates to compensate), it will snap back with more force, but overstretch (over compensation) the spring it will lose its elasticity. The dilated LV will lose some of its elasticity (when over compensated), but reduce the size to normal will increase EF. An ACE inhibitor and coreg will decrease the heart's afterload, and this should help the heart to recover and reverse remodeling.
I had hypokinesis at the distal portion of the heart. I saw the wall impairment on the echo monitor during the test. There doesn't appear to be any impairment currently, or very little. Your other M-Mode values are better than mine were, so that is a plus, and even if the EF can't get to the normal range, that may not interfere with your lifestyle. There is an estimate that 26% of the heart disorder population has an EF 0f 29% (heart failure range) and are not aware of a heart problem!
Kenkeith, I am impressed the way you have explained the medical terms of heart related tests. I have been to many cardilogists for my post MI treatment and symptoms thereafter. My doctors do not clearly explain my condition and I am left with lot of doubts about my test results and whether people having heart condition like me can survive for few years or more. I wonder if I can have your suggestions from your experience and information base.
I am 48, male, had MI in august 2007 and stent was put in LAD. My EF at the time of MI was 30%. Gradually my condition recovered and by December 2007 I was able to walk 2-2.5 miles daily and attend my office activities. I was on 12.5x2 Carvidilol(beta-blocker), 5x2 Ramipiril(ACE Inhibitor), nitrate, aspirin, clopidogrel and diuretic.
In January 2008 I had syncope event and though it looked like a vaso-vagal doctors decided to put an ICD even though my Electrophisiology Study was negetive considering my low EF. During full January month I had to reduce my beta-blocker and ACE Inhibitors. Post ICD doctors adviced me to increase betablockers upto 25x2 mg daily. I have so far reached 18.75 mg daily. I have reached 2.5x2 mg ACE Inhibitor. I am having tough time reaching my levels of walking. I get strange sensations in my neck, upper part of nose and head when I walk or try to do brisk activity similar to my activities prior to ICD. I am worried that my condition may be deteriorating and my future very short.
Today I got my ecocardiography report which says:"Dilated LV with varying hypokinesis of most walls sparing the lateral wall. LVEF=30%, MR+. Other parameters read as:
Tricuspid Valve: Normal
Pulm valve : Normal
Right Atrium : Normal
Right Ventrical : Size 15.9 Motion Normal
Paricardium : Thin
Paricardium Effusion : Nil
Arotic Valve : Narmal
Mitral Valve : Normal
I am not really able to make out what these parameters mean except that my EF is low. My doctorts say that things are normal considering I had a MI. Nothing more. What will be your assessment Kenkeith? Does hypokinesis of LV Walls mean that there are chances that they may get back to normal if I increase my ACE Inhibitor. Any chances of increasing my EF. Your advise and suggestion will help me in understanding where I stand with respect to my disease. I forgot to mention that I have 80% blockage in D2 artery and some minor blockages in smaller ones. My doctors say that these need to be managed by medicines till collaterals develop.
I am 48, male, had MI in august 2007 and stent was put in LAD. My EF at the time of MI was 30%. Gradually my condition recovered and by December 2007 I was able to walk 2-2.5 miles daily and attend my office activities. I was on 12.5x2 Carvidilol(beta-blocker), 5x2 Ramipiril(ACE Inhibitor), nitrate, aspirin, clopidogrel and diuretic.
In January 2008 I had syncope event and though it looked like a vaso-vagal doctors decided to put an ICD even though my Electrophisiology Study was negetive considering my low EF. During full January month I had to reduce my beta-blocker and ACE Inhibitors. Post ICD doctors adviced me to increase betablockers upto 25x2 mg daily. I have so far reached 18.75 mg daily. I have reached 2.5x2 mg ACE Inhibitor. I am having tough time reaching my levels of walking. I get strange sensations in my neck, upper part of nose and head when I walk or try to do brisk activity similar to my activities prior to ICD. I am worried that my condition may be deteriorating and my future very short.
Today I got my ecocardiography report which says:"Dilated LV with varying hypokinesis of most walls sparing the lateral wall. LVEF=30%, MR+. Other parameters read as:
Tricuspid Valve: Normal
Pulm valve : Normal
Right Atrium : Normal
Right Ventrical : Size 15.9 Motion Normal
Paricardium : Thin
Paricardium Effusion : Nil
Arotic Valve : Narmal
Mitral Valve : Normal
I am not really able to make out what these parameters mean except that my EF is low. My doctorts say that things are normal considering I had a MI. Nothing more. What will be your assessment Kenkeith? Does hypokinesis of LV Walls mean that there are chances that they may get back to normal if I increase my ACE Inhibitor. Any chances of increasing my EF. Your advise and suggestion will help me in understanding where I stand with respect to my disease. I forgot to mention that I have 80% blockage in D2 artery and some minor blockages in smaller ones. My doctors say that these need to be managed by medicines till collaterals develop.
The test was performed to analyze wall motion defect (hypokinesis) of the left ventricle (pumping chamber) and septum (wall between chambers). The defect is/can be the result of a heart attack causing necrosis (death of cells) or ischemia (lack of blood flow to the heart tissues). Sometimes with hypokinesis the cells are in hypernation or stunned and with treatment to increase blood supply to the deficit area the cells can recover. Reversibility is the return to normal or near normal after a period of rest during the testing phase.
Global hypokinesis of the LV indicates symetrical enlargement and septum is thickened and less flexible.
The fraction of blood pumped into circulation with each heart beat is termed ejection fraction (EF). Normal is an EF of 55 to 75%, and heart failure range is below 29%. When the heart walls are thickened and the chamber dilated with damaged heart cells the contractions will be weak and EF will be low.
Diastolic dysfunction addresses the filling phase of the left ventricle. If the walls are thickened, there will be less space for the filling phase and cardiac output will be reduced accordingly.
Aortic sclerosis is the narrowing of the aortic valve (usually due to calcification with age) and the will adversely add pressure to the left ventricle and dilate left atrium and left ventricle. The report indicates the condition is mild and I have outlined the worst case scenario.
About 4 years ago my EF was below 29%. With medication my heart size is currently normal as well as an EF55%. I had some hypokinesis at the distal portion of the heart. A stent in a coronary artery increased blood flow and there is very little heart wall motion defect if any.
The medication is an ACE inhibitor that will dilate blood vessels and lightened the load the heart has to pump against. Also a beta blocker and for a while a diuretic, digoxin to strenghten contractions, aspirin. And isosorbide for chest pains (angina) when needed. Sometimes the heart will fully recover form a heart attack. Apparently, I had a silent heart attack as I had no indication until congested heart failure.
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