Please Help Me with Echo Results!

[GirlGhost]

Ok so I came across this site 9 years ago when my husband was diagnosed with HOCM. A few years later, at the suggestion of his cardiologist, he met with a doctor at Hopkins and had genetic testing done and found that it was genetic. Every year he does his normal visits and testing and has been taking Metoprolol 100mg 1 time a day (morning) and Verapamil 120mg 1 (nightly).

I will post his latest ECHO below. But this latest ECHO, due to a slight increase in gradient, prompted them to send him for further testing in the way of an MRI (he's never had this done). They also have him set to do his normal Stress Echo. Neither test has happened yet as they are scheduled in the next coming weeks. But in all past Stress tests he's done very well!

Anyway, also due to the increased gradient they had him wear a Xio heart monitor for two weeks. Well the results came back and they called him immediately saying that it showed a few episodes of Ventricular Tachycardia and want him to meet with a Cardiophysiologist on Friday.

Now here's the thing, each time he felt his heart beating faster or flutter, he pushed the button and made note like they told him to do. But that's all he was experiencing each time........just either a rapid heart rate for a short period of time or a flutter feeling. They DID NOT include pain, shortness of breath, dizziness, fainting, etc. All of which the doc seemed baffled by. He told the doc he NEVER feels dizzy unless he bends over and occasionally when he stands too quickly. All in all he has not experienced ANYTHING new or unusual from the very first time he was diagnosed 9 years ago. Everything to him, feels and is the same. Nothing new has come up as far as symptoms go.

I can also post what the monitor listed if anyone wants to see it. I'm just wondering if these VT can be benign at all. Of course we're now worried out of our minds and don't know what to expect. He keeps saying how he doesn't understand it because he always feels great.

Is there anything we should be asking on Friday when we meet with the EP? Is there any better meds he could be on that would perhaps work better for him? THANKS A MILLION!!!

Here are the echo results...........


AORTIC VALVE:
The aortic valve is trileaflet.
Structurally normal aortic valve.

ARTERIES:
The aortic root is normal size.

EFFUSION:
There is no pericardial effusion.
There is no pleural effusion.

LEFT ATRIUM:
The left atrium is mildly dilated.
The interatrial septum is intact with no evidence for an atrial septal defect.
There is no Doppler evidence for an atrial septal defect.

LEFT VENTRICLE:
There is moderate concentric left ventricular hypertrophy.
There is a known history of hypertrophic obstructive cardiomyopathy.  There
is a resting LVOT gradient of 54 mmHg which increases to 164 mmHg with
Valsalva.  Clinical correlation is advised.
The left ventricular cavity is small.
Left ventricular systolic function is normal.
The left ventricular ejection fraction = 60-65%.
No regional wall motion abnormalities noted.
The interventricular septum is intact with no evidence for a ventricular
septal defect

MITRAL VALVE:
Structurally normal mitral valve.

PROCEDURE DETAILS:
A complete two-dimensional transthoracic echocardiogram was performed (2D,
M-mode, spectral and color flow Doppler).
The study was technically adequate .
Previous Echo performed on 01/09/2019 .

PULMONIC VALVE:
Structurally normal pulmonic valve.

RIGHT ATRIUM:
The right atrial size is normal

RIGHT VENTRICLE:
The right ventricle is normal size.
The right ventricular systolic function is normal.

SPECTRAL AND COLOR DOPPLER ANALYSIS:
No aortic insufficiency is present.
No aortic stenosis present.
There is no mitral valve stenosis.
There is mild mitral regurgitation.
There is no tricuspid stenosis.
There is trace tricuspid regurgitation.
There is no pulmonic valvular stenosis.
Trace pulmonic valvular insufficiency.
The inferior vena cava is normal in size, and collapses normally with
respiration.

TRICUSPID VALVE:
Structurally normal tricuspid valve.

MMode 2D Measurements & Calculations
IVSd (0.6-1.1) 1.6 cm
LVIDd (3.5-5.7) 3.8 cm
LVIDs (2.3-3.9) 2.2 cm
LVPWd (0.6-1.1) 1.5 cm
IVS/LVPW 1.1
FS 43.8 %
EDV(Teich) 63.2 ml
ESV(Teich) 15.4 ml
EF(Teich) 75.7 %
EDV(cubed) 56.3 ml
ESV(cubed) 10 ml
EF(cubed) 82.2 %
LV mass(C)d 229.5 grams
LV mass(C)dI 107 grams/m^2
SV(Teich) 47.9 ml
SI(Teich) 22.3 ml/m^2
SV(cubed) 46.3 ml
SI(cubed) 21.6 ml/m^2
Ao root diam (2.0-3.7) 3.1 cm
Ao root area 7.4 cm^2
LA dimension (1.0-4.0) 4.1 cm
LA/Ao 1.3
LVAd ap4 29.3 cm^2
LVLd ap4 8.5 cm
EDV(MOD-sp4) 81.3 ml
EDV(sp4-el) 85.9 ml
LVAs ap4 14 cm^2
LVLs ap4 7.3 cm
ESV(MOD-sp4) 23.5 ml
ESV(sp4-el) 22.9 ml
EF(MOD-sp4) 71.1 %
EF(sp4-el) 73.4 %
LVAd ap2 31.3 cm^2
LVLd ap2 9.1 cm
EDV(MOD-sp2) 89.4 ml
EDV(sp2-el) 91.6 ml
LVAs ap2 15.9 cm^2
LVLs ap2 7.3 cm
ESV(MOD-sp2) 29.9 ml
ESV(sp2-el) 29.4 ml
EF(MOD-sp2) 66.5 %
EF(sp2-el) 67.9 %
LVLd %diff 6.9 %
EDV(MOD-bp) 87.3 ml
LVLs %diff -0.21 %
ESV(MOD-bp) 26.5 ml
EF(MOD-bp) 69.6 %
SV(MOD-sp4) 57.9 ml
SI(MOD-sp4) 27 ml/m^2
SV(MOD-sp2) 59.5 ml
SI(MOD-sp2) 27.8 ml/m^2
SV(MOD-bp) 60.8 ml
SI(MOD-bp) 28.4 ml/m^2
SV(sp4-el) 63.1 ml
SI(sp4-el) 29.4 ml/m^2
SV(sp2-el) 62.2 ml
SI(sp2-el) 29 ml/m^2


Doppler Measurements & Calculations
MV Peak E 115.9 cm/sec
MV Peak A 61 cm/sec
MV E/A 1.9
MV V2 max 139.1 cm/sec
MV max PG 7.7 mmHg
MV V2 mean 66.1 cm/sec
MV mean PG 2.1 mmHg
MV V2 VTI 42.4 cm
MV P1/2t max vel 111.8 cm/sec
MV P1/2t 47.9 msec
MVA(P1/2t) 4.6 cm^2
MV dec slope 683.1 cm/sec^2
Ao V2 max 188.6 cm/sec
Ao max PG 14.2 mmHg
Ao max PG (full) -141.2 mmHg
Ao V2 mean 104.8 cm/sec
Ao mean PG 5.7 mmHg
Ao mean PG (full) -46.1 mmHg
AoV V2 VTI 37.1 cm
LV V1 max PG 155.4 mmHg
LV V1 mean PG 51.7 mmHg
LV V1 max 623 cm/sec
LV V1 mean 283.5 cm/sec
LV V1 VTI 103.5 cm
SV(Ao) 273.5 ml
SI(Ao) 127.5 ml/m^2
PA V2 max 74 cm/sec
PA max PG 2.2 mmHg
PA acc slope 761.5 cm/sec^2
PA acc time 0.1 sec
TR max vel 171.9 cm/sec
TR max PG 11.8 mmHg
RVSP(TR) 14.8 mmHg
RAP systole 3 mmHg
PA pr(Accel) 33.9 mmHg

Boston Z-Scores(Vital Signs)
BMI 30.6 kilograms/m^2
Diastolic Pressure 86 mmHg
Heart Rate 61 BPM
BSA(Haycock) 2.2 m^2
Weight (metric) 96.6 kg
Height (metric) 177.8 cm
Systolic Pressure 136 mmHg


Conclusion
The left ventricular cavity is small.
There is moderate concentric left ventricular hypertrophy.
There is a known history of hypertrophic obstructive cardiomyopathy.  There
is a resting LVOT gradient of 54 mmHg which increases to 164 mmHg with
Valsalva.  Clinical correlation is advised.
Left ventricular systolic function is normal.
The left ventricular ejection fraction = 60-65%.
No regional wall motion abnormalities noted.
The left atrium is mildly dilated.
The right ventricle is normal size.
The right ventricular systolic function is normal.
There is mild mitral regurgitation.
There is trace tricuspid regurgitation.
Trace pulmonic valvular insufficiency.

[1JMarkL2]

Your husband's "Trace pulmonic valvular insufficiency", means it is barely detectable at this point. His left ventricle hypertrophy means there is thickening of the inside walls of the valve and is moderate, but something to continue monitoring.  Words like "insufficiency" is different from phrases like "dysfunctional", "moderately dysfunctional" and "...severely". {Note: I'm not a med pro of any kind but highly studied in some areas.}. The mild dilation of valves and mild leakage - especially of the mitral valve, is fairly common in the population. It is also called "Mitral Valve Prolapse" and when it causes palpitations, orthostatic hypotension (dizzy when arising from seated or lying down positions), etc., med pros say, this is not actually harmful in the vast majority who have it but is MVPS (add "Syndrome" to the abbreviation in this case). I was found to have - I believe mild enlargement of 4 heart cavities and mild LVH (another Card. doctor said moderate). I posted my results which you can likely see via my user icon and mine matches your husband's, in several areas. The history of HOC, I believe is from his family's history, although you may know otherwise, and it may be his own history. The Valsalva is a type of suppressed breathing maneuver they have you do, to see if it lowers HR and his report indicates that HR increased instead (please do know, you need to double check me on this and ALL my other mentions). The HOCM is heart thickening and MAY BE the more serious of the results/findings, so it too needs to be monitored.
Best Wished to You and Your Husband!

[Missie52816]

I have no suggestions or input, because I know firsthand how different HOCM can be for each patient.  I have it as well and had a septal myectomy 04/2012.  I just wanted to stop by and say I hope you got the answers you needed and I hope your husband is well.

[erijon]

It sounds like they're just being careful due to the left ventricle anomalies which may be a normal variant. Thes LV function is still good as is his EF of 60 -65% and there are no wall motion issues, just a small cavity with a little thickening of the muscle which would most likely explain the change in gradient.  Really just sounds like they want to be careful, I wouldn't get overly stressed yet.