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Variation in Echocardiogram and Nuclear Stress Test Results
Hi:
I just had an outpatient echocardiogram and nuclear stress test.
During the stress test, I exercised well, got my heart rate up to about 90% and had no problems. A cardiologist monitored the treadmill portion and said everything looked great. The overall results were: "Gated wall motion images demonstrate a left ventricular ejection fraction measured at 63%. No wall motion abnormalities are seen. SPECT images demonstrate no evidence of infarct or ischemia."
I am concerned, however, about my resting echocardiogram. It's findings were: "Normal left ventricular size and function. Mild concentric left ventricular hypertrophy. Mid to distal septal hypokinesis noted in some views. Endocardium not well visualized in some views. Left ventricular ejection fraction is 55% to 60%."
My family doctor said the ventricular hypertrophy is so mild that she doesn't see it as any concern. She did say, however, that "distal septal hypokinesis noted in some views" is worth talking about.
However, she said, since the stress test showed no problems and the echo noted the "endocardium not well visualized in some views" her feeling was that we should just watch it. Her plan is to have me carefully monitor my cholesterol and blood pressure and do a second echo in a year. She said that test may well show that this first one was a fluke and that there is no problem.
I am a 43-year old male. I'm overweight -- 6 feet tall and 245 pounds -- without much family history of heart disease. My grandfather died of a valve problem (but my echo showed all my valves functioning well). I have been diagnosed with benign PVCs but my heart health has been generally good. My blood pressure is perfect, but my cholesterol is high (HDL 30 and LDL 143).
Does it seem like the approach my doctor is taking is reasonable or should I ask to be referred to a cardiologist? She is very nice and said she would refer me if I want but that she doesn't view it as necessary.
I just had an outpatient echocardiogram and nuclear stress test.
During the stress test, I exercised well, got my heart rate up to about 90% and had no problems. A cardiologist monitored the treadmill portion and said everything looked great. The overall results were: "Gated wall motion images demonstrate a left ventricular ejection fraction measured at 63%. No wall motion abnormalities are seen. SPECT images demonstrate no evidence of infarct or ischemia."
I am concerned, however, about my resting echocardiogram. It's findings were: "Normal left ventricular size and function. Mild concentric left ventricular hypertrophy. Mid to distal septal hypokinesis noted in some views. Endocardium not well visualized in some views. Left ventricular ejection fraction is 55% to 60%."
My family doctor said the ventricular hypertrophy is so mild that she doesn't see it as any concern. She did say, however, that "distal septal hypokinesis noted in some views" is worth talking about.
However, she said, since the stress test showed no problems and the echo noted the "endocardium not well visualized in some views" her feeling was that we should just watch it. Her plan is to have me carefully monitor my cholesterol and blood pressure and do a second echo in a year. She said that test may well show that this first one was a fluke and that there is no problem.
I am a 43-year old male. I'm overweight -- 6 feet tall and 245 pounds -- without much family history of heart disease. My grandfather died of a valve problem (but my echo showed all my valves functioning well). I have been diagnosed with benign PVCs but my heart health has been generally good. My blood pressure is perfect, but my cholesterol is high (HDL 30 and LDL 143).
Does it seem like the approach my doctor is taking is reasonable or should I ask to be referred to a cardiologist? She is very nice and said she would refer me if I want but that she doesn't view it as necessary.
MEDICAL PROFESSIONAL
I think this is definitely a reasonable approach.
I agree that mild LVH isn't too concerning. The areas of hypokinesis are vague, and when they aren't confirmed in multiple views, they are less concerning. The fact that the endocardium wasn't well visualized also makes it difficult to comment on wall motion.
For now, risk factor modification is key -- lose weight, get your cholesterol down, etc. If you have another stress test in the future, it may be worthwhile to do an exercise nuclear stress test, rather than an exercise echo.
I agree that mild LVH isn't too concerning. The areas of hypokinesis are vague, and when they aren't confirmed in multiple views, they are less concerning. The fact that the endocardium wasn't well visualized also makes it difficult to comment on wall motion.
For now, risk factor modification is key -- lose weight, get your cholesterol down, etc. If you have another stress test in the future, it may be worthwhile to do an exercise nuclear stress test, rather than an exercise echo.
Thanks so much!
Just thought I'd bump this up to see if anyone had any thoughts.
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