Ventricular Hypertrophy and Tricuspid Regurgitation

[regslady]

My hubby was recently hospitalized with a heart attack, pancreatitis and a variety of organs beginning to fail.  He checked himself out of the hospital and went to another one because he felt like he was not getting adequate care.  He's now at home, which the first hospital told me would never happen.

The new hospital didn't do any follow-up on the heart attack.  I just got a copy of the EKGs and I'm wondering how quickly this needs to be addressed / how dangerous it is.  He's not able to do much and I'm worried.

Summary:

1.  Moderate concentric Left Ventricular Hypertrophy
2.  Trace tricuspid regurgitation present
3.  Impaired LV relaxation with normal LV filing present

LA 5.05
LV EF 66.4

[kenkeith]

M-Mode     Dimensions    Dias       Syst      Normal Range
RVID                ---            ------       ------       < 3.0 cm diast
Right ventricle inside diameter
LVID               ----            4.9         3.10       < 5.6 cm diast
Left ventricle inside diameter
LA                   ---            ------        5.05       < 4.2 cm syst
Left atrium high
AO                 -----            3.30       ------        < 4.0 cm diast
Aorta orifice normal
IVS                 ----            1.50       ------         < 1.2 cm dist
Interventricular septal thickness above normal
LVPW             ----            1.60        -----         < 1.1 cm diast
Left ventricular posterior wall above normal
EPSS              ---             ----         -----           55 %
E-point septal separation.  This is an alternative method to measuring EF (55%).  The method is measurement independant of the left ventricle metrics, size and abnormal motion.  

QUOTE: "Regional wall motin pororly assessed due to poor endocardial definition".

It seems there may have been a problem assessing data.  That may be due to a fast heart rate at the time of the test.  Heart rate is marginally high at rest according to the EKG.  

QUOTE "Left Ventricule - Structure and Systolic Function:  the left ventricular cavity size is normal.  There is globally grossly normal left ventricular function.  there is moderate concentric left ventricular hypertrophy".

Grossly normal indicates it has been visually seen as functioning normally...wall movement (contractions) appears normal.

[regslady]

Thank you!  

Sorry it took me so long to reply, I ended up bedridden myself for a few days.

Here are the summaries:

Echocardiogram   12/28/08  12:57 am

EKG Impression     Heart Rte 103
                             Sinus Tachycrdia, v-rate:99
                              Consider Left Ventricular hypertrophy (S v1/v2+R v5/v6) > 3.50 mV
                              Borderline T abnormalities, Inferior Leads, T flat/neg II III aVF

PR Inteval    156
QRS Interval  90
QT Interval  372
QT Corrected 487
Frontal Axis:  P  48
Frontal Axis:  Initial   64
Frontal Asix Mean QRS
50
Frontal Axis:  Terminal  29
Frontal Axis ST   8
Frontal Axis:  t   -10
EKG Severity:  T  -Abnormal ECG-

----  Next Report ---

Electrocardiogram
12/28/2008 1:40 am

EKG Impression   heart Rate 96
                           Sinus Rhythm, normal P axis, V-rate 50-99
                           Consider Left Ventricular Hypertrophy, (s v1/v2+4 v5/v6)  > 3.50mV
                            Borderline T abnormalities, inferior leads, T flat,neg II III aVF
                            Anterior ST elevation, Probably due to LVH, ST >.20 mV in V1-V4 & LVH

PR Interval   140
QRS Interval  86
QT Interval   360
QT Corrected 455
Frontal Axis:  P  49
Frontal Axis:  Initial  58
Frontal Axis mean QRS  47
Frontal Axis:  Terminal   33
Frontal Axis:  ST  -16
Frontal Axis:  T  -32
EKG Severity:  T  - Abnormal ECG-


----- Next Report -------

Electrocardiogram
12/28/2008  2:35 am

EKG Impression   heart Rate 76
                           Sinus Rythm, normal P Axis, V-rate 50-99
                           ST Elev, Probable normal early repol pattern, ST elevation, age475mS

PR Interval  148
QRS Interval  90
QT Interval   428
QT corrected 481
Frontal Axis:  P  48
Frontal Axis:  Initial  54
Frontal Axis Mean QRS  42
Frontal Axis:  Terminal  28
Frontal Axis:  ST  -19
Frontal Axis : T  0
EKG Severity:T  - Borderline ECG-

-----------Next Report--------

Note from Nancy:  Time not specified on this, not sure which of the three echos from 12/28 this refers to..but it says previous echo 9/2007, so I think it is the first one

ECHO Report

M-Mode     Dimensions    Dias       Syst      Normal Range
RVID                ---            ------       ------       < 3.0 cm diast
LVID               ----            4.9         3.10       < 5.6 cm diast
LA                   ---            ------        5.05       < 4.2 cm syst
AO                 -----            3.30       ------        < 4.0 cm diast
IVS                 ----            1.50       ------         < 1.2 cm dist
LVPW             ----            1.60        -----         < 1.1 cm diast
EPSS              ---             ----         -----           55 %

Left Ventricule - Structure and Systolic Function:  the left ventricular cavity size is normal.  There is globally grossly normal left ventricular function.  there is moderate concentric left ventricular hypertrophy.  Regional wall motin pororly assessed due to poor endocardial definition.

Left Ventricle - Diaastole:  the overall diastolic pattern is one of mild (grade I) impairment of left ventricular relaxation with normal left ventricular filling pressure.

Left Atrium:  Left Atrial size is normal

Right Atrium:  Right atrial size is normal

Right Ventricle:  The right ventricle is not well seen.

Aortic Valve:  the aortic valbve is normal

Mitral valve:  the mitral valve is structurally normal.  doppler interrogation reveals no evidience of valvular senosis or insufficiency.

Tricuspid Valve:  the tricuspid valve leaflets are normal (with good mobility and coaptation) in apparance.  Trace tricuspid regugritation is present.

Pulmonic Valve:  The pulmonic valve is not well visualized.

IVC/Hepatic Veins:  The inverior vena cava is not well seen.

Summary:

1.  Moderate concentric left ventricular hypertrophy
2.  Trace tricuspid regurgitation present
3.  Impaired LV relaxation with normal LV filling pressure.


---Next Report -----

Elec trocardiogram
12/30/2008  12:33 am

EKG Impression    Heart Rate 197
                            Abnrm R Prog, Consider ASMI or Lead Placement, Q > 30mS, diminished R, V2
                            Nonspecific T Abnormalities, Inferior leads, T 99
                              Borderline T abnormalities, Inferior Leads, T flat/neg, II III aVF KK
                              Poor Progression of R waves
PT Interval   136
QRS Interval   86
QT Interval   300
QT Corrected   441
Frontal Axis:  P 18
Frontal Axis: Initial  46
Frontal Axis:  Mean QRS   42
Frontal Axis:  Terminal   39
Frontal Axis:  ST    -31
Frontal Axis: T   -34
EKG Severity: T - Borderline ECG


------Next Report-----

Electrocaardiogram
12/31/08  9:39 am

EKG Impression     heart Rate 113
                             Sinus Tachycardia, V-rate>99
                             Borderline T abnormalities, inferior leads, T flat/neg, II III aVF
                             no significant change

PR Interval   124
QRS Interval   85
QT Interval   336
QT Corrected   461
Frontal Axis:  P   17
Frontal Axis:  Initial  37
Frontal Axis:   Mean QRS  26
Frontal Axis: Terminal   17
Frontal Axis: T   -12
EKG Severity: T   -Borderline ECG-

[kenkeith]

What is the source of the LA 5.05,  LV EF 66 and the report and comments?  An aprropriate test would be an echocardiogram or stress test.  Feel free to post to post summary page comments, etc. and we will try to sort out the information and understasnding.

[regslady]

Thank you!  Your comments definately confirmed one thing...hubby was right to get himself checked out of that first hospital.  Those results were from the EKG that they said indicated he had a heart attack.

Of course, now I'm more confused than ever.  Can you make any recommendations as to what I should be asking or what type of follow-up should be done?  I made copies of the summary pages of the EKGs done at the first hospital...but I don't really know what they mean.

It'd be confusing enough if it was just the heart issue, but with so many other concurrent problems (and his mind not really being there since this happened), I feel like I'm flying in a hail storm.  Thanks for the informative answer and any other advice you can provide!

Nancy

[kenkeith]

The left ventricle is enlarged;  the systole function (pumping phase) is normal.  An EKG doesn't calculate dimensions or the ejection fraction (EF).  EF is the percentage of blood pumped into circulation with each heartbeat. Trace of tricuspid regurgitation is not medically significant.  The report you post indicates an echocardiogram procedure?

If not treated, the LV hypertrophy can/will eventually cause the EF to drop to a level that does not adequately meet the blood/oxygen demand and then there is heart failure.  The 66.4 EF indicates no impairment at the present time.

Hypertrophy can also indicate the left ventricle walls or septum are thickened (less space to fill) and rigid and as a result the loss of flexibility can impede the amount of blood filled into the chamber.  Apparently, that is the present condition.

The heart attack didn't damage heart muscle as the LV EF is normal.  A heart attack (MI) damages heart muscle and as a result heart wall movement is impaired and unable to squeeze out a sufficient supply of blood...Present EF and heart attack is inconsistent with each other?!.