Echo results interpretation - do i need follow up?

[Dentalmaniac]

41year old female, weigh 112 pounds. Am paranoid about my heart health. Got an echo and stress echo done in late 2010. The doctor’s only comments after these tests were they’re normal. Got these tests done a year ago and just picked up the reports from the doctors’ office. Also never have had high blood pressure. Cholesterol has always been under 200, however in a recent test done a month ago, the total was 214 so slightly above normal range.
Echocardiogram (done in July 2010, a month before stress echo)
Dimensions:
IVSd: 1.17 cm
LVDd:3.71 cm
LVDind:2.55 cm/m2
LVPWd:0.76 cm
LVDs:2.49cm
AO RTd:2.34 cm
AO RTind: 1.61cm/m2
LADd:3.15 cm
LADind: 2.16cm/m2
Teich EF: 62%
Vol EF: 62%
LV FS: 33%
LV Mass Index: 74g/m2
Aortic Valve:
Max vel: 1.93 m/sec
VTI: 37.2mmHG
Peak PG: 14.9mmHG
Mean PG: 6.9mmHG
Mitral Valve:
E Max: 1.23 m/sec
A Max: 0.68m/sec
E/A: 1.81
MR Peak PG: 10.3mmHG
Tricuspid Valve:
TR Max: 1.46m/sec
RSVP: 18.5mmHG
Pulmonic Valve:
Mean PG: mmHG
Peak PG: 4.8 mmHg
Pulmonary Veins
IVC
LVOT
Findings Summary:
A complete two dimensional transthoracic echocardiogram is performed (2D M mode Doppler and color flow Doppler). The study is technically adequate.
Left Ventricle: Normal size and function. Mild concentric left ventricular hypertrophy
Right Ventricle: Normal size and function
Left Atrium: normal
Right Atrium: normal
Tricuspid valve: Trace tricuspid regurgitation
Aortic valve: normal
Pulmonic valve: normal
Pericardium: normal. No pericardial effusion
Physician conclusions:
Normal ventricle size and function. Mild concentric left ventricular hypertrophy
Stress echocardiography report (done in august 2010):
The patient excercised 11.4 minutes on the treadmill using the bruce protocol, attaining 112% of maximal predicted heart rate. The test was stopped primarily due to fatigue and secondarily due to attainment target heart rate. The patient did not experience chest pain during stress testing. The resting ecg revealed sinus rhythm with normal conduction and non-specific ST-T wave changes. The stress electrocardiogram was negative for ischemia. Occasional PVCs were seen. The calculated Duke Treadmill Score was 11.4 indicating a low risk of future cardiac events.
Imgaging data: Wall motion
Post Stress: EF%: 70-75
Rest: EF%: 60-65
Stress Echo Conclusions:
Normal Study. No evidence of ischemia or infarction
Resting Echocardiogram findings:
1. Normal resting left ventricular size, estimated EF 60-65%. No resting regional wall motion abnormalities noted.
2. Aortic valve sclerosis. No evidence of aortic stenosis or insufficiency.
3. Thickened mitral leaflets.
4. Structurally and functionally unremarkable tricuspid and pulmonic valves.
My question is how is aortic sclerosis diagnosed? Are these measured by the Aortic Valve values, which for me are as follows:
Aortic Valve:
Max vel: 1.93 m/sec
VTI: 37.2mmHG
Peak PG: 14.9mmHG
Mean PG: 6.9mmHG
What are the normal value ranges for the above?
Another concern is mild concentric left ventricular hypertrophy, which was never mentioned in any of my previous echos. I have an echo from 2001 which showed a measure of IVsd: 0.8 and from 2005, which measured 0.7cm. So higher in 2001 echo vs. lower in 2005. Could these measurements be subjective and the recent one picked up an artifact?
Should I request another echo since it’s been 2 years since the last one?
I’m panicking thinking these findings are not normal and why did the doctor not show any concern?

[Midijane]

Hi dentalmaniac,
The echo says you have an EF (ejection fraction) of 60-65% which falls in the normal range. Your EF is the amount of blood your heart pumps out of your left ventricle with each beat. Since the left ventricle is the largest and main pumping chamber of your heart, physicians measure this to help determine the blood flow to the rest of the body.

The echo also says no evidence of ischemia or infarction. This last sentence means that no areas of your heart muscle have been previously damaged by lack of oxygen or a heart attack. This is exactly what you want the echocardiogram to show :).

To answer your question, aortic stenosis means a narrowing of the aortic valve. Any stenosis just simple means a narrowing of blood flow. You have 4 heart valves but the mitral valve and the aortic valves take the brunt of the work of our hearts. Normal wear and tear as we age can change our valves in time. Your echo says no evidence of aortic stenosis or insufficiency. Again, that is what you want to see. Honestly, don't get hung up on the aortic valve normal range. I have worked in the cardiac ICU for 15 years and have never once held a discussion with a physician regarding those specific numbers.

Left ventricular hypertrophy means a thickening of you left ventricle which we already mentioned is your main pumping chamber. In time, LVH may worsen, or not, and "may" be someting your doc may watch in the future depending on your symptoms and clinical presentation and history.

Take a deep breath now and just know that this last echo was reported as normal, and I would not push for another one at his point unless your doc orders one. If you're not comfortable with this, second opinions are the only way to feel better.

Hope this helped a bit. Take care of yourself and stay in touch.

[Chuckie327]

Hi, I agree withSparks485. Take your overall health into consideration. No fatique to speak of and no hypertension and your parents did not suffer from heart disease means an even better picture. Do you tolerate Garlic?  Also helps keep you in good health. I was responding to your post and lost it in cyberspace. Just wanted to say keep calm. I have a wonderful friend who has been taking Atenolo for twenty plus years due to irregular heartbeat...murmur of the Mitral Valve. Neither of us have had progressively worse valve problems. So hope this news reassures you that todays technology keeps us ticking quite well. Feel free to write back and great  that you are eager to learn more about good health..

[sparks485]

It looks like something that has to be watched every six months...this hypertrophy shows thickening of the valve where over time it can lose its function to flap and the blood can back flow into the first chamber which can produce irregular rhythm and clots.... Usually with agae aortic stenosis always happens, but only minnimal and you must keep your cholesterol within normal range and take your fish oil.. So with the thickened leaflets you just want to be careful as the last resort would be to take them out when they are too weak and reimplant with pig valves. Thats worst case scenerio, so nothing can happen as your report looks nice..you made it through the stress test wonderfullly--everyone has PVC premature ventricular contractions, but if they occur in 7 or more in a row thats when they worry. also they look at the  EF% that shows how well your heart pumps out the blood. EJECTION FRACTURE... Artifiact is always in question but then is ruled out when they read it or will re do it...but Highly doubt it..trust me your in good health.. also they go by your blood pressure and how you feel..are you overweight on medications, have a family history of heart disease...and what is your EKG??