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My echocardiogram results and questions
Going to Doc: please comment
The left atrium was approaching the upper limits of normal size at 3.90 cm. The left ventricle is normal in size at 3.95 cm, with a systolic dimension of 3.90 cm. The left ventricle demonstrates moderate hypertrophy. The left ventricular wall, including the septum, altered its size and shape normally and moved appropriately in systole and diastole. There was no evidence of segmental wall motion abnormality. The estimated ejection fraction is 85%. The mitral valve shows mild annular calcification. The valvular leaflets appear pliable and move appropriately without evidence of stenosis or prolapse. Doppler studies of the mitral valve reveal evidence of trace mitral insufficiency, and the prominent A wave noted on Doppler inflow suggests decreased left ventriclular compliance. The right atrium and right ventricle, including inflow and outflow tracts, appeared normal. The aortic valve shows annular calcification with mile calcification of the aortic valve cusps. The valvular cusps appear pliable and move appropriately without evidence of stenosis or insufficiency. There is a measured transvalvular gradient of 6.11 mm of mercury across the valve, which is clinically insignificant for stenosis. The tricuspid and pulmonic valves were normal with evidence of mild tricuspid insufficiency and mild pulmonic insufficiency on Doppler study. There were no vegetations seen on any valve. No intracavity masses or thrombi were noted. There was no evidence of pericardial infusion. Conclusion: Left atrial size approached the upper limits of normal. Normmal left ventricular chanber size with moderate concentric hypertrophy and normal left ventricular function with an ejection fraction of 85%. Mitral sclerosis with trace mitral insufficiency and a Doppler inflow pattern suggestive of decreased left ventricular compliance. Aortic sclerosis with no evidence of significant valvular dysfunction. Mild tricuspid insuffiency. Mild pulmonic insufficiency.
The left atrium was approaching the upper limits of normal size at 3.90 cm. The left ventricle is normal in size at 3.95 cm, with a systolic dimension of 3.90 cm. The left ventricle demonstrates moderate hypertrophy. The left ventricular wall, including the septum, altered its size and shape normally and moved appropriately in systole and diastole. There was no evidence of segmental wall motion abnormality. The estimated ejection fraction is 85%. The mitral valve shows mild annular calcification. The valvular leaflets appear pliable and move appropriately without evidence of stenosis or prolapse. Doppler studies of the mitral valve reveal evidence of trace mitral insufficiency, and the prominent A wave noted on Doppler inflow suggests decreased left ventriclular compliance. The right atrium and right ventricle, including inflow and outflow tracts, appeared normal. The aortic valve shows annular calcification with mile calcification of the aortic valve cusps. The valvular cusps appear pliable and move appropriately without evidence of stenosis or insufficiency. There is a measured transvalvular gradient of 6.11 mm of mercury across the valve, which is clinically insignificant for stenosis. The tricuspid and pulmonic valves were normal with evidence of mild tricuspid insufficiency and mild pulmonic insufficiency on Doppler study. There were no vegetations seen on any valve. No intracavity masses or thrombi were noted. There was no evidence of pericardial infusion. Conclusion: Left atrial size approached the upper limits of normal. Normmal left ventricular chanber size with moderate concentric hypertrophy and normal left ventricular function with an ejection fraction of 85%. Mitral sclerosis with trace mitral insufficiency and a Doppler inflow pattern suggestive of decreased left ventricular compliance. Aortic sclerosis with no evidence of significant valvular dysfunction. Mild tricuspid insuffiency. Mild pulmonic insufficiency.
MEDICAL PROFESSIONAL
Hello
For clarification GXT? Ia your kidney function normal? Was you bradycardia and isolated event. Did you have any symptoms? Do you reside at that home all of the time. If you didnt have symptoms and that was an isolated event, your physician may lean towards continuing you on atenolol. It really is the gold standard for what he is trying to accomplish which is to protect your "moderately concentrically hypertrophied" ventricle from increasing in size from over work. Fortunately, all of the other features of your heart look good. Other alternatives like calcium channel blockers dont provide the same protection to the ventricle. Im sure that your doctor would be happy to listen to your concerns if you voice them. In the absence of symptoms however, atenolol is great
Im sure that you have been worked up for all secondary causes of your hypertension given the young age at which it developed. In my opinion, your biggest concern should be to make sure that other secondary end organs like your kidneys, eyes and cebrovascular system have no evidence of chronic disease. Your kidney function is reflected by you electrolytes and creatnine and a simple ultrasound of your carotid blood vessel would assess your cerebrovascular disease
Make sure that you are managing your diet with an ultra low fat less than 30 gm day total fat, <10 gm sat fat. Omega fish oils, co enzyme Q 10 and consider d-oxyribose
visit www.personalwellnesswheel.com to learn about an empowering step by step personal program to Optimal Health. Its perfect for the person like your self who is actively managing your healthy lifestyle
Good Luck!
For clarification GXT? Ia your kidney function normal? Was you bradycardia and isolated event. Did you have any symptoms? Do you reside at that home all of the time. If you didnt have symptoms and that was an isolated event, your physician may lean towards continuing you on atenolol. It really is the gold standard for what he is trying to accomplish which is to protect your "moderately concentrically hypertrophied" ventricle from increasing in size from over work. Fortunately, all of the other features of your heart look good. Other alternatives like calcium channel blockers dont provide the same protection to the ventricle. Im sure that your doctor would be happy to listen to your concerns if you voice them. In the absence of symptoms however, atenolol is great
Im sure that you have been worked up for all secondary causes of your hypertension given the young age at which it developed. In my opinion, your biggest concern should be to make sure that other secondary end organs like your kidneys, eyes and cebrovascular system have no evidence of chronic disease. Your kidney function is reflected by you electrolytes and creatnine and a simple ultrasound of your carotid blood vessel would assess your cerebrovascular disease
Make sure that you are managing your diet with an ultra low fat less than 30 gm day total fat, <10 gm sat fat. Omega fish oils, co enzyme Q 10 and consider d-oxyribose
visit www.personalwellnesswheel.com to learn about an empowering step by step personal program to Optimal Health. Its perfect for the person like your self who is actively managing your healthy lifestyle
Good Luck!
Delta1949 here again: sorry, I was limited by 2000 characters. I would like to know what to ask my doc. I am 60 next week, had high controlled BP since I was 25, normally 123/71 with resting pulse of 56-63. I take Avalide 300/12.5 and was taking atenolol 12.5 a day until I was in the mountains where I have another home and it raised my BP and lowered my pulse to almost 41 resting. (Again, I ride an exercise bike forty minutes a day) I am a licensed professional and the LVH thing has me worried as if I have to I may need to have a GXT and a Holter 24 hour monitor. My doc just said (through a nurse) my heart is working a little harder then it should and to increase the atenolol to 25mg a day but I want to tell him my concerns about the bradycardia. Can you suggest a good line of questioning and a possible drug to talk about to take with the angiotension Avalide? Thanks.
Delta one last time for now. By the way, I have no symptoms whatsoever. I had the echo because my last yearly EKG showed an inverted T wave. I want to step up my cardio even more if I can to see if I can inhibit this LVH. Obviously, while I feel great and am in better shape than my young partners I don't want to keel over with a heart attack and I want to ask the doc how this affects my life expectancy. Never had a chest pain, a palpitation, or whatever. Thanks, will wait for a reply.
Thank you. Yes my kidney function is normal, all of my blood work is good actually. I take Crestor as well (Doc says high chol is worse than high BP) and my past blood work in November was Col 143, Trigly 72, HDL 61, LDL 68, VLDL 14 with a 2.3 ratio. As I mentioned my resting pulse was always below 60 before atenolol and then went to 49 for my EKG with an inverse T wave and when I kept taking it in the high mountains of Colorado at 9600' my BP went up but because I am in good shape my pulse would go to 39-41 so I got worried and stopped it. Is bradycardia necessarily bad? I can still get my pulse rate through exercise over 150 for max and aerobically maintain 125 for 35 minutes. I also take Lovaza which takes care of the oils. Bun-Creatinine ratio is 14.7. All my CBC was within range. I am just freaked by the moderate LVH. Will this kill me before my time, so to speak? Thanks again. GXT - graded exercise test. Does the normal size of my LV offset the hypertrophy? I am exercising like a bandit now and want to really step it up. I have no pain, shortness of breath, nada. I am bewildered but frankly worried. Is this a diagnosis that is going to necessarily shorten my life if I do all the right things? I just checked my BP and it is 116/71 with a pulse of 63. This after a long work day climbing up and down the sides of ships! Do I need atenolol - opinion - to get my pulse down? Hope you can comment. Am I gonna go with a sudden cardiac arrest? Can I live to 80?
BY the Way, Doc, thanks for your keen insight.
Delta
Delta
Doc, if I still have comment and reply privileges: I was thinking that an ejection fraction of 85% was good but have read in a few places that 55-75 was normal. One cardiologist reported this was not bad but elsewhere it said too high is a problem as well. Your thoughts?
Thanks,
Delta
Thanks,
Delta
MEDICAL PROFESSIONAL
55-75% is normal EF. Echo is an indirect way to measure EF. I dont think there is any evidence that you will have imminent heart problems. I would recommend that the most important thing for you to do is to have periodic visits with your docs for maintenance follow up. By the sounds of it, you appear very healthy and you should keep up the hard work. Its paying handsome dividends
Hate to belabor this issue, Doc, but perhaps you can comment further.
I saw my doc and beforehand, I went to the cardiologist that opined and picked up my echo report from the technician.
First of all, my ejection fraction was 72%. My doc wondered why he wrote 85%.
Also, my LVPW thickness is 13mm and my Interventricular septum is 14mm. My doc says don't worry, just watch the BP, and we'll do another in 2 years.
Me? Am I mistaken that these dimensions are more borderline than moderate and given all of the other values on the report that are within guidelines excepting: pulmonic valve Vmax 1.0 vice the normal upper limit of .9, mitral valve EF velocity of 67 vs, the normal >80, aren't I in pretty good shape?
I have for the past month upped my cardio work to 45 minutes daily in target range, eat well anyway, and have zero symptons.
I am pro-active on my health and almost feel that a yearly echo might be a good idea because I want to see if I can lose a mm or two on those thicknesses!
Anyway, thanks, Doc, thanks again.
Delta
I saw my doc and beforehand, I went to the cardiologist that opined and picked up my echo report from the technician.
First of all, my ejection fraction was 72%. My doc wondered why he wrote 85%.
Also, my LVPW thickness is 13mm and my Interventricular septum is 14mm. My doc says don't worry, just watch the BP, and we'll do another in 2 years.
Me? Am I mistaken that these dimensions are more borderline than moderate and given all of the other values on the report that are within guidelines excepting: pulmonic valve Vmax 1.0 vice the normal upper limit of .9, mitral valve EF velocity of 67 vs, the normal >80, aren't I in pretty good shape?
I have for the past month upped my cardio work to 45 minutes daily in target range, eat well anyway, and have zero symptons.
I am pro-active on my health and almost feel that a yearly echo might be a good idea because I want to see if I can lose a mm or two on those thicknesses!
Anyway, thanks, Doc, thanks again.
Delta
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