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  • New user really confused

    Hello I am a new user here and would like some advice on what to do. I am a 26 years old male. The bolded results are the ones that I am concerned about. Here is my not so brief medical history begining In 2008. I went to a new Doctor due to symptoms of palpitaitons, chest pain and a newly discovered murmur. He could not hear the murmur and told me I was just hearing things, but gave me an echo to ease my mind. Here were the results from 2008:

    1. Left ventricular systolic function is normal.
    Left Ventricle - Structure and Systolic Function: Left
    ventricular systolic function is normal. Overall left ventricular
    ejection fraction is estimated to be about 55%. No regional wall
    motion abnormalities are seen.
    Left Atrium: Left atrium is normal size.
    Right Atrium: Right atrium is normal size.
    Right Ventricle: Right ventricular size and systolic function is
    Aorta: The aorta appears structurally normal.
    Aortic Valve: The aortic valve is has three leaflets and appears
    normal. Trace aortic valve insufficiency.
    Mitral Valve: The mitral valve leaflets have normal appearance
    and mobility. There is no mitral regurgitation.
    Tricuspid Valve: The tricuspid valve is structurally normal.
    Trace tricuspid regurgitation is present. The peak gradient is
    22.1 mmHg , thus right ventricular systolic pressure is 22.1 mmHg
    above the right atrial pressure.
    Pulmonic Valve: The pulmonic valve is not well visualized.
    Pulmonary Artery: There is no elevation of pulmonary artery
    pressure. The pulmonary artery systolic pressure is 30.1 mmHg.
    IVC/Hepatic Veins: The IVC is normal in caliber and has normal
    response to respiration.
    Pericardium: No pericardial effusion seen.

    M-Mode Dimensions Diastole Systole Normal Range
    RVID 1.50 < 3.0 cm diast.
    LVID 5.00 2.85 < 5.6 cm diast.
    LA 2.55 < 4.2 cm syst.
    AO 2.55 < 4.0 cm diast.
    IVS 0.85 < 1.2 cm diast.
    LVPW 0.90 < 1.1 cm diast.
    EPSS 0.55 < 0.6 cm
    FS 43.0 25 - 53 %

    2D Diastole Systole Normal Range
    RVAW 0.2 to 0.7 cm diast.
    RV 1.63 1.9 to 3.8 cm diast.
    IVS 0.76 0.6 to 1.1 cm diast.
    LV 5.01 3.32 3.5 to 6.0 cm diast.
    LVPW 0.86 0.6 to 1.1 cm diast.
    Ao Root 2.81 2.1 to 3.4 cm diast.
    LA A/P 2.75 2.3 to 3.8 cm syst.
    LA Area A4C 8.8 to 23.4 cm2 syst.
    LA Volume 28 to 48 cc

    I wanted a second opinion and changed my primarycare physician. I told my new Doc about my symptoms and that I thought I might have Marfan Syndome so he gave me another echo to rule out aneuysm/dissection and referred me to a geneticist. Here is my second echo from 2008:

    LV- sytolic function normal. LV cavity size normal.Ventricular wall thickness normal.LV systolic function normal. Overall LV ejection fraction esstimated 55 to 60%.
    LV- Diastole: LV isovolumetric relaxation time prolonged at 104msec. The doppler derived earl diagnostic time is prolonged.
    Aorta: The aortic root diameter is normal,measuring 3.22cm no evidence of dissection.
    Aortic Valve: Has three leaflets and appears normal. Mild aortic valve insufficiency. The pressure half-time of velocity envelope of the aortic insufficeny jet is 753 msec. The noncoronary and right
    coronary cusps failed to coapt completely
    .Peak systolic graident 8.3mmhg, and mean systolic gradient is 4.0mmhg.
    Pulmonic Valve: is not well visualized. Mild to moderate pulmonary regurgitation is seen.

    Trip to the geneticist and a gene test only confirmed a 10% chance of marfan syndrome, which my geneticist just recently told me i was unlikely affected by it, due to my history of stable aortic root
    size, and no longer needed annual echo checkups. I was really glad to hear the news, but my symptoms of chest pain, daily palpitations, migraine with aura, sob when exercising, feeling of blood pooling in head, chest pain when jumping, still bothered me. THree echos, CT of aorta, and MRI angio of brain and carotids later Here were the results:

    2009 echo findings:
    LV Ejection Fraction 60 to 65%
    Aaortic Valve: THe aortic valve is native and bicuspid. Right and Left coronary cusps are partially fused. Trace Aortic Valve insufficiency.
    Aortic Root measured 3.10 cm.
    Pulmonic Valve is normal no regurgitaiton is seen.

    2010 Echo findings:
    Left Ventricle - Structure and Systolic Function: The left ventricular cavity size is normal. Ventricular wall thickness is normal. Left ventricular systolic function is normal. Overall left ventricular ejection fraction is estimated to be about 60%.
    Left Ventricle - Diastole: The overall diastolic pattern is onof normal left ventricular relaxation.
    Aortic Valve: Mild aortic valve insufficiency.
    Aortic Root measured 3.22 cm.

    Newest and Last 2011 echo findings:
    Normal left ventricular wall thickness.
    Normal left ventricular size.
    Normal LV systolic function with a visually estimated ejection
    fraction of 65%.
    Normal wall motion.
    Normal diastolic filling indices.
    Normal right ventricle structure and function.
    The ascending aorta and the visualized portion of the arch is
    normal in caliber and contour. There is no evidence of
    coarctation by spectral Doppler.
    Trace aortic insufficiency otherwise normal valves.
    Normal pulmonary artery pressure.
    Compared with previous echocardiogram performed on 8/17/2010
    there is no significant change.
    Aortic root 3.22cm.

    CT and MRI didn't find anything significant.

    I asked my PCP about my murmur and BAV findings in 2009 and he said it was a normal finding and nothing to worry about. Sorry for the long history, but now I am not sure how I should continue with my doc. I still have chest pains, heart palpitaitons, shortness of breath, murmur, migraine with aura, dizziness/lightheadedness. Do I have a BAV or don't I and if I do will it get worse over time? Should I not lift weights/run? Do I need to see a cardiologist? Or am I just overreacting to all of it? What do you guys think I should do? Thanks for reading any advice is appreciated.

  • #2
    Sorry for the double post. Can someone delete one of them for me? Thank you.


    • #3
      I'm not a medical professional, but your echo readings look fairly normal to me.
      If you're having chest pain and shortness of breath, I would certainly see a cardiologist. He could rule out any coronary artery disease.
      Never stand afar and view with fear and trembling that which lies in your way. Face it boldly and see how very small it is, after all. member since 2004, avr in 2005


      • #4
        How frustrating for you. 30 years ago, i had a physical for school, the doc heard a murmur, and I was sent to a cardiologist. He thought it sounded like a BAV but an echo didn't show it. I had echos every 5 years or so. Then one year it did show a BAV. The next echo didn't show it. Eventually, all my echos showed it but it took awhile. It's not always easy to visualize.
        With the conflicting reports you have combined with symptoms that might be heart related, I think I would make an appointment with a cardiologist if it were me.
        Keep us posted!
        3/7/12: AVR ( 21 mm St Jude mechanical) for BAV; repair ascending aortic aneurysm with tube graft
        UPMC Presbyterian Hospital, Pittsburgh, PA; Dr. Lawrence Wei


        • #5
          That sounds very frustrating. I would say your best bet would be to see a cardiologist. I have had palpitations and chest pain since I was a teenager and my primary dr has always brushed it off, it was not until I made an appointment on my own to see a cardiologist that they found I have a probable BAV and Ascending aortic aneurysm. Good luck, and I hope you get the answers you are looking for.


          • #6
            THanks for the replys and thanks for sharing your experiences it makes me feel a lot better knowing other people have gone through similar struggles. I will contact my pcp and demand a referral to see the cardiologist (hmo plan). I will hopefully be back with some answers lol.


            • #7

              I have a BAV, and my family doctor (who delivered me into the world back in the days when your own doctot actually did this), detected a heart murmer at birth. He died a few years later and no other family doctor ever heard the murmer. I had a detailed medical in my late teens and a very very senior and experienced physician had mean lean forward (so the heart came forard a bit and made the murmer more audible in the stethescope) and only then could he could detect a faint murmer...but it took a very thorough and clearly experienced doctor to hear it. I then had an echo to confioirm, and had echos every few years since, and I learn't very quickly that the best echos were actually performed by the cardiologist themselves, and not a cardiac echo technician. I could even tell the person doing the assessment where to place the probe to get the best view of the aortic valve and also if I went to doctor and they couldn't hear the murmer, I would then tell them how to have me lean forward and would point to where they should listen on my chest, and then they would say.."oh yes, I can hear it now"...but some junior doctors wouldn't know a murmer from a whisper from a shout...the lesson here....I would only go to a cardioloist for the cardiac echo (not a junior technician). Anyway, my aortic valve was monitored every few years over almost 30 years until the regurgitation got a little worse, my left ventricle started to enlarge and eventually I started to become slightly breathless under exertion. We (surgeon, Dr, myself) then decided to have the AVR, as it was explained it should ideally be done before the aortic root started to enlarge or the left ventricle started to stretch beyond the point where it would be unable to return to normal. Some Drs aren't doctors and some cardiac echos aren't cardiac depends who is doing them and who is interpreting them unfortunately....You need to work backwards....start by getting in touch with a senior experienced cardiac surgeon who does aortic replacement regularly, and ask this surgeon to recommend a specialist cardiologist who also does cardiac echos who will assess you and if necessary work closely with that surgeon to determine the best course of action....thats one approach anyway...and one that worked very well for me. I don't trust just any mechanic to work on my car, and I certainly don't trust just any doctor to give me specialist advice on my heart....I hope that helps?
              Congenital bicuspid aortic valve was replaced at 49 years of age with St Jude Trifecta 27mm tissue valve. May 2012.
              Brisbane, Australia.


              • #8
                In an HMO, the PCP is the gatekeeper. You can demand all you like, but that doesn't mean you will get a referral. Chest pains and SOB should warrant a cardiology visit, but your PCP may think you're too young to warrant a further look into CAD. You can see a cardiologist on your own and pay for it.

                Most BAV people don't require surgery; however if the valve gets to the point where it's not functioning well, you probably will need it.

                An echo is the least reliable diagnostic test for valve stuff; it's pretty much entry-level, if something doesn't look right, it would warrant further testing; however mild aortic insufficiency is not a sign for concern.


                • #9
                  Originally posted by TheBFG View Post
                  THanks for the replys and thanks for sharing your experiences it makes me feel a lot better knowing other people have gone through similar struggles. I will contact my pcp and demand a referral to see the cardiologist (hmo plan). I will hopefully be back with some answers lol.
                  If after you see your pcp and he doesn't agree to refferal, speak with patient ombudsman or liason. Lay out your thoughts and reasons for requesting refferal, then maybe they can do something. Years ago my husband and I were part of an HMO plan and my husband's cardiologist did not feel the need to speak with me when I was in the room. I had him replaced.
                  Livin' Life At A Snail's Pace
                  AVR May 19, 2008
                  Edwards LifeScience Bovine Pericardial