Cardiac MRI and Cardio Follow-Up

[susieq14]

Last week I had a cardiac MRI and will be seeing my Cardiologist next week for my 6 month check-up & follow-up and would sure appreciate some input about what to ask about. Here's a brief summary of my story:

In July 2004 at 53 ½ (with BP of 146/84 and weight of 192) I was diagnosed with ?Moderate to Severe? Mitral Regurgitation by Cardio #1. Since then I changed Cardios, lost weight (164), take 20mg Lisinopril and am now being told that the MR is only ?Mild?. Is it possible for MR to get better? And if it does why don?t my ?echo numbers? look better. I asked the Dr. which number he was watching and what would cause concern. He said the LV Systolic Dimension is supposed to be less than 3.5 and he would be worried if it got to 4.0. Well it looks like mine has increased. What do you think? Here?s my echo numbers:

ECHO #1 (JULY 04)
DX: Moderate to Severe MR
LV Systolic Dimension: 27mm
LV Diastolic Dimension: 49mm
LV Septal Thickness: 7mm
Left Atrium: 37mm
LV Posterior Wall Thickness: 7mm
Ejection Fraction: 60%

STRESS ECHO #2 (DEC 04)
DX: Moderate MR
LV Systolic Dimension: 2.1 cm
LV Diastolic Dimension: 4.5 cm
LV Septal Thickness: .8cm
Left Atrium: 3.2cm
LV Posterior Wall Thickness: .8cm
Ejection Fraction: 60 ? 65%


ECHO #3 (NOVEMBER 05)
DX:Mild MR
LV Systolic Dimension: 3.0 cm
LV Diastolic Dimension: 4.6
LV Septal Thickness: .9cm
Left Atrium: 3.8cm
LV Posterior Wall Thickness: .9cm
Ejection Fraction: 60- 65%

At my November visit because of my differences and what I see as increases and what I read here about echos not always being definitive I asked if I could have a cardiac MRI. (He had told me in May 05 that he would do an MRI if and when my left ventricle increased in size.) At first he said no but then he agreed to do the MRI instead of just an echo.
He just called and told me I had normal heart function with mild leakiness and that my forward effective ejection fraction is good at 64%. The report says:
DX: Mild MR
LV Systolic Dimension: 33mm
LV Diastolic Dimension: 54mm
Ejection Fraction: 73% (LV) 69% (RV)

Is my cardio interpreting everything okay? Anything special I should be asking him? Also all echos and MRI show Trace Pericardial Effusion ? is this a problem? Should I get a second opinion? Or should I just chill out? This diagnosis came out of the blue and has just thrown me for a loop as you can tell.

FYI: I am basically asymptomatic except that I have asthma and severe reflux esophogitis so it is confusing to know when I'm SOB from my asthma or when the chest pains are GERD or heart-related.

I apologize for the length of this post and thank you in advance for your help.
Sue

 

[Mary]

I don't know much about mitral valves, but if you are uncertain about the mixed messages you're receiving, I would ask him to specifically point out, using the results you have shared here, where he is seeing the improvement.
I think that your weight loss should have resulted in your numbers decreasing, rather than increasing, so you might ask him about that.
Perhaps in his mind, the determining factor is that you're asymptomatic. I would press him for his rationale and ask questions until you understand it yourself.
Good luck!

 

[susieq14]

Thanks Mary

Thanks Mary

Your answer makes perfect sense - I know I need to ask him to explain it all to me again but sometimes it is so hard. He thinks I'm worrying needlessly and wants me to chill - I have a copy of the letters/updates that he sends to my Primary Care Physician and that is more or less what he wrote last November.

I would like to just put this on a backshelf and not obsess so much but that is not easy for me to do. I like to be in control of things and this waiting in the "waiting room" is not my cup of tea. sorry to whine....

Sue

P.S. Let me be the first to wish you an early birthday Mary!