Questions to ask Cardiologist

[hubcap1324]

Hi all. Have had this condition for life and see my cardiologist once a year. I have a biscupid aortic valve with mild stenosis, and moderate to severe regurgitation. My question is that I see a lot of you post specific test results and I know nothing about these. I want more specific info from my cardio instead of "not much change since last year" which is what I get every year. If anyone can give me some specifc things to ask i would greatly appreciate it....

Thanks,

Marty

 

[davidfortune]

Marty,
I'm assuming that in order to get a "not much change from last year" comment you must undergo some testing each year (hopefully at least a sonogram/echo).

You should ask for (and get) copies of all such test results from previous and current tests. Ask your doctor to explain the measurements and what he is looking at as key indicators for "not much change from last year". Ask him? what could change that would cause him to give a different answer.

If he won't spend that time with you helping you understand then find a different doc. Still get the test results though.

Key indicators (from an echo):

Ejection Fraction (EF) - a percentage of the blood that actually gets pushed out of the heart through the aortic valve with each heartbeat. It will be something less than 100%. Expect it to be less than 45% if you are categorized as moderate severe regurgitation (leakage back in the heart so a smaller percentage is actually ejected). EF from an echo is an ESTIMATE. Two different doctors reading the same echo will likely give it a slightly different EF % reading (often they will express it as a range to communicate that it IS NOT an exact number).

Left Ventricle Size - two numbers here:

End Diastolic Diameter = the interior diameter of the left ventricle measured in CM or MM during the relaxation period of the heart beat. This measures the maximum size of the ventricle while at rest, and

End Systolic Diameter = the interior diameter of the left ventricle measured in CM or MM during the contraction period of the heart beat. This measures the minimum size of the ventricle when fully contracted.

Analyze the trend of these two numbers over time. If they are increasing, that is bad as it means the heart is enlarging to compensate for the fact that less blood is pushed into the body (out of the heart) on each heartbeat. If they are stable then that is good since it means the reduced efficacy of the valve is not causing damage to the heart muscle. These numbers may remain stable for many years. THey may also start to change at some point if the valve is "wearing out" due to stenosis or bicuspid formation.

Also watch the measurements of the ascending aorta since there is some correlation between aortic annuerism (enlargement or ballooning of the arotic which risks rupture = classify this as a catastrophic event) and Bicuspid Aortic Valve (BAV).

Again, hopefully you have been getting sonograms each year and can compare the results over years. That give you a reliable trend which is key. If you haven't gotten echos each year get a new doctor since EKG and/or stress test cannot divulge anything about EF, LV size, or aorta size.

Good luck,
David

 

[hubcap1324]

Thanks so much, great information!

Yes.... I undergo the same test every year, resting ehco, followed by a stress test on the treadmill, followed by another ehco (stress ehco they call it).

I will request this info when I see him!

Thanks again,

Marty

 

[Marguerite53]

David gave you a great answer! Thanks David. We should put that concise version somewhere in the resources!

Marty, another thing you might want to ask is when the cardiologist would consider calling in a surgeon. In other words.... you may be lucky to squeek through life with no need for surgery...honestly....you certainly may. However, there are measurements, symptoms, etc.. that the cardio watches, looks for that would determine when he/she might call for surgery. Why not ask what YOUR cardio "when do you call in a surgeon". Of course, you, yourself may call a surgeon at any time. However, it is generally the cardio's assessment that gets things moving. Some cardio's are very conservative and want you to keep your native valve until it's just completely used up. Lately, it seems, some cardios are of the mindset that if it is obvious a patient will definitely need surgery (replacement, repair....) it can be best to get in there before the heart gets too tired of sustaining the condition. You might want to know what kind of cardio you have. Is he/she one who thinks you should keep your own valve until it is almost completely worn out, or is he/she one who opts to make a repair abit earlier.

Hope I'm making sense. Maybe someone else can describe this more clearly for me!

Good luck. Be sure to get ALL you echo reports mailed or faxed to you. They are yours. They will be interesting to review.

Marguerite

 

[davidfortune]

Good,

Stress echo is a good general test (better even than resting echo alone). Recognize that echos by nature are somewhat open to intrepretation since the skill of the technician, skill of the doctor reading the video, quality of the equipment, and mass of chest/abdomen all affect the ability to get a good "picture". Doesn't mean that you can't get reliable results just means that at some point you may need more definitive tests such as a Trans-Esophogeal Echocardiogram (TEE) (where the put the sonogram emitter down your throat while sedated) or a MUGA which is a nuclear based test that gives EXACT EF, LV size readings.

BTW - forgot to mention that 50 - 60% is typically considered "normal" EF since nobody actually ejects 100% of the blood from the left ventricle with each heart beat. Expect less than 45% EF if you are truly moderate/severe regurg.

 

[ALCapshaw2]

Thanks so much, great information!

Yes.... I undergo the same test every year, resting ehco, followed by a stress test on the treadmill, followed by another ehco (stress ehco they call it).

I will request this info when I see him!

Thanks again,

Marty

Marty -

It would be BETTER to go the his office and fill out a Request for Test Results BEFORE your next appointment so that you can review them and form your questions ahead of time. Write them down and go over each at your next appointment. Otherwise, you will waste a lot of office visit time getting confused by the basics. Doctors don't like to WASTE TIME bringing patients up to speed.

Many (most?) good test results will include the Normal Ranges for each parameter. I was of the understanding that the Normal Range for Ejection Fraction is above 55% and less than 75(?)%. Anything over the upper limit is a sign that your heart is pumping too hard to compensate for a defective (too narrow) valve. Anything below the lower limit indicates other issues such as insufficiency / regurgitation or weakened/damaged muscles.

'AL Capshaw'

 

[davidfortune]

Marty -

Many (most?) good test results will include the Normal Ranges for each parameter. I was of the understanding that the Normal Range for Ejection Fraction is above 55% and less than 75(?)%. Anything over the upper limit is a sign that your heart is pumping too hard to compensate for a defective (too narrow) valve. Anything below the lower limit indicates other issues such as insufficiency / regurgitation or weakened/damaged muscles.

'AL Capshaw'

Typically the "normal" range I have seen from cards re: EF is 50 - 60% although I have seen normal defined as 55-65%.

 

[Granbonny]

Hi Marty

Hi Marty

Lexington, N.C...Best Bar-be-que in N.C. I go thru your town to visit my Grandson when he is with his Mom's family in Thomasville, N.C. just down the road from you?Where is your Cardio?High Point..Greensboro?.... Just wanted to welcome you to VR.Com..Bonnie

 

[Mary]

Good,

Stress echo is a good general test (better even than resting echo alone). Recognize that echos by nature are somewhat open to intrepretation since the skill of the technician, skill of the doctor reading the video, quality of the equipment, and mass of chest/abdomen all affect the ability to get a good "picture". Doesn't mean that you can't get reliable results just means that at some point you may need more definitive tests such as a Trans-Esophogeal Echocardiogram (TEE) (where the put the sonogram emitter down your throat while sedated) or a MUGA which is a nuclear based test that gives EXACT EF, LV size readings.

BTW - forgot to mention that 50 - 60% is typically considered "normal" EF since nobody actually ejects 100% of the blood from the left ventricle with each heart beat. Expect less than 45% EF if you are truly moderate/severe regurg.

David, stress echos are a topic that easily raise Tobagotwo's irritability level, so please keep in mind that they are not unanimously loved. In some cases it is felt that they have the potential to be dangerous. The MUGA is not generally used as a diagnostic test before AVR; sometimes afterwards (Gadgetman and Gnusal) but not to check on the valve.

As Al Capshaw mentioned in regards to EF, higher ranges are actually indicators that something is amiss, so don't assume that an ER of 70% or above is good news.
And finally, I'd want to know what my AV # is, and if they've assigned a number to your regurgitation.