Gradient 'slightly better' (ECG technician)? Is this possible?

[bivalve1]

Gradient was 64 in March and heart doctor said I would need an operation this autumn. Bicuspid valve discovered 2003. No symptoms, so it has been difficult to accept. Just been for another ECG, there's a six-week wait before I see the consultant, so I asked the technician if she could give me the new figure. At first she demurred but after the test, did say the gradient was 'slightly better', without giving a figure. I have never heard of the gradient improving on its own, and I wondered if this had happened to anyone else.

Of course it may be an imaging problem - this time or last time - and I have an exercise test coming up to give more data.

 

[Julian]

In my experience with echos and gradients in general are that this info is exactly that, "general". When you have a couple of echos and it looks bad enough for a doctor to say its time it probably is. Some people show lower gradients in echoes than others. What I mean is that your gradient may be even higher than what the test reports. In 2 short years I had several echoes and each had different results. Some seemed to improve, point is I needed the surgery 3 years ago and I put it off to almost the point of no return.

It is totally possible to have the same tech as well as different techs get different results. It happened to me. I totally didn't want the surgery and was set on having to be taken in an ambulance unconscious to get it done, I wasn't going to voluntarily walk in to do this. It didn't happen for me that way I slowly got worse and worse to the point where I would struggle to talk without taking deep breaths between sentences. At this point I threw in the towel and had it done. My advice is to get it done before serious symptoms show up.

 

[Just ASK]

Also keep in mind that a Tech is just that, a Tech. They may deal with results every day, but in most hospitals, they are forbidden to even hint at any diagnosis as that is the role of a physician.

 

[epstns]

Also keep in mind that with many of these tests, including echo's, there is a margin of variance -- meaning that different tech's may get different results for the same patient, but these results will be within an understandable range. Machines vary, so do their operators. As long as the readings are similar, you can rely on them. If one is greatly different, I would have it re-done.

We watched my stenotic bicuspid aortic valve over 9 or 10 years. The readings varied a bit, but if you graph them the progression is unmistakable. The doc's take several different measures into consideration when they say ". . . it is time." They will also want to do an angiogram (cardiac catheterization) to validate the measurements taken in the echo's because echo's do vary and the cath is much more precise and accurate. If the cath shows that the situation is not ready for surgery, they will say so.

 

[bivalve1]

Thank you for these sensible replies, all three. I will ask for angiogram at my next appointment. I have readings over 8 years and they do show an umistakeable progression, except the first which was wildly too high - something like gradient over 100, 25, 45, 64. I'm not really expecting my valve to get better.

I did not get alerts that you had replied, just thought of looking for replies today. Very nice to know you are out there!

 

[epstns]

bivalve, I also forgot to mention another observation we have here at vr.org. That is, with stenotic aortic valves, the worse they get, the faster they get worse. So you may progress as I did, having relatively small decreases in area over many years, then suffer a sudden downhill slide that is aimed right at the door to the operating room. If that is your case, heed the advice and have it taken care of before any permanent damage is done to your heart.

 

[Mentu]

I concur with all that Steve has said to you. My cardiologist is suspicious of any anomalous reading from an echocardiogram. Just as Steve mentioned, my doctor said that there are a lot of variables that can produce less accurate readings. When an echocardiogram produced values he found unexpectedly different, he immediate arranged for me to have a heart cath. In my case, the heart cath showed that my valve was worse than the echocardiogram had indicated. One test can give inconclusive results. It is better to check singing a different one. The heart cath should provide definitive answers as to the state of the valve. Both my cardiologist and my surgeon said that a heart valve does not improve.

Larry

 

[Paleowoman]

My cardio has told me that an echo just gives an estimated gradient.

 

[Lynlw]

Thank you for these sensible replies, all three. I will ask for angiogram at my next appointment. I have readings over 8 years and they do show an umistakeable progression, except the first which was wildly too high - something like gradient over 100, 25, 45, 64. I'm not really expecting my valve to get better.

I did not get alerts that you had replied, just thought of looking for replies today. Very nice to know you are out there!

Hi, Caths are good for getting the most reliable measurements, but I was wonderring if you've had other less invasive tests beside the echo, like MRI/MRAs or CT Scans? They usually are more accurate than echos, so often doctors order them to confirm echos and might order them every year or so until it is time for surgery, and then do the cath since they (caths) are more invasive and even tho the risks are low they still come with more risks than the other tests.
So usually -not always- caths are saved until they're pretty sure you'll be having surgery soon or part of the pre-op testing (to make sure there is nothing else wrong with the heart, like blocked arteries that they would want to take care of while they are already operating on your heart.)

So IF you haven't had MRIs or CT scans recently, I would probably ask for one of them if I was going to ask for more tests. Unless there is a good reason for a needing CT scan over a MRI, I would prefer to have MRIs since CT scans use alot ofradiation.

Good luck with everything. I hope you get some clear cut answers when you have your appt.