Initial Echo Results

[JeffB]

Ok, so met with my new cardiologist and here are the results of last weeks Echo. The below is an exact copy of what my cardiologist received from the echo from another office.

************************************************** *

Interventricular septal thickness IVS: 0.8 (Normal 0.6-1.1)
Left ventricular end diastolic diam LVIDd: 5.3 (Normal 3.5-6.0)
Left ventricular end systolic diam LVIDs: 3.2 (Normal 2.3-4.0)
Left ventricular post wall thickness LVPW: 0.9 (Normal 0.6-1.1)
Aortic root diameter AO: 2.8 (Normal 2.0-3.7)
Left artrial diameter LA: 3.2 (Normal 2.0-4.0)

Interpretation: The left ventricle is normal in size and contractility. The left ventricular systolic function is normal. Estimated ejection fraction is 55%. There are no regional wall motion abnormalities. The right ventricle is normal in size, thickness and contractility.

The left atrium is normal in size. The right atrium is normal in size. The interatrial septum appears normal. There is no pericardial effusion, mass or thrombus. The IVC is normal in size. The aortic root is normal size.

The aortic valve is heavily thickened and calcified and probably bicuspid. The mitral valve is normal in mobility and thickness. Ther is no mitral annular calcification. The tricuspid valve is not well visualized. The pulmonic valve is not well visualized.

Color flow and Doppler shows normal systolic flow pattern. There is moderate aortic regurgitation. There is mild mitral regurgitation. There is mild to moderate tricuspid regurgitation. There is no pulmonic regurgitation. Estimated RSSP is 34mmHg. Peak gradient across the aortic valve is 14 with a mean gradient of 8.

Impression:
1. Normal left ventricular size and systolic function.
2. Probable bicuspid aortic valve with heavy calcification and moderate aortic insufficiency as well as mild aortic stenosis.
3. Polyvalvular insufficiency with mild pulmonary hypertension.

Dr. A. Smith
Attending Psysician
5-11-09

Ilana B. Kutinsky, D.O., F.A.C.C
Interpreting Physician
IBK /lks

*****************************************************
Since the cardiologist I'm seeing did not do the Echo, she wants to do another Echo for herself, a basic stress test and she wants an CT before she will explain anything in detail other than all my valves are leaky. I suppose I can't blame here.

What she told me was that I am not to do any heavy lifting and when I run, to keep my heart rate away from the 170 range until she knows more.

Question: Can anyone explain the Impression? I looked up #3, and I'm thinking that maybe that was caused by being a heavy smoker for 21 years, even though I quit 5 years ago. Is any of this reversable through any type of lifestyle or diet change?

And what's this mean? "Estimated RSSP is 34mmHg. Peak gradient across the aortic valve is 14 with a mean gradient of 8."

Thanks!

Jeff

 

[Mary]

Jeff,
Your gradient is good. Before my aortic valve was replaced, my peak was 85 with a mean of 60. Not good.

Regarding the pulmonary hypertension, that can be caused by the valve insufficiency. It's classified as mild, so that could resolve on its own after your valve is replaced.

The report is really pretty good. I would guess that you're still a year or two out of needing anything replaced.

 

[ALCapshaw2]

MY Non-Professional interpretation of your EchoCardiogram report is that you are showing the Early Signs of Aortic Stenosis and Regurgitation (back flow) that should be monitored regularly (at least every 2 years, every year if you want a more conservative approach) to watch for signs of deterioration. Your gradient numbers sound pretty normal so far.

Another alternative to having your new Cardio perform a repeat echo ($$$) would be to get a copy of the Tape or CD of your Original Echo and let her review that tape. At this point, I wonder what she would do that would be different from what the first tech did.

This would be a good time to start learning about BAV and the often related Connective Tissue Disorder. See that forum for LOTS of info.

'AL Capshaw'

 

[JeffB]

Thanks for your comments Mary and Al.

I'll keep reading and reading and occasionally asking questions as time progresses and hopefully, within time, I'll begin to understand all this. I know that I'm not going to die anytime soon and with my current exercise routine, I hope to stay fit for years to come. Actually, thanks to members on this site, it doesn't seem like getting a valve job is that big of a deal, and people seem to live very active lives after surgery. That's a huge encouragement for me!

I'm not even sure if I'll ever need surgery, but I'll continue praying that I don't, but it will be what it will be. Better I learn as much as I can now, than stick my head in the sand and pretend otherwise. It will be good to hear what comes of the up coming tests.

Thank you all again.

Jeff

 

[JeffB]

Well, I got my results back from the Stress Test and the CT scan. I don't have them in front of me and I can post them at a later date, but basically I have an aortic aneurysm and according to the cardiologist, it's right at the base of the heart, so it would be a complicated surgery because of where it's located.

My Blood pressure is good and so is my cholesterol. I'm hoping that my BP continues to drop as I become fitter.

The aneurysm is at 4.1, so were just going to watch it for a bit and I have a list of do's and dont's.


Do's.
Get plenty of exercise and continue to eat well.

Dont's

Don't max out my heart rate. For me, this means no hard fast sprints where I've seen my heart rate peak at 184. I really, really enjoy the short 100 yard sprints........
Don't push 85% of heart rate while jogging.
Don't lift heavy weights. I can do light weights, but nothing that strains me.

I have a 5k (3.2 mile) run this Saturday, and I wanted to do my best. Recently, and before my restrictions, I've been able to sustain a heart rate of 168-172 for four miles. Well, now I'm not supposed to get my heart rate over 155-160 due to the aneurysm, and my cardiologist prefers me to stay below 150... I'm kinda bummed, because for me to keep my heart rate down, puts me at a 10 minute mile

I've only recently started running again, and I've seen some fantastic results. I'm sure as I continue to become more fit, I'll be able to keep my heart rate down while improving my times... So I'm not out of the running yet (pun intended lol!)

 

[JeffB]

I have a friend that is in Medical school and I was offered a free MRI. How could I resist?

Well, good news and bad news.
First the good news,
My Stenosis is gone Yippie!
Bad news,
The aneurysm is at 4.7

Question for anyone who may know.
The 4.1 measurement was from a CT scan while the 4.7 was from an MRI. Is it possilble that one may be wrong?

 

[MrP]

Jeff,
Margin of error is small for both CT and MRI of your aorta. Since your last measurement this past summer, your aorta has increased in size with a very concerning growth rate.
All my best,
MrP

 

[Bill B]

I like AL's idea of getting the cardio to review the echo tape OR at least get 6 months between the echos. A second echo at 6 months or so, would be more helpful then immediately repeating the current echo. HOWEVER, it may be your cardio was expecting more from the echo, such as AV cross sectional area (I don't see it) and something more definite about whether you actually have BAV or something else. The tape may not be definitive, and a repeat may be called for. The CT scan is needed regardless to define the condition of your aorta and was a key test for me. Your cardio is being more aggressive than mine was. I like that.

OH, I see now I'm a little late. That was May.

Do you have a repeat echo? I see you list BAV in your sig, whereas the first report was not definitive.

The aneurym would concern me. Please let your cardio know about that result and what advice s/he may have regarding running and other stress in light of that.

 

[JeffB]

Hi Bill and Mr. P

Bill,
The MRI was positive on the BAV and it included the cusps that were fused together. Also, the report from the MRI was hand written and I am unsure of the DR. who read it since the MRI was for college students who were learning how to use the MRI. (I was in there for just over an hour and a half).

I'm thinking that Monday I'll get a hold of my cardiologist and let her take a peek at the MRI.

Mr. P,
Yes the increase from 4.1 to 4.7 is very alarming especially in such a short time. I'm hoping that it's simply due to an inexperienced reading...

For the most part, I've been trying to accommodate the dr's orders not to exercise to the point where I'm sustaining a heart rate of 170bpm, but I kinda got foolish when I ran the Detroit half marathon a few weeks ago and totally disregarded the dr's orders... Could running for two hours at 180 + bpm cause the growth? and yes, I know I know, it was a stupid thing to do...

BTW, my max heart rate is 196 -198 and I'm 43.

 

[MrP]

hypertension and increased bp will contribute to growth rate of aneurysmal dilatation of the aorta. A beta blocker such as Atenolol will help reduce bp and growth rate of your aorta.

 

[JeffB]

Thanks for the infor Mr P
Well, boy oh boy did I make a mistake! And it’ to the good this time! I don’t know where I got 4.7 other than I read the report and the 7 got stuck in my head and when I wrote the post, I put a 4 in front of it.

Yesterday I decided to look at my MRI results again. Let me share 

- Mildly thickened bicuspid aortic valve, with fusion of the left and right cusps.
- No evidence of aortic stenosis. Valve opening measures 3.16 cm2 by planimetry (normal valve area is 2.0-4.0cm2)
- Normal Atria and Ventricles. No left ventricular hypertrophy or chamber dilation
- Dilated ascending thoracic aorta. Measures 3.7 cm in maximum diameter.

James Peters MD

Now then, if I’m reading this right, and please tell me if I’m reading this wrong. But the 3.7 would by my aneurism right? If that’s the case, then it actually shrunk by almost a half a centimeter!

 

[jjay32]

that is correct. Measurements can change depending on when the snapshot of the heart is taken, (systolic, diastolic) so a change in size downward is possible.

 

[Maryka]

Well, what helped stabilize my 4.7 aneurysm was to take huge amounts of betablockers and stop ALL aerobic exercise. I stayed stable for about 17 year that way. However, your photo indicates you love to run. Maybe you want to increase your medication a great deal or give up the exercise. I know you don't agree with my approach, but, it worked!