My doctor seems unconcerned about echocardiogram report

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sheryl wally

Hi everyone,

I'm new to the club. I just saw my primary care doctor today to ask questions about the echocardiogram I had done recently. Thankfully, she has referred me to a cardiologist who can tell me all about the report but I will have to wait a few weeks to see him. In a nut shell, she said I had nothing serious to be concerned about but I wanted to post the findings and echo measurements and see what you guys think. The following is quoted directly from the report:

The aortic valve is trileaflet and thickened with moderately limited mobility. The estimated aortic valve area (AVA) was 0.75 cm2 by the continuity equation calculation. (severe stenosis)

Moderately increased left ventricular wall thickness with normal chamber size and contraction; the estimated left ventricular ejection fraction is normal. Diastolic transmitral flow and tissue Doppler signals characteristic of normal left ventricular relaxation and chamber compliance.

Doppler Measurements

Aortic Valve peak velocity: 4.6
Peak Est. Gradient: 72
Cross Sectional Area: 0.7

Personally, I'm still worried. Those numbers don't sound good to me from what I have just read on the web. Everything else on the report concerning the heart valves and ventricles was normal, which was a surprise to me since I had been told for years that I have mitral valve prolapse. I have no symptoms other than the irregular heart beats I've had for years. I'm 52 years old and in pretty good health otherwise. My blood pressure tends to run around 100 over 66 or thereabouts. I will be retested in April and I hope to speak to the cardiologist before then. I live near Chapel Hill and Durham if anyone has some thoughts on good doctors. Why isn't my primary care doctor more concerned?

Sheryl
 
I'm with you, your numbers are in the range that normally result in a referal to a surgeon. Personally, I recommend having the SURGEON make the call on when to operate since they are more concerned about minimizing permanent damage to the heart muscle / walls that results when the valve starts closing off. "Thickening and Enlargement" are the key words to watch for. Either your PCP doesn't want to alarm you, or is not very aware of the 'markers' pointing to surgery.

I believe Duke is rated in the top 5 for heart surgeries so that is where I would go based on your location. Several of our members have had their surgeries at Duke and a couple of names keep coming up as EXCELLENT surgeons. Unfortunately, I don't recall them. Hopefully one of our NC members will chime in with some names. You may even want to do a self referal to one of those surgeons and have him recommend a cardiologist.

Whether you contact a surgeon or cardiologist first, I would recommend calling NOW and ask to see someone ASAP. If you are not able to get an early appointment, then get after your PCP and tell him that it is your understanding that 0.75 sq cm is under the surgical recommendation guideline and you want to be evaluated ASAP.

We have an expression that goes "The worse it gets, the faster it gets worse". It took me 2 months to get my surgery set up after my tests indicated it was time and I strongly suspect I got there 'just in time', hence my recommendation for prompt evaluation.

Start shaking the trees!

'AL'
 
Sheryl,

I had Dr. Glower at Duke do my mitral valve replacement and really did like him. At the Duke clinics you can make a self-referral if you want. If you have your history documented and test resports then I think this is an excellent idea. I did this myself a couple of years ago.

There is a group called the Private Diagnositic Physicians at Duke Medical Center and Dr. D. Glower is part of that group. Cardiologists, also of the Private Diagnostic Physicians, who I have seen are Dr. Andrew Yang and also Thomas Bashore (919-684-2463). All three of these doctors are considered among the very top valve specialists.

Maybe your doctor just doesn't want you to get upset but I think your numbers are highly significant and you need to be seen by a specialist ASAP.

Are you a tarheel or a Duke fan? I'm a true-blue 56 y/o tarheel fan. My oldest son who went to UNC used to tease me that the real reason I was put in the hospital a day early for my valve replacement was to give them time to work on the tarheel/Duke incompatibility problem. ;)

If you want to talk then PM me and I'll give you my number. I would be happy to help in any way I could. I live down in Pinehurst.

Betty
 
I live in TN but I'm a long-term NC resident (30yrs) and also had my surgery at Duke. I believe Duke is rated #3 in this year's News & World Report. I would highly recommend them. As Betty mentioned she used Dr. Glower and he comes highly recommended. I chose to have a Ross Procedure and I also needed my congenital VSD repaired so I chose Dr. Jaggers, who is the chief of pediatric cardiac surgery.

I also have heard good things about Wake-Forest Baptist Medical Center in Winston Salem (western side of NC) and Pitt County Memorial (E.C.U. eastern side of NC). Dr. Neal Kon (WFBMC) and Dr. W. Randolph Chitwood Jr (Pitt) are both nationally recognized surgeons and both hospitals recieve high ratings in the News & World Report ratings.

I agree with the others, it sounds like it's time to consult with a surgeon to get their input. I would be much more comfortable if a surgeon told me I could wait than a cardio. My surgeon was blunt, but ultimately left it in my hands. He said that we could treat my enlarging left ventricle with ace-inhibitors for 6 months and see if that helped...but ultimately that I would need this surgery...and there were no guarantees that the ace-inhibitors would help relieve the symptoms I was currently experiencing. Since my cardio (and a surgeon he referred me to) in Nashville recommended surgery I was already coming to terms with having the surgery and decided not to put it off, mostly because my symptoms were keeping me from performing my job and being as active as I was used to being. Having said that...since I grew up and lived 30 minutes from Duke for 30 years I didn't hesitate to make arrangements to have my surgery there.

Good luck! :)
 
Betty,

I had my first follow-up with Dr. Bashore's group last month and was most pleased with the thorough and friendly care I recieved there (definitely a breath of fresh air ;) ). As a die-hard Wolfpack fan I pretty much kept my mouth shut...lol...but I loved the color of their heart pillows. :)
 
Sounds to me like your head is screwed on straight. I agree that your numbers are not good. Your peak gradient is very high, suggesting severe calcification, and .75 is generally past time to start surgeon searching. My valve was done at .8, and was in dire straights when replaced. While your heart is not showing much enlargement yet (if the echo is accurate), I am not sure how long that should remain a key criterion.

Plus, the problem accellerates as the valve opening decreases. The worse it gets, the faster it gets worse. Months will cause deterioration that it used to take years to do.

I suspect that the reason the doctors are letting you slide is that you are not presenting as symptomatic. Unfortunately, symptomatic doesn't usually mean clutching your chest in agony or being unable to walk to the kitchen, and cardiologists don't explain that to their patients. Most often, symptomatic will mean something far less dramatic, sometimes a change that hasn't really been noticed over time.

If you're experiencing increases in SOB (shortness of breath), fatigue level, angina, noticeable arrhythmias, or general chest/heart noise, those can help as rough, personal gauges as to your heart's condition. These are symptoms. Compare them to how you remember things being months or a year ago, as your unique history is your own best gauge.

Many people have angina and don't realize it. The classic is the left arm, left shoulder/back, or left side of chest pain. However, it can also show up as a feeling at the top of your lungs like you've been breathing cold air, or a feeling like a lump in your throat, or just a slight throat tightness. It can show up solely in your back, or be confused with heartburn issues. Or you can feel it as neck or jaw pain (this is especially common in women).

It may well show up when (or just after) walking uphill or up stairs, although not necessarily every time you do it. It's often not the dramatic, agonizing pain that is portrayed on TV shows, but more of a lower level discomfort or an uncomfortable tightness.

My personal bent is that I would be looking for a surgeon for a second opinion at this point. I wouldn't want to wait until I had permanent damage before getting my valve fixed. Cardiologists seem to let women go longer, as if they had less strain in their lives, or wouldn't mind as much if they had limitations after surgery. (Yes, female doctors as often as men.) Pure sexist hogwash.


Best wishes,
 
How can I get that US News & W Report list?

How can I get that US News & W Report list?

I've been looking for a listing of surgeons and their rankings, etc. The stuff I've encountered has a price on it. Isn't there a free list somewhere?
 
Hi
I read anything about your injection fraction thaat was the big thing for theem to proceed with the repair and the replacement besides everything else the echo showed.
 
Hi Sheryl..I don't get here to often these days but I just happened to be on today and saw your post. I live in Raleigh/Wake Forest and had my AVR and Triple bypass done at Duke 3 years ago by Dr Donald Glower. He is an excellent surgeon and the Heart Group is also very good..My Cardio there is Dr Harrison..but I have also been seen by the other doctors in the Group..they are all Valve specialists. If I can help in any way please feel free to email me and I will send you my phone number..we live quite close to you :)
Joan
AVR and triple bypass ,St Jude Stentless Porcine Toronto Valve, Duke Medical center 9/23/01 Dr Donald Glower
 
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