Accuracy Of Echos?

[JAF1984]

Hey all. Have any of you had a structural heart issue that was initially missed on an echocardiogram? How often does this happen, realistically? I thought I could find info online but actually didn't get a hold of anything. Thanks so much!

 

[pellicle]

Hi

Hey all. Have any of you had a structural heart issue that was initially missed on an echocardiogram? How often does this happen, realistically? I thought I could find info online but actually didn't get a hold of anything. Thanks so much!

firstly, no.... indeed my aneurysm was first identified in a "routine" echocardiogram

However my understanding is that its not very precise and requires an amount of "skilled interpretation", so mild stenosis may be ... unlike an MRI which can be highly accurate.

look at the online images (plenty) and see what you can identify from them ... not much I bet.

[IMG2=JSON]{"data-align":"none","data-size":"full","src":"http:\/\/www.daviddarling.info\/images\/echocardiogram.gif"}[/IMG2]

you also need to sort of know what you're expecting to find when you go looking ... of course they search for the obvious things

There is actually a bundle written on it ... what words did you use on a google search? (did you do a google search)

https://www.ncbi.nlm.nih.gov/books/NBK2215/

https://academic.oup.com/bjaed/artic...asound-imaging

https://www.ncbi.nlm.nih.gov/pmc/art...00103-0041.pdf

its a bit thick to trawl through though and is written for specialists in the main.

 

[Agian]

Hey all. Have any of you had a structural heart issue that was initially missed on an echocardiogram? How often does this happen, realistically? I thought I could find info online but actually didn't get a hold of anything. Thanks so much!

is there anything in particular you're worried about? Maybe people here can reassure you if you provide more information.

 

[epstns]

The biggest variable, I believe, is the skill and experience level of the doctor interpreting the echo. Right after that is the skill and experience level of the technician who does the study. These things (echo's) are quite variable, and if a particular anomaly is very subtle, it may be missed by either person. The more pronounced a defect is, the less likely they are to miss it, but they may mis-judge the severity.

As an example, I have a very small ASD (atrial-septal defect). The defect causes me no symptoms and hasn't changed over all the years I've been having echo's. I have probably had it since birth. Some echo's mention it, others do not. It doesn't go away, but some echo's might make the novice think so.

 

[JAF1984]

Thank you all for replying. I have very specific chest pains that I would have sworn were valve-related. I was convinced it was the prolapsing of my mitral valve and the pain was the pulling of the chordae tendineae -- thats just what it felt like to me. Of course it could be something totally different - I really don't know. But I know when something isn't right and my echo came back normal. On top of that, my new cardiologist is irresponsibly dismissive about the whole thing and was from the moment I walked in. So I'm trying to figure out if I should push for more testing or what.

 

[Midpack]

Just relax. If your echo came back as normal, then you have an structurally normal heart. And for your own mental health, stop medical googling! Take care.

 

[Zoltania]

I have very specific chest pains that I would have sworn were valve-related. I was convinced it was the prolapsing of my mitral valve and the pain was the pulling of the chordae tendineae -- thats just what it felt like to me.

I had mitral valve prolapse with flail leaflet and ruptured chordae tendinae and did not experience any chest pain from that. Plenty of other symptoms (mostly shortness of breath) but no chest pain. Of course that's just my personal experience.

 

[jwinter]

I keep trying to decide if I should respond to this post and can't let it go. I have NEVER had any chest pains and had my second valve replacement last November. After first surgery I saw my cardiologist once and twice per year for echos, ultrasounds, and 24 hour monitor testing. He saw me 1 year ago and gave me a complete clean bill of health. He always told me I was fine and had just this one cardiac event 3 months later(flown to different hospital) my valve was found to be severely stenosed. To say I was upset is an understatement! I even considered a lawsuit but tests showed that either they had been reading something wrong, porcine valve was too small in first place, and there was a loose suture by the time I got to Mayo. Now, just who would I sue and what good would it do?

This background leads me to tell you to always listen to your body as best you can and if something doesn't seem right or you have any other concerns, speak up!

I no longer take everything for granted when it comes to my heart. I will NEVER be passive again. I do not over "Google" things and don't give anyone an attitude but simply get on the phone and take the steps to take care of myself.

 

[dornole]

If you come in with a self diagnosis that specific, you always risk getting dismissed. . . . and lots of people experience anxiety in their chests, my own husband was kept overnight in a hospital for this because it felt so real to him. I 100% believe this is real pain. Do you have any history of anxiety? Any history of heart problems?

I have had moderate mitral stenosis and felt zero chest pain. Instead what I experienced was lack of exercise tolerance, a persistent dry cough at night to the extent I had to sleep in a chair for weeks, and ultimately coughing up quarter sized splots of blood. I'd follow up on any of those. : ) I now have moderate-severe mitral regurgitation and again zero chest pain. In fact mitral regurgitation/prolapse is often asymptomatic to the point where you can proceed to surgery with no symptoms based on an echo. If you had rupture of the chordae tendineae, you would have chest pain but it would be acute and sudden like a heart attack.

Not sure what you can do to follow up except get another opinion (maybe go back to primary care?), this time just say your specific symptoms (how often how severe what causes it how disabling) and let them take it from there. . . no theories. : ) You might have something wrong completely unrelated to your heart that is causing the chest pain. If you don't feel well then follow up.

 

[Duffey]

Then there's my case. When I was pregnant, I suddenly developed PVC's that were unrelenting. It was summer, and I was a month from my due date. I went to the ER, was admitted to the hospital, had an echo, and my heart monitored for 24 hours. The cardiologist said my heart was structurally sound and the pvc's were due to anxiety. Fast forward fifteen years where an echo revealed a stenotic bicuspid valve. So I believe that echos can be very inaccurate. If you are still concerned, I'd get a second opinion.

 

[neil]

pvs suck for sure duffey

 

[dornole]

Come to think of it my advanced mitral stenosis and congestive heart failure was misdx'ed as just pregnancy, but that was by an OB not a cardiologist . . . always a balance I guess, tough for either docs or patients to always get it right.

 

[jyg]

This is very interesting to me. My aneurysm was never seen on echos, a regular echo and even a TEE. It was only caught with a CT. One significant difference for my aneurysm was that it wasn't at the aortic root as most with AV issues, but rather it was way up in the proximal arch. My root was only about 4cm, but the bulge in the arch was almost 5.5cm when they caught it. My cardiologist swore up and down that the echo wouldn't find such an aneurysm because of location and the 2-dimensional nature of echos. That is, they just don't look there for someone with a run of the mill bicuspid AV. Honestly, I still have trouble believing my cardiologist about this, wondering if he's just trying to cover his ass. How was it finally found before it dissected? I had what the surgeon swears was a piece of calcification pop off my aorta and it went into my eye. That alerted me to get to the ER, still no idea I had a dangerously large aneurysm in my aorta. Before the surgeon was on the scene, rveryone figured I had a Hollenhorst of cholesterol broken off from my carotid. But my pipes are apparently quite clean. While looking for the source of the clot they CT scanned me from my head down until they found the balloon in my chest. Who'd ever thing that losing a bit of vision in my right eye would be a blessing?

 

[Warrick]

yep doctors sure don't seem to like it when you tell them whats wrong with you.... "I've been a doctor for 40 years" blah blah If in doubt I'd keep pushing, theres certainly plenty of general medical cases when they don't get it right

 

[Superman]

Mine wasn't a "miss" so much as an item noticed and dismissed as not a big deal. They noted my aortic root dilation and indicated they would follow up next year. I pressed for them to check prior echo's since it wasn't mentioned before. Turns out it was expanding at a rather alarming rate of 0.75 cm per year over the prior two years. Alarming to me anyway. This led to a CT scan, which led to a more precise measurement showing it larger than what they though. I was on the table in a month and a half after that echo for an aneurysm repair.