Echo results... any opinions?

[davidwattsjr]

Friends,

I've just had my fourth six-month echo for aortic regurgitation. Here's my trend:

All of these correspond to left ventricular end diastolic dimension:

4/2003: 4.7 cm.
10/2003: 5.6 cm.
3/2004: 6.1 cm.
Yesterday: 4.8 cm.

Hmmm... I asked the cardiologist - what about these previous two echo's that showed significant increase in the left ventricle size. He said - they were not accurate.... mine is accurate.

Anybody experience this kind of thing before? Should there be this much inaccuracy?

Thanks for your thoughts.

David.

 

[Nancy]

Unfortunately, echoes aren't known for their accuracy, being VERY dependent on the tech who does them, plus the test is just a snapshot in time and things can vary within your body.

Your doctor must be confidant about the tech that does his.

Echoes are good because they aren't invasive.

For a more accurate picture, a TEE or cath is better.

 

[tommy]

David,

Soooooooo, does that mean that the previous higher readings were not accurate? How unsettling! What's the deal?

My pre-surgery echos were from 1984 until 2000. Technology changed over time and I was never sure if the new information represented a change in my heart, or the change in the machine's capability.

The shame is that the change from one echo to the next is important. The heart size is often the final indicator for many of us that surgery is due sooner rather than later. It seems like you are starting from scratch.

Were there any other results that help you/the doc know where you stand? How do you feel?

In an earlier post, you mentioned changing docs. Is this the new one?

 

[davidwattsjr]

new doc

new doc

Yes, this was a doctor down at the Texas Heart Institute in Houston.... as opposed to my local cardiologist in Longview.

In general - I seem tired much of the time... perhaps that's just the fact that I'm 37 and not 17 any more.

Either way, he said ejection fraction was good - (didn't give me the number) - but it has always run aobut 65%

David.

 

[ALCapshaw2]

Step 1 - Get a copy of all of your Echo Test Results

Step 2 - Check ALL dimensions
Chamber Sizes
Valve opening area
Pressure gradients across each valve

 

[tommy]

In general - I seem tired much of the time... perhaps that's just the fact that I'm 37 and not 17 any more.

That is what I thought. I was wrong. No one should be feeling tired all the time. Feeling pooped is the pits. It is a symptom. Keep an eye on it and keep letting your doctors know. Exercise (as you are able and have doctor's clearance) can actually help raise your energy level.

Based on the cardio's reaction, it sounds like you are not in any danger. However, Al's advice is good. Get your hands on the data. There may be a processing cost, but you should be able to get it all.

Keep us posted.

 

[tobagotwo]

Being 37 doesn't make you tired. Unless you are extremely inactive, that is likely your heart.

My valve affected me so much that when I had my valve done at 51, I came home feeling like 30. I kid you not. I felt like I had been so cheated those last few years.

As far as the echoes: no, there shouldn't. Unfortunately, Nancy is right about the tech, and it sounds like you have been going to a slacker in Longview.

If the new doctor is that highly confident, then you need to bring the results back to your doctor in Longview and let him know what kind of half-baked quality he's been getting. According to your original tech, your ventricle is enormous.

Heck, you should get your money back.

Make sure your next echo is with the new tech, so you can compare apples to apples. Also, I'd really wonder why your doctor in Longview didn't freak out when he saw those sizes. He should have been extraordinarily curious about the cause of that hypertrophy, and very concerned for you. Maybe he already knows that his echo tech is no good, and was accounting for it.

Best wishes,

 

[Nancy]

We found a tech that we now always request for Joe's echoes, because they are very, very difficult to do, poor cardiac windows, and lots of things can't be visualized. I am guessing that it's all of the scar tissue that is in his chest. But she does her darndest to do it all, and she's very persnickety.

He just had two echoes about a month or so apart, one regular and one Dobutamine stress echo, which knocked him for a loop for a few days. They were looking at the pacemaker function under stress. Couldn't get his heart rate up to where they had targeted it for (160), he only got to 108 before they stopped the test.

Even so, they are still not highly accurate with the best tech in the world.

 

[Shine_on_Syd]

sorry, red flag time for me.

sorry, red flag time for me.

Something doesn't make sense to me. If the last reading is accurate then you are very lucky! But for me, your post is causing me to think....Whoa whoa whoa! Firstly, I know for me, having Aortic insufficiency from regurgitation. the LV diastolic dimension was the single most important measure to determine my time of surgery. When mine hit 7.00 cm, they suggested I shouldn't wait much longer.
You have a very steady progression of widening LV dimension which is not atypical for a patient with AI. I find it hard to believe that you had three echoes showing an increasing enlargement of your LV and then it meausres below 5.0 cm. As far as I know that is unusual. Heck after very successful surgery it was a miracle that I got mine down to 5.2.
I am sorry, if you have AI, but how can the previous three readings be "wrong" and this one right? The odds are against that. I would get some more readings before concluding the other ones are wrong. If the are not wrong you may be getting close to surgery. I wouldn't let things go based on the last echo, it could just as well be wrong.
My two suggestions, get at least one maybe twomore echoes demanding a top tech and then get thee to a surgeon.
I am very demanding when it comes to situations like this I would make the cardio be in the room fro the echo or have a TEE which is performed by a cardio.
I am a low key person, but when it comes to my heart valves and heart I am relentless and demanding. You have some very mixed test results begging for resolution

 

[Shine_on_Syd]

David,
I hate to belabor the point but something is not making sense to me. What makes your cardio so certain that the last test result is right and the others were wrong? If you are have echoes that often and you have AI, I would be surprised if you had an LV diastolic 4.8 unless you have a very mild caseof AI.
Not to be over dramatic, but If that would have been me in the appointment with that trend of LV dimensions and the doctor said the last one was correct and all the others wrong, I would said there is something wrong and demand better measurement. I would have accepted nothing less. We are talking about you crossing a line to CHF. You need to get aggressive. As you can tell I have little faith in cardios. I have been through about 5 in as many years. I let them do my echo and send the results to my surgeon. He is the only one I trust and knows my heart in detail.
James

 

[Buzz Lanning]

Echo Results

Echo Results

David,

Based on the LVED dimensions shown, I don't think there's too much concern yet. Your LVED dimensions are significantly below the normal criteria for valve replacement. Normally, surgery is recommended when the LVEDD exceeds 7.5 cm, and/or the LVESD exceeds 5.5 cm, and/or the ejection fraction is less than 50%. However, these are ONLY guidelines.

My last echo before surgery showed a significant increase in the LVESD (from 3.9 cm to 5.2 cm). The rapid change, including the dimension, where major factors in deciding to have AVR. Note: My LVEDD was 7.3 cm & EF was down to 54%. I had moderate / severe regurgitation.

Hopefully this info will be helpful. Good luck . . .
Buzz