Echo today........very interesting!!!

[Marguerite53]

So I had an echo today. (I'm 50, BAV) Last one, 6 months ago showed there was virtually no change meaning I can still wait for AVR. Now that I have learned so much from this website I went in today loaded with questions for the poor tech. He was a doll. Very communicative. I really appreciated how generous he was with his time.

I tried to be good, really. I only asked for the significance of a few things. He talked a lot about the subjective nature of his work. Showed me which valve was which on screen. Talked a lot about LVOT measures. Described what a healthy aortic valve should look like (no Mecedes Benz in my chest!), showed me the difference between a healthy ejection velocity (the peak velocity) etc. I had never had anyone echo my throat area (that I recall) and he said that was an extremely important part of the test if it was thought that I had a BAV. It was all VERY interesting.

Then toward the end I started asking him about my numbers. (Of course I will request a copy next week --I'm not actually scheduled to see the cardio until Sept 7th ). I can't remember what my estimated ejection fraction was, or even my peak gradient thingy, but when I asked him about the aortic valve measurement he casually said, "oh, .75"

Whoa. So I said, well, that's changed, hasn't it? (February's was estimated at 1.2 ). He hadn?t realized that there were any old reports in my file since technically, this was the first echo done by my ?second opinion? doctor. I had brought 3 old reports to the ?second opinion? cardio and he found them in my file and started studying them. He said that a good tech will take off from the last echo to verify measurements and try to keep things consistent. He complained a lot about different techs and lazy techs. He said that the echo 6 months ago (at my first cardiologist) was nowhere near as good as the one from a year ago (taken at my general practitioners!) Glad I?m switiching cardios!! He studied them for a long time. Long time. Mumbled afew things. Said my ?case? was fun to figure (truly, I was fine with that -- I liked being interesting!!) Then finally, he just said. ?hm, okay, well, it?s a .95? And that was the end of the test!

I don?t think I need to freak out here or anything, but I could call the cardio?s office tomorrow and double check with them as to whether they want to see me sooner than Sept. 7th. What do you think??

Thanks, guys.

Marguerite

 

[Mary]

Marg,
I bet they won't get you in any sooner. I had an echo in March that came back a .7 and they just kind of pooh-poohed it. I've forgotten, have you had a heart cath? They scheduled my second heart cath after the echo results and it showed a 1.1
The last echo that I had in late May showed a .8 and the surgeon who reviewed it and the cath thinks the echo measurement is more accurate, but my cardiologist doesn't.
Maybe your lady doc will be be better about it, but I wouldn't count on it. Don't forget they'll want to know whether you're having any symptoms.
I would wait until the 7th and see what's said then. If you press to get in sooner, they might think you're "over anxious"--what a laughable idea--and downplay it.
I hope your experience turns out better than mine, but I'm dubious about the whole process.
Mary

 

[bvdr]

I think if you call and try to get in earlier based on the tech's comments you might get him into trouble and a couple of weeks isn't going to make much of a difference. Particularily, if he reports a .95. (Or was the .95 his interpretation of your last echo?)

 

[Harpoon]

"I had never had anyone echo my throat area (that I recall) and he said that was an extremely important part of the test if it was thought that I had a BAV. It was all VERY interesting"


I believe (at least this was the case every time it was done to me) when they put the echo probe on your throat like that, they're actually looking down on TOP of your heart, where the aorta and pulmonary artery come out.


When they take the probe to your neck (I've had this as well) they're looking to see what your carotid arteries look like, checking for plague buildup or thickened walls or other problems that might affect bloodflow.

 

[Bryan B]

They didn't do my throat when checking for endocarditis and at the end of antibiotic therapy to make sure the veggies were gone, but they did check it post-op. Probably checking my pulmonary artery since I had a RP and the pulmonary valve was replaced with a homograft.

 

[tobagotwo]

Echo techs are highly discouraged from talking about their findings, as they're usually technically working for the doctor. As such, using information directly from him would very likely get him into serious trouble. If there is anything of an emergency nature, the doctor is usually made aware right away - meaning that he wouldn't let you expire just to stay out of trouble.

One thing you see from this is that it's an estimate. The difference between .75 and .95 is enormous, in terms of what is happening to the rest of your heart. Not a big change in his calculations.

Best wishes,

 

[Marguerite53]

Thanks!!

Thanks!!

Thanks for your feedback. I was so pleased about the encounter and I do value the relationship with the tech. I assume I can continue to request him. He's very proud of his work, I can tell. Wouldn't dream of getting him into trouble and I, too, suspect that I might (gee, I hope he's not worrying about that!). I'm happy to wait -- busy few weeks anyway.

Mary, your experience must be frustrating. I haven't had the cath yet. Kind of assume that will be next. My symptoms have increased (maybe I'm just newly aware of them, or maybe it's a bit of anxiety) but not to the point of scaring me much. I just figured I could get an echo sooner (originally scheduled on the 30th) and if there was any perculiar finding, I'd at least have covered myself off on that.

The tech did tell me why he was looking at the throat -- for Bicuspid patients it's extremely important to look for something (erg....can't remember) that is a condition which can go along with the BAV. It was a ch or cor or cathe kind of word -- wasn't cartoid which I thought before I asked him. I recognized the word as having heard it here once or twice. Didn't feel right about writing anything down! and have no memory power for such things.

I did mention vr.com to him in the hopes that he might check us out and chime in once in awhile!!!

Thanks for your feedback -- it's been very reassuring.

Marguerite

 

[tobagotwo]

He could have been checking for coarctation, which is a narrowing of the aorta near the left subclavian vein. That is associated with some bicuspid valves.

He might have been checking the carotid arteries.

Or (a stretch) he could have been checking the aortic arch from the base of your throat, looking for aneuristic tendencies in your aorta, also sometimes linked to bicuspid valves.

If not, when you find out, let us know what that was that he checked in your throat, please. It could be new information, and valuable to our friends with bifurcated valves.

Best wishes,

 

[Marguerite53]

Yes, coarctation....

Yes, coarctation....

Bob. That was it. Coarctation. Because after that he mentioned that blood pressure would be measured in the legs and I nodded mentally since doctors have reached down to casually check a pusle in my lower leg before. Basically the tech said that it was a very important question on his test! (as in the one he studied for to get his license). You must perform the throat portion of the echo if there is a possibility of bicuspid valve since these two conditions can be linked.

I "googled" coarctation and this was the first entry........

"The "coarctation" is a narrowing of the aorta, typically found just after the vessels are given off to the left arm. This is a cause of high blood pressure, as the kidneys do not "see" as high of a blood pressure as they would like. This leads them to release substances to raise the pressure, but it only rises substantially in the part of the circulation before the blockage. In this fashion, the heart and brain are still subjected to the very high pressures induced by the kidney?s desire for more blood.

This can cause no symptoms, and be discovered as part of the evaluation for high blood pressure when the person is in their teens, twenties, or beyond. The key finding is elevated blood pressure in the arms, with low blood pressure in the legs. Pulses in the leg may be decreased in intensity, or delayed compared with their occurrence in the arm.

Coarctations generally require repair. Dilating the segment with balloons is a possibility, particularly in the young. Surgical removal of the narrowed segment may need to be accomplished. If allowed to persist, the high blood pressure which is induced may become "permanent" even after removal of the segment due to changes in some organs which are irreversible.

Other abnormalities may co-exist, particularly abnormalities of the aortic valve. It is quite common, accounting for about 15-20% of cases of congenital heart disease, and is more common in men than in women."

I will ask more of the doctor when I get the opportunity. Thanks.

Marguerite