Echocardiogram Report

[Harmony]

I recently had an Echo and Holter Monitor done at NY Presbyterian-Cornell hospitals. I am really confused by the test reports I was sent. The report shows the normal values and my values Nothing seems right to me. There is something called Stroke Index mine says 74 normal is 32-58 what does this mean. Ejection Fraction 74 every echo I have taken for the past 2years including one in Dec 05 was 65. I dont understand these huge differences. The Cardio I saw is away for a few weeks and no one at the hospital will talk to me. Another strange thing is is shows Mitral Regurg +2-3, for the past 2 years my regurg has been 4. I have even spoken to surgeons about surgery. I dont think regurg goes down. Is there some place I can check out the normal values for an echo. Is there also some place I can check Holter results as well.

Would appreciate any help
Thank You

 

[dej72]

try this site

try this site

http://www.medhelp.org/perl6/cardio/messages/35430.html

 

[tobagotwo]

Ventricular Hypertrophy Cycle

Ventricular Hypertrophy Cycle

It does sound like they may have had a less accurate reading this time, although there are some very short-term factors, such as pseudo-beneficial calcification (calcification that serendipitously forms in a way that temporarily aids fuller valve closure) and plain old torque from the way the heart was positioned during the echo that can temporarily reduce the level of regurgitation (insufficiency).

Ejection Fractions fluctuate fairly easily, and can be misleading. They do change with anxiety, and sometimes even with the positioning of the heart. Like blood pressure, the number only becomes trustworthy with repetition. Unlike blood pressure readings, echoes are not repeated every office visit, nor are they taken at home. However, from the very sketchy information in your post, an EF of 74 would not necessarily be out of line for you.

A high ejection fraction can be developed through atheletic pursuits. However, it's more often the case that it's a result of left ventricular hypertrophy, the muscular enlargement of the left ventricle that develops when the heart is put to severe service. With regurgitation at the levels you are describing, your heart is pumping very hard to get the proper amount of blood to your body, as much of what it pumps out leaks back into the ventricle.

The ventricle, like other muscles, enlarges when it's worked harder. Think of it as a small hand, squeezing a small orange for juice. You might get half of the juice with a good squeeze. Imagine the orange in a somewhat larger and stronger hand. It can can get a better grip, squeeze harder, and get 70% of the juice out of the orange. More efficient.

Now imagine the little orange in a giant, Mickey Mouse-sized mitt. Suddenly, the hand is so large, it's too big to wrap tightly around the tiny citrus anymore, and no longer has the flexibility or leverage to compress the fruit evenly and push the juice out effectively. As the hand continues to grow, the once very high Juice Ejection Fraction suddenly plummets.

That's the cycle of valve-induced left ventricular hypertrophy that eventually ends in heart failure (call it "Mickey Mouse ventricle"). The left ventricle outgrows its ability to compensate for the valve leakage.

While it may sound good to have a high EF, when it's due to this type of problem, it's a sign of reaching the top of a slow cycle that has a bad ending (if there isn't surgical intervention). This is a cycle that the vast majority of aortic valve patients get at least partway through. It doesn't happen overnight. There's time to decide your best course.

There is much information in this site's Reference Sources forum. It's a good place to look for some basic information. It's good to keep an awareness of dates on the entries, as things change rapidly in the heart valve world. However, the issues you are researching are stable information, and shouldn't have that issue.

Best wishes,

 

[Harmony]

I found your answer very interesting. I am not sure how it applies to me. I have Mitral Valvle prolapse with regurg. I do not have a Aorta problem. +2-3 Mitral regurg is not normally considered a problem as you say it is for the Aorta. The first echo taken at NYP one week earlier showed no regurg and had to be be redone. Since 04 I have taken 6 echos and the regurg has been 4 and the EF 65%.
I went to NYP to be tested as they have a Valvular Heart Disease dept. Either it was a huge mistake or the Cardio I have been seeing for 2 years is not competent. I was upset and worried before now I am doubly upset

 

[tobagotwo]

I apologize, Harmony. I read enough posts that I lose track in mid-reply once in a while. I should always stop as soon as I get tired. Your post plainly states mitral regurgitation, not aortic.

To level-set, 2-3 is considered moderate, and 4 is considered severe regurgitation.

Basically, take what's posted above and push it back one chamber. The mitral valve is between the left atrium and the left ventricle. Rather than the blood leaking back into the ventricle from the aorta, the blood is leaking back into the atrium from the ventricle. The ventricle loses either way, and eventually enters the same cycle.

MVP can lead to an enlarged atrium, and also higher pressures in the pulmonary artery that can back up into the lungs (pulmonary hypertension), and even increase pressures in the right heart (the side that pumps blood to the lungs).

The Stroke Index you are referring to is calculated by taking the amount of blood the left ventricle ejects in one beat and dividing it by the estimated body surface area. This helps define how much the heart's action is being affected by the leaking valve and resultant ventricular hypertrophy, as reflected in a hyperdynamic heartbeat and an appropriate amount of blood moved to feed the calculated body mass. It's the stroke of the pump that is being referred to, and is not a reference to danger of having blood clots or strokes.

This isn't intended to cause fear or overconcern for you. You are in the hands of a number of physicians who will advise you appropriately. If you have had a level 4 regurgitation (insufficiency) for several years, there is a high likelihood that it will affect the rest of your heart, and that some action will need to be taken. You should look at your ventricle sizes, which are likely also defined in your test results. If they are higher than normal, it's a sign. Also, any symptoms you are having are important to determining an appropriate course of action.

Best wishes,

 

[Mb]

Dear Tobagotwo:

That is the most comprehensive explaination of high EF I have read. My husband went from an EF of 40 presurgery, to 75 post surgery for the past four years. This is due to mildly leaking mitral and aortic valves and severely leaking tricuspid valve. Obviously initially we thought the high EF was great, only to learn a few months later that it meant the heart was working pretty hard to get the blood out into his system. Thank you for the explaination.

Marybeth