Help needed for cardio visit please

[susieq14]

I was diagnosed with MVR in Summer 2004 and I posted my history in February 05 and received many nice replies. Since then I've been lurking off and on. I just had my 6 month echo and have a follow-up with the cardio on Nov 16 and I was hoping that you would offer me some assistance. I have copies of the 3 echos I have had and am totally confused trying to interpret them and am trying to formulate an intelligent list of questions to bring to the Doctor.

Briefly...
First-ever echo in July 04 said I had moderate to severe MR.

Saw a new cardio in August. He put me on 5 mg Lisinopril for my high BP and encouraged me to monitor/record BP. Scheduled me for a stress echo in Dec 04.

Dec echo report says moderate MR. Doc told me to come back and see him in May

At May visit he raised the lisinopril to 10 mg based on BP readings since Dec. No echo was done. He scheduled an echo and follow-up visit in November.

November echo report says mild MR.

Is it possible for your echo results to change so dramatically? Can your MR go from moderate-to-severe to moderate to mild??? I'd like to be happy that it got better but I don't want to jump for joy if there's a possibilty there is a mistake somewhere. I hope I am not being too paranoid but I've been reading lots & lots of course and am worried that either the tech didn't do a good job doing the echo or there is a difference in the way the cardio interprets the echo?

Is there a more definitive test that is not open to interpretation or improper administration? Someone (her daughter just had a semi-emergency pulmonary valve replacement) suggested I ask for a cardia MRI. What is your opinion of that? I don't thinkI have seen that mentioned here very often. I do see TEE mentioned. Should I ask for that?

Did the increase in lisinopril help? My BP never goes lower than 120/80 and sometimes is higher. I did lose 25 pounds since July 04 - could that make a difference?

What all should I be asking the cardio when I see him next Wednesday?

I'm going to post my echo results in the hopes that might help you with my questions. Please note that the Jul 04 report is in a different format from the other two since it was done at a diffente facility.


Nov05 - Dec04 - Jul04
Cardiac Chamber Sizes
Left Atrium: 3.8 - 3.2 - 37mm
Aortic Root: 3.0 - 2.6 - 24mm
LV Diastolic Dimension: 4.6 - 4.5 - 49mm
LV Systolic Dimension: 3.0 - 2.1 - 27mm
LV Septal Thickness: 0.9 - 0.8 - 7mm
LV Posterior Wall Thickness: 0.9 - 0.8 - 7mm

Ejection Fraction: 60-65% - 60-65% - 60%

Two Dimensional Imaging
Right Ventricle: Normal - Normal
Left Atrium: Normal - Normal
Right Atrium: Normal - Normal
Aortic Root: Normal - Normal
Pericardium: Trivial Effusion - Normal - Normal

Heart Valves
Aortic: Tri-leaflet - Tri-leaflet
Mitral: MildlyThickened - MildlyThickened
Tricspid/Pulmonic: Normal - Normal

Doppler/Color Flow Imaging
Aortic: Normal - Normal - Tricuspid
Mitral: Mild MR - ModMR - Mod-SevereMR
Pulmonic: Normal - Trace PI -Trace PI
Tricuspid: Mild TR - Mild TR - Mild TR

Peak Velocity: 2.0m/sec - 2.1m/sec
Est.PASP: 21-26mmHg - 22-27mmHg - 16 mmHG+RApressure

Other information:

Nov05: Normal left ventricular size, thickness and systolic function with no regional wall motion abnormalities

Dec 04: Normal left ventricular size, thickness and systolic function with a highly trabeculated apex. (WHAT DOES THAT MEAN?)

Jul04: Normal LV chamber size, wall thickness, and systolic and diastoloc function. There is a false tendon noted from apex to mid septum. (WHAT DOES THAT MEAN?)

I apologize this is so lengthy.Thank you very much in advance for your help. It will be very much appreciated!

Susie

 

[Lotti]

Try a TOE, Suzie

Try a TOE, Suzie

I had a TOE a few years back. Trans asoesophogial echocardiogram. This is basically an echo performed from inside the chest, under a drug to relax you. I was told that this was a more indepth way of looking than a normal echo. Also in my understanding regurgitation does not suddenly get better, so I would ask why it's been read as different. The other thing I have been told is that every operator that does an echo will do it slightly differently, and get slightly different readings. This may be the only reason for your varied readings. I hope that they will set your mind at rest next week as I know from my varied gradient readings that it can be worrying to have a seemingly sudden rise or fall in any test results.

Take it easy

Lotti

 

[JimL]

Hi Susie,
I think you got it right: "Is there a more definitive test that is not open to interpretation or improper administration?" I certainly don't have all the answers to your questions. I just had an echo this week, and I asked to know only the EF, ejection fraction, the only number I can comprehend.
There is a series of tests they run to determine what is going on inside the heart; the tests range from the non-invasive but less accurate to the more invasive and more accurate. This series makes sense to me.
First you have an echo, which is non-invasive, non-painful (for me anyway). The echo can indicate the need to do a more invasive kind of test. So they can do a catheterization, which is much more invasive, and allows the doc to look at your heart valves. That can then indicate the need for a much more invasive kind of test: The surgeon really sees what your heart is like when he cuts you open.
Obviously, this is just skimming the surface, but hopefully it gives you some things to ask the cardiologist about.

 

[PJmomrunner]

Hi Susie:

Your question about reports going from moderate to severe to moderate to mild is one that I am currently wondering about too. It seems like both weight and BP reduction could help, since both are always advised if they're on the high side (not a very scientific assessment). I hope someone with better understanding comes along. I do know that with my own BP management I have not achieved a significantly lower average BP, but I don't have nearly as wide or swift a variation as I used to, so maybe that shows up on an echo as a less leaky valve? And maybe even lower BP would be even less leaky???

Dec 04: Normal left ventricular size, thickness and systolic function with a highly trabeculated apex. (WHAT DOES THAT MEAN?)

Jul04: Normal LV chamber size, wall thickness, and systolic and diastoloc function. There is a false tendon noted from apex to mid septum. (WHAT DOES THAT MEAN?)

I looked up trabeculate (a small bar, rod, bundle of fibers, or septal membrane in the framework of a body organ or part) and it seems like both comments probably mean the same thing. You should ask your doc about the significance of this "false tendon" or "highly trabeculated apex."

 

[susieq14]

Just wanted to say thanks to Lotti, Jim and PJ and add another question if I may.

If my cardiologist does not feel any further testing is necessary and sticks to his interpretation that my MR is now Mild, should I request a second opinion from another cardio? Can the actual "pictures" from the echo be read by another cardio or should I request another echo? (I belong to an HMO and need a referral for everything so I'm not even sure if my insurance and primary care physisian will allow that. Another headache....)

Jim mentioned the importance of tracking his EF and I have read that is important but on the last two echos my EF is recorded as a range. Is there anyway to pinpoint it? or is this again a question of interpretation?

Last March I read the posts here about the "Mayo Clinic Study Sets Threshold for Valve Repair Surgery" which talked about asymptomatic patients and deciding when surgery was necessary and it said that the size of the "regurgitant orifice" was an indicator - specifically patients with a regurgitant orifice larger than 40 mm - do I know what my regurgitant orifice measurment is? Should I ask the cardio about that study? He should know about it right???

I am basically asymptomatic except that I have asthma and severe reflux esophogitis (which Is being investigated and treated as we speak) so it is confusing to know when I'm SOB from my asthma or when the chest pains are GERD or heart-related.

Sorry I asked more than just one more question but one thought just leads to another and I do want to be prepared for my appointment.

thank you!

 

[JimL]

A range for the EF is probably more accurate than a single number, given the difficulty of reading it. I asked at my last echo and was told it was 81, which is rather high. On whether or not to get a second opinion, I think you'd have to ask how much you trust your current cardiologist; do you feel comfortable with his/her explanations; do they make sense? It seems that cardiologists tend to postpone surgery, while surgeons tend to recommend surgery sooner. I hope this helps.

 

[mntbiker]

Can the actual "pictures" from the echo be read by another cardio or should I request another echo?

When they do an echo they make a cd of the test, they can copy this and send it to the other doctor. Have the new doc request it and they will send it over.

A second opinion is always a good thing. I changed cardios three times when I first found out and picked the one I liked best.

 

[susieq14]

Mtnbiker: Thank you for explaining about the CD. that makes sense.

JimL: I think I have confidence with this cardiologist - I've only met/seen him 3 times in the last 15 months. And he did answer my questions and didn't rush me like some doctors do.

I have a feeling this visit will be a good test. the first time I saw him in August 04 I was so overwhelmed with the news that I had a problem, the second visit was actually the administration of my stress echo test so that was tough to judge.
Anyway I think I understand my problem a little better and I have a good set of questions to ask - thanks to this board! - but I won't know until Wednesday - gee I wish it would hurry up and get here. I'm very anxious about this appointment - I can't stop thinking about it. Seems like that is all we do here is hurry up and wait and I'm not very good at that. I
Well thanks for listening to me ramble
Susie