Left Atrial Dilatation - Severe on latest Echo

[FixedAgain]

Thanks for reading this post..

Try to keep the story short but I had my MR repaired 2 years ago. Due to a doctor not monitoring my blood test results and allowing my HCT and RBC levels to go unnoticed (high ranges), my Ejection Fraction got worse and worse..and we coudn't figure out why.

Finally on my own, I figured this out and donated blood and adjusted the medication that was causing my blood to get thick and viscous.

He had put me on high dosages of Diovan and Coreg but they didn't help..Only the solutions I came up with worked...That's the great news!

I got my ejection fraction up from 35% to 51%.

I just got the good news of the improved EF but the bad news that my Left Atrium is enlarged and the Echo report shows it's Severe..gulp..The (new) cardiologist has not called me about this yet (grrrr!).

A few things about this and my best guesses and if anyone can shed some light I would greatly appreciate it.

The two prior Echos showed the Left Atrium as MILD (30ml) July 2012, then MODERATE (39ML) August 2013, and now SEVERE January 2014 (59ML).

I had slowly stopped the Coreg and the Diovan starting in August 2013.

The study quality as noted on each test was "Good" but the most recent test study quality was "Difficult"..Not sure how much that might effect the results.

I don't have any shortness of breath since I donated blood a few times and adjusted my other meds that were causing high HCT and RBC..that was the root of the problem and I am very proud I figured this out on my own...and had a rather fierce struggle with the doctor who simply missed the high levels in tests he ordered.

I guess the questions are has anyone any experience or information on the likelihood that the Left Atrium can shrink back to normal size? WIth probably a lower dose of Diovan that we were talking about starting anyway..and maybe some Coreg to help the heart remodel..and also a good exercize regiment that I have finally started...(Been living a bit of couch potato lifestyle last year.

Blood pressure is not too high..

I'm feeling much better since I got the EF up but need to get in to better shape..Not overweight or a smoker..

Anyway, as many of you can relate, I was so happy to get the EF up WITHOUT meds..but getting this Severe result on the Left atrium enlargement has made me quite anxious and it's two days of calls to the doctor and a long email and no answer..

THis was my Second MR repair, so you guys know what he means to be getting Echos and watching Mild, turn to Moderate and turn to Severe! I think I have PTSD from all this..I was shocked to say the least and I have no information yet from my doctor...

Thanks for reading and Happy New Year!

 

[Eva]

Hi,

I'm not sure about the relation between your ejection fraction and blood results!

According to Stanford, you LA dilation is mild!

http://www.stanford.edu/group/ccm_echocardio/cgi-bin/mediawiki/index.php/Left_atrium_dimensions

Go to the last para on the page.

 

[FixedAgain]

Hi Eva,

Thank you for the post and the link. I see why you say that and it's confusing...The volume is measured in ML and the size is measured in MM...My LA has measured in the lasdt 3 echos from 30ML (Mild), 39ML (Moderate) and now 58ML (Severe).

I do know the reason this happened as my blood was building up viscosity and was very thick...as a result my EF was getting worse and worse and worse...

I did things to fix that and was delighted to be proved right and see the EF go from 35% to 51%, WITHOUT Meds!!

And yet the LA volume is now Severe...The $#@ Doctor STILL has not returned my call! I am really getting annoyed about that...

I've researched this to the best of my ability and I can see that this has only turned severe in the last 3 months...maybe because of discontinuing Diovan and COreg or maybe the test result is not accurate! The study quality was listed as 'Difficult".

I think the heart will shrink wiht exercise and maybe some medication but I wish the doctor would call and set me straight...

Thanks for reading and posting!

 

[clay_from_nj]

For heart failure, hypertension, and cardiomyopathy, Coreg is really good stuff. I definitely wouldn't discontinue it if I didn't have to. If it causes you problems, you can go with a reduced dosage. From what I've read, it also reduces irregular heartbeats, like PVCs (http://www.ncbi.nlm.nih.gov/pubmed/1378137) and anxiety, and is even a potent antioxidant (http://www.ncbi.nlm.nih.gov/pubmed/11152373).

 

[ottagal]

Hi FixedAgain,
Sorry to hear that you have to go through this worry. I do hope the cardiologist gets back to you soon. I wonder if it wouldn't be worth your while getting/requesting another test. I know that echos aren't always accurate. It may give you some peace of mind.
Wishing you all the very best,

 

[Eva]

I'm sorry about how the results are affecting you. Though all technicians should be trained the same way as as from where and how to measure, yet many of them may measure differently!

Call you doctor again, and as said above, try to have the echo redone at another clinic, if affordable, to have peace of mind!

I'm just curious if this test was done by a different technician, and how come you got the report/results before your cardio seeing it!?

Try to think positive and I hope you hear from your doctor soon.

Keep us posted.

 

[mbeard]

Eva, I have a situation similar to this. My echo was read by a rookie, prescribed by my astute inernist. I am at a crossroads about where to go for my second opinion . I have looked at Adam picks website and my second opinion surgeon isn't listed there. Anyway, I wish you good luck.

I'm sorry about how the results are affecting you. Though all technicians should be trained the same way as as from where and how to measure, yet many of them may measure differently!

Call you doctor again, and as said above, try to have the echo redone at another clinic, if affordable, to have peace of mind!

I'm just curious if this test was done by a different technician, and how come you got the report/results before your cardio seeing it!?

Try to think positive and I hope you hear from your doctor soon.

Keep us posted.

Eva

 

[Eva]

Eva, I have a situation similar to this. My echo was read by a rookie, prescribed by my astute inernist. I am at a crossroads about where to go for my second opinion . I have looked at Adam picks website and my second opinion surgeon isn't listed there..........

Melissa,

Not all surgeons are in Adam's book. You may make your own search about your surgeon or others near you, or

You may start a new thread asking members in AL or nearby for suggestions.

Good luck.

 

[clay_from_nj]

My echo was read by a rookie

One thing I don't have to worry about. My cardiologist insists on personally reviewing the data after every echo, apparently not trusting anyone else to do it.

 

[DebbyA]

Melissa, I agree with Eva: "Not all surgeons are in Adam's book. You may make your own search about your surgeon or others near you, or
You may start a new thread asking members in AL or nearby for suggestions."

One thing I did was use the advanced search on the Society of Cardiothoracic Surgeons and just put in a city name. I looked at the subspecialties and interests, and then looked at the background. My opinion was that if the surgeon had worked in several different hospitals, rather than getting his training, residency and still at the same place, that was a plus, and another plus if some of the experience was at major center. I used the listing of my first surgeon for comparison--you could use your first choice surgeon. I realize this is totally subjective, since I have only my one AVR and reading here to base it on, but it made me feel better.

the link: http://www.ctsnet.org/surgeons/surgeons-advanced-search

 

[clay_from_nj]

My cardiologist and insurance system are very good and I trust their advice, and therefore felt that the surgeon recommended to me would at least be worth talking to. He is the one that I went with and I have no regrets.

 

[FixedAgain]

For heart failure, hypertension, and cardiomyopathy, Coreg is really good stuff. I definitely wouldn't discontinue it if I didn't have to. If it causes you problems, you can go with a reduced dosage. From what I've read, it also reduces irregular heartbeats, like PVCs (http://www.ncbi.nlm.nih.gov/pubmed/1378137) and anxiety, and is even a potent antioxidant (http://www.ncbi.nlm.nih.gov/pubmed/11152373).

Thank you for all the replies! My story is long but I had a second successful MR repair two years ago. Due to high Hematocrit and Red Blood Cell levels, my blood became thick and viscous. My cardiologist at the time, didn't realize this was the CAUSE of the lowered Ejection Fraction which went from 50, 45, 40,35 in each successive test over 1 1/2 years..Finally he threw up his ands and said, "I don't know if i should increase or decrease the Coreg and Diovan"

That was when I did my own research and against the 'judgement' of the nurse practitioner who was given me the usual banal advice, I marched to the Red Cross (barely making it I might add) and donated a pint of blood. Within hours I felt substantially better..I was able to donate the following week again and then once again..This brought my Hematocrit levels down from about 58 to my normal 45!!

My cardiologist didn't react well to being told he was wrong. To say the least.

But I was right!!! and I may have saved my life, as I felt so weak I was afraid of a stroke..I had to rest 4 times to walk the mile to the Red Cross!

I then found my current cardiologist and waited for the appointment and finally saw her...She was patient, nodded her head in agreement with all I had done...but she is just impossible to get on the phone and this isn't working for me.

We had discussed me being on a low Diovan and or Coreg dose anyway...but she just will not call me back. It's insane.

I sweet talked the office manager into sending me the test results.

The Ejection Fraction confirms what I had expected...a FIFTY percent increase!!!

and with zero medication!

The three prior tests all said "Study Quality Good"..this is the only one that shows "Study Quality Difficult"...Why was this difficult, I am in good shape and not overweight..I never had any echo that showed Difficult Study quality.

I called the doctor two more times. No answer. I emailed her this weekend.

I am sure she will call me back but this isn't good for me and I am just going to have to tough it out and find a new one..but I will listen to her take on the test results of course.

I started myself on a low dose of Diovan. I know that's what she is going to do for sure. I've taken Diovan for most of ten years and it might be calming the heart down a bit already..

I do have a refill for Coreg and I am sure she will put me on that too...I've taken it for two years but only to help with the Ejection Fraction!

I will not start that until a doctor suggests it.

I have researched this as exhaustively as a non expert can. I was the only one who figured out why the EF went down!!! I was right. That's really incredible.

And I think that even though I stopped the Diovan and Coreg with the knowledge of the new cardiologist (over several weeks), that I should still be on them as I get myself to commit to 30-45 minutes of daily exercise to strength my heart as I have lived this couch potato lifestyle for too long.

The test results might be wrong or not accurate on the Enlarged Left Atrium..but, I actually have felt something is not right..I, like may of us, is very sensitive to our hearts..and my instincts are very finally honed...I have felt palpitations and maybe some missed beats...

I have not been able to get information that tells me the left atrium can shrink back to normal size..But I do know that as of August 2013 it was only Moderately enlarged..This was due to the thick blood for certain.

This new doctor and the old one are at the two leading hospitals in NYC. They are not stupid people by any means. The first one is just an arrogant asshole and the second is distracted and absent minded. But when she does call she will spend one hour on the phone with me. The funny/scary part is that I will bet she will agree with everything I posted here and will prescribe Diovan and Coreg and tell me to test again in 6 months...I am already prepared to tell her we are testing again in 4 weeks. That's a fact.

The elation I felt when I heard the EF was up from 35 to 51% was so great...I have been suffering for two full years for NO reason..All of this could have been avoided.. I've been through hell with the first doctor blaming me!!! can you guys believe this???? Told me to see a psychiatrist and I am difficult and a drug abuser (yes he said that)...

You can't make up a story like this...It's been so hard to function for well over a full year feeling like crap and thinking my heart was failing.

I'll update as soon as I hear more and thank you guys for all the posts and listening.

 

[FixedAgain]

Hi FixedAgain,
Sorry to hear that you have to go through this worry. I do hope the cardiologist gets back to you soon. I wonder if it wouldn't be worth your while getting/requesting another test. I know that echos aren't always accurate. It may give you some peace of mind.
Wishing you all the very best,

Thank you Ottagal. I am going to make sure I get another test but this doctor is just moving too slow for me. My guess is she will start me on Coreg and Diovan lose doses..and I will insist on another test asap as well.

I'm sorry about how the results are affecting you. Though all technicians should be trained the same way as as from where and how to measure, yet many of them may measure differently!

Call you doctor again, and as said above, try to have the echo redone at another clinic, if affordable, to have peace of mind!

I'm just curious if this test was done by a different technician, and how come you got the report/results before your cardio seeing it!?

Try to think positive and I hope you hear from your doctor soon.

Keep us posted.

Thank you Eva, the tech who did the test happened to be trained by the person who did my tests in the past at a different hospital. I am sure she is ok at it..but much younger and there was something about how she did it that it doesn't surprise me the Study Qulaity was "Difficult"...All prior echos were done at the other hospital by the people who taught her.

For heart failure, hypertension, and cardiomyopathy, Coreg is really good stuff. I definitely wouldn't discontinue it if I didn't have to. If it causes you problems, you can go with a reduced dosage. From what I've read, it also reduces irregular heartbeats, like PVCs (http://www.ncbi.nlm.nih.gov/pubmed/1378137) and anxiety, and is even a potent antioxidant (http://www.ncbi.nlm.nih.gov/pubmed/11152373).

I was taking Carvedilol and hated it BUT...I was hating it for the wrong reason..I did not realize the Thick blood was what was making me feel so bad and thought it was the medication..It might have been a combination of both..I actually wouldn't mind to be on a low dose of it if the doctor agrees that it might help as I exercise to strengthen the heart muscle. That was my original cardiologists thesis. Too bad he failed to look closely at the blood test results!

 

[Agian]

If you don't mind me asking: Why is you blood so thick?

 

[FixedAgain]

If you don't mind me asking: Why is you blood so thick?

Good question. A side effect of taking testosterone is often high hematocrit levels. I finally learned simple blood donation fixes this problem, is healthy for men and is a good deed too!

Called the doctor two more times with no answer.

 

[mbeard]

Thanks to everyone about my second opinion option. I will start a thread the right way about the journey I will go on with my second opinion.

Everyone on this heart forum is so smart and willing to share.

I continuously remind myself that the heart surgeon, when he evaluated my records, said that For Me, the risk of surgery was greater than the waiting and watching. , At this time. I have to believe in him, and not live my life in constant fear.

Anyway, YOLA! And also "this isn't a dress rehearsal.".

 

[FixedAgain]

Hey Guys,

Finally got a call from the doctor after leaving a scathing message on her voicemail last night.

The first thing she said was that she thought I was on vacation...and then she thought I never went off the Diovan and Coreg..(sheesh)

We spent 40 minutes on the phone and I told her that I started the Diovan at 80mg when I couldn't get her on the phone. She said that was what she would have suggested. As suspected she put me back on the Coreg and we discussed the dosage and agreed on 6.25mg 2x a day...or I could start on 3.125mg 2x a day...

Here's the bottom line stuff she shared...Firstly, The MV is in good shape only showing mild leaking (thank god), The severe LA dilitation it is expected to go down as I get on these medications and get into a good exercize regimen. She said it is doubtful it will ever get to 'normal' but she is reasonably sure it will return to Mild or Moderate. (Thank you God again).

We went over every detail of the Echo, including some issue with the Aortic valve and the 'loading'. Nothing to be very concerned with but it was a good education on it and how it might vary due to stress or dehydration.

It's great that I was prepared for this discussion. I had read reports on the efficacy of Diovan and Coreg vs other heart meds and she brought up both studies. It was nice that I had read the same information and understood it.

She wanted to do another Echo in 6 months but will do it in 3 months which is the minimum amount of time she felt to give the heart a good chance to remodel.

Besides all the emotions of seeing the EF increase 50% (wow) the Severe Left Dilitation really did spook me of course but more importantly as I am sure many of you can relate to, I am very aware of how my heart feels...and it hasn't felt 'right'..not that bad either..no shortness of breath and much better since I donated blood and brought down the Hematocrit levels. I asked her if I will be able to run again...as it just feels now that while I can, it feels to hard..She said absolutely I can!

I am very happy with the results of the talk with the doctor and am hopeful that in a few months I will get another test...wiht even higher EF and reduction in the Left Atrium.

I know I can't go back in time and I hope my heart wasn't damaged from all this thick blood and time...I do have regrets about that..I also wished I had the 2nd MV repair done sooner..Maybe next life I will..Meanwhile, I thank god for the good news and lastly she said that we will revisit the medications after we get good Echo results and eventually might wean down or off of them. Right now I am thankful they exist.

Thanks for reading all of this.

 

[AZ Don]

Glad you finally heard from the Dr. I believe it is very important to be pro-active and knowledgeable about your condition. Good thing that you were.

 

[FixedAgain]

Glad you finally heard from the Dr. I believe it is very important to be pro-active and knowledgeable about your condition. Good thing that you were.

THanks Don. This was a very scary tale and could have had a bad ending..It's partially my own fault for not having the blood monitored during this time but I thought the cardiologist who ordered the tests would make the connection between high HCT and lowered EF. He literally fought me tooth and nail about this..It got personal and he is a highly regarded cardiologist at a major hospital!! He is just too arrogant and bombastic to slow down and do his #$@ job.

It's incredible that I had to figure this out on my own and against his advice..

But that is in the past and I have to take in that things are pretty good and I really expect great news in the next Echo..I just know EF will improve and the LA will shrink back to Moderate or hopefully Mild size...and I can put this all in the past.

Started the Carvedilol today and got a headstart self medicating the Diovan a few days ago...Now it's to the threadmill I go!