Lost faith in echos

[barbwil]

Several times in the last couple of years my local cardiologist's reports on my echos came out 3+to 4 so he began talking to me about going to the Cleveland Clinic for evaluation. I finally said I would go there to see what they thought. When the echo was done there (#1 in the country, right?) it said it was only 1-2 and this had taken about 4 times as long as the local one. BUT the cardiologist at the clinic said that still left to be seen why I was so symptomatic with SOB and extreme fatigue.

The following day I had the heart cath. done and sure enough it showed definitely that the mitral regurgitation was indeed a 3+ to 4.

The cardiologist still wanted to have a TEE the next day to determine if there were any clots that had formed while my INR was 1.2. And the TEE said also that the regurgitation was only 1-2.

So the only thing that gave a true picture was the heart catheterization, neither the echo or TEE.

Talked it over with my PCP the other day and he told me how much of the results depended on the person in control of the test as well as other factors.

Thus "I have lost faith in echos!"

Barb

 

[Nancy]

You're right, sometimes, echoes are almost useless. My husband has had many chest surgeries and as a result has a lot of scar tissue. He's had echoes in which NONE of his valves could be visualized well. I suppose this is due to the scar tissue, but who knows?

We fired one tech, and found a terrific one, but even she has trouble getting proper results. And she is super fussy.

His caths both right and left were the most informational tests.

But they're invasive, and he has to be hospitalized for quite a while due to bridging from Coumadin.

And they are not without risk.

So echoes are used the most because they are less trouble. And I would assume liked better by the insurance industry.

 

[barbwil]

appt monday

appt monday

Nancy, this monday I have an appt. with my local cardio., the first since my surgery three weeks ago. He is the one who trained the fellow who does my echos. Wait til I tell him his man beat out the Cleveland Clinic; hope he can get his head thru the doorway!!

Might I add that I always appreciate your informative posts; you and hubby have gone through so much together and it is of such value to others when you share the knowledge you have accumulated through the years.

God bless, Barb

 

[tobagotwo]

My take on it is that you still don't really know. Because of the symptoms, it makes sense to believe the 3-4 insufficiency, and I would certainly go with that.

However, in my experience, the cath is really not more accurate than a really good echo, anyway, despite interventional cardiologists' claims of it being the "gold standard." In a number of posts here, the cath results were no closer or even further off than the echo results when the valve was finally measured. It really does surprise me that the TEE read low, though. I suspect you may have pericardial or similar issues that make echoes difficult to read.

For most folks, echoes are still quite accurate, with the caveat that the technician's ability is always a major factor in accuracy.

You certainly have good reason to personally question them, though. I can't disagree with that. I would stick to your cardio's technician - which I am sure you were already planning to do anyway!

Best wishes,

 

[Marty]

Cath..gold standard

Cath..gold standard

One of my valve buddies with an aortic St. Jude mechanical has been getting echocardiograms in the cardiologist office showing an increasing gradient, Last exam over 40. He was warned repeat surgery is in the offing. He is asymptomatic so I suggested second opinion from my surgeon, a top valve man. He was told after that consultation that he is probably OK and definitely does not need surgery in the near future. It was news to both of us- the echo is unreliable and cath the only true gold standard .......at least for aortic gradient.

 

[geebee]

I think there are so many variables with echos. Obviously the first problem can be an idiot tech. The second can be excessive scar tissue that most of us with multiple surgeries have. The third can be how the doctor reads the echo. Even tho we think our doctors are great, it really depends on what they are looking for (or not looking for) as to what they actually "see".

I had an echo a few weeks ago. The tech had no clue what he was doing. He kept talking to himself saying things like "I guess this is the measurement I should use" and "maybe that's the aortic valve".

My cardiologist seemed to be focused on whether my St. Jude mitral valve looked OK and not on whether there might be involvement of other valves in my symptoms. The tech had mentioned he saw the mitral valve leaking but the cardiologist said nothing about it.

I mentioned to my cardio that I did not think the echo was complete and he said the tech was a good one. Go figure.

Right now I am researching another cardio to see so I can make sure my valve disease has not involved other vavles and that might be what is causing my symptoms.

SO, keep in mind that you need to know you have a good medical group behind you for ANY test to make sense. On the other hand, none of my caths provided information on the extent of the problems the surgeons found when they actually were looking at the valve during surgery.

 

[McCln]

I am not sure which of the basic test are the best accurate picture of the condition of the heart. I always hope that the techs and the doctor is looking everything over in an accurare manner. It might depend on the doctor or tech how one reads the results. Good luck and always get a second opinion.

 

[Nancy]

Gina-

I don't think a doc will rat out any of the techs. So they'll "all" be good. When we complained about Joe's echo not showing any of the valves, and I mentioned that perhaps Joe got a poor tech, the answer was, "We have NO bad techs here."

Well, anyway, regardless of what he said, we fired that one and got the other who is very, very competent. At least if she missed something, it wasn't for lack of trying.

You had a real neophyte tech for your echo--Wow!

 

[tobagotwo]

I believe that both echoes and caths are accurate enough to show problems appropriately in the overwhelming majority of people, including when it's time for surgery. A gradient of 40 with no symptoms is not be a surgery point for many cardios, regardless of method. As there is no mention of a recheck by catheter angiogram, the second cardio may have been pointing out that the first cardio was jumping the gun, not that the echo was necessarily incorrect.

People who do caths always say caths are better. I disagree. People who do echoes often say they are incredibly accurate. I think that is open to conjecture, too. I do think there needs to be more than one way of measuring to be sure, as both have their drawbacks. Caths tend to be least accurate when there is rough calcificaton in the bloodpath, as far as I can tell. Standard echoes can have problems when the person is large, has thick bone structure, scar tissue, pericardial thickness or opacity, etc. A lot of things, but most people really don't have them.

Echoes done by poor techs are untrustworthy. I also don't like echoes done by techs who want to know the patient's current history and past echoes before sharing results, as it's a sign the tech is tailoring his results to what he thinks they should be.

Still, more often than not, the results verify each other, rather than prove each other wrong. Best to do as McCln points out and get verification, if there's doubt.

I have no idea what was happening in barbwil's case. It must be very frustrating.

Best wishes,

 

[Bunny_Rabbit]

I guess I'm lucky...

I guess I'm lucky...

I go to see an Internal medicine doctor yearly for my heart check-ups, and every time I've gone, my doctor comes in at the end of the echo and double checks everything. I guess she does this with everyone because the tech happened to say something like..."well I'm done, but I'm sure she'll be in here to put in her 2 cents". Apparently my doctor was watching the echo somehow in her office, and sure enough, she comes in, grabs the wand, and checks the measurements.

It's sorta nice to know that I'm always getting a second opinion.

 

[gageyk]

I, too, have lost faith. I had one bad echo a month ago, the third echo in the past 4 years and the only one that indicated a severe problem. It indicated that I needed AVR now. I'm asymptomatic but aware of my problem. I was having my pre surgery angiogram when the technician noticed my gradient was much lower than the echo indicated. So instead of being discharged today from the hospital I'm going bicycling.

The bad echo indicated my gradient went from 22 mmhg to 64 mmhg amd my valve went from 1.3 cm to 0.9 cm in 6 months. Angio indicated 34 mmhg and valve area of 1.25 cm. Cardio said his techs were better that the local hospital. His techs gave the out of synch numbers, go figure. I will second guess every echo from now on.

 

[tobagotwo]

That is one of the reasons for the routine cath before surgery. A double-check always makes sense if there are no corroborating symptoms.

It's a shame you had to go through the anguish of The Wait for no reason.

You never know when you might run up against an incompetent or sloppy tech (hmmm...same thing!) for any tests you might have done.

I had a similar issue with a chest x-ray, which showed that I had large growths in both lungs. It resulted in several nights of my wife and me determining what we were going to do with the time I had left. I was eventually scheduled for a cat scan, which showed nothing wrong. I feel so bad for the fellow who originally got my results by mistake. The techs and x-ray doctor never apologized to me for it, although they did apologize to my doctors.

Best wishes,

 

[Innercalm]

Lost faith in echos

Several times in the last couple of years my local cardiologist's reports on my echos came out 3+to 4 so he began talking to me about going to the Cleveland Clinic for evaluation. I finally said I would go there to see what they thought. When the echo was done there (#1 in the country, right?) it said it was only 1-2 and this had taken about 4 times as long as the local one. BUT the cardiologist at the clinic said that still left to be seen why I was so symptomatic with SOB and extreme fatigue.

The following day I had the heart cath. done and sure enough it showed definitely that the mitral regurgitation was indeed a 3+ to 4.

The cardiologist still wanted to have a TEE the next day to determine if there were any clots that had formed while my INR was 1.2. And the TEE said also that the regurgitation was only 1-2.

So the only thing that gave a true picture was the heart catheterization, neither the echo or TEE.

Talked it over with my PCP the other day and he told me how much of the results depended on the person in control of the test as well as other factors.

Thus "I have lost faith in echos!"

Barb

Barb: I have not agreed to any catheteriazations since I have been told by several that if they are done, it is on the day of surgery. I have been reluctant to agree to the cath because of the invasiveness. The surgeons I have consulted have all asked for echos. Help me. Susan

 

[barbwil]

not in my case

not in my case

Barb: I have not agreed to any catheteriazations since I have been told by several that if they are done, it is on the day of surgery. I have been reluctant to agree to the cath because of the invasiveness. The surgeons I have consulted have all asked for echos. Help me. Susan

Susan, I had three days of testing on July 13-15th, the cath. on the 14th. I told them I would not have surgery until after my son's wedding which was on the 23rd of July. My INR had been brought down to 1.0 so the cardiologist thought we should hold off until August for the surgery. I don't see why you should have the surgery the same day unless they found severe enough blockages of your coronary arteries. I was admitted on the 3rd for IV heparin and had the mitral repair and maze on Aug 5th, (home on the 10th).
It was only the catheterization that gave them a clear picture of my mitral valve, neither the echo or TEE showed anything but a slight regurgitation.

Who are the ones who have been telling you it had to be done the same day? I have an appt. with my local cardiologist tomorrow morning and I intend to talk over my very differing echo results with him. (The surgery was not done locally but in the Cleveland Clinic.)
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I'm sorry I can't be of more help to you, Susan, can just tell you of my experience.

I pray that you will find the correct answers to your problem. God bless, Barb

 

[barbwil]

not in my case

not in my case

Barb: I have not agreed to any catheteriazations since I have been told by several that if they are done, it is on the day of surgery. I have been reluctant to agree to the cath because of the invasiveness. The surgeons I have consulted have all asked for echos. Help me. Susan

Susan, I had three days of testing on July 13-15th, the cath. on the 14th. I told them I would not have surgery until after my son's wedding which was on the 23rd of July. My INR had been brought down to 1.0 so the cardiologist thought we should hold off until August for the surgery. I don't see why you should have the surgery the same day unless they found severe enough blockages of your coronary arteries. I was admitted on the 3rd for IV heparin and had the mitral repair and maze on Aug 5th, (home on the 10th).
It was only the catheterization that gave them a clear picture of my mitral valve, neither the echo or TEE showed anything but a slight regurgitation.

Who are the ones who have been telling you it had to be done the same day? I have an appt. with my local cardiologist tomorrow morning and I intend to talk over my very differing echo results with him. (The surgery was not done locally but in the Cleveland Clinic.)
%
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I'm sorry I can't be of more help to you, Susan, can just tell you of my experience.

I pray that you will find the correct answers to your problem. God bless, Barb

 

[tobagotwo]

Frequently, the cath is done the day before surgery. Occasionally, it is done the prior week. They will be looking to verify the echo findings as a part of what they do.

Their other main function is to perform the angiogram, illuminating the coronary arteries with dye from the catheter to determine if you need bypasses, "as long as they're there anyway."

Best wishes,

 

[Marty]

That is one of the reasons for the routine cath before surgery. A double-check always makes sense if there are no corroborating symptoms.

It's a shame you had to go through the anguish of The Wait for no reason.

You never know when you might run up against an incompetent or sloppy tech (hmmm...same thing!) for any tests you might have done.

I had a similar issue with a chest x-ray, which showed that I had large growths in both lungs. It resulted in several nights of my wife and me determining what we were going to do with the time I had left. I was eventually scheduled for a cat scan, which showed nothing wrong. I feel so bad for the fellow who originally got my results by mistake. The techs and x-ray doctor never apologized to me for it, although they did apologize to my doctors.

Best wishes,

Bob, As a radiologist still working half time I hate to hear a story like yours. Frankly I would confront the radiology group and ask for an explanation if not an apology. Also you can check out the films and have them reviewed by another group.If the the results of that inquiry show a radiologist who might be a danger to the community you can refer the matter to your local medical society. Unfortunately I've never heard of a radiologist sued for overdiagnosis.
Overdiagnosis is becoming much more common particularly in areas like chest and mammography because of the current litigious climate.A missed lung or breast cancer no matter how explainable is almost an automatic lawsuit these days. Marty

 

[tobagotwo]

Not overdiagnosis, Marty: sleight-of-hand. The radiologist mixed up my x-ray with that of another fellow who he was doing in an adjacent room.

That's why I felt so bad for that fellow. I thought I was done for, and was saved by circumstance. He thought he was saved.

Best wishes,

 

[Marty]

Not overdiagnosis, Marty: sleight-of-hand. The radiologist mixed up my x-ray with that of another fellow who he was doing in an adjacent room.

That's why I felt so bad for that fellow. I thought I was done for, and was saved by circumstance. He thought he was saved.

Best wishes,

Quite a story. Have heard of "mixed up" films occasionally. It can lead to real trouble but now with computers and all it is quite rare. Glad you are OK. Marty

 

[catwoman]

I go to see an Internal medicine doctor yearly for my heart check-ups, and every time I've gone, my doctor comes in at the end of the echo and double checks everything. I guess she does this with everyone because the tech happened to say something like..."well I'm done, but I'm sure she'll be in here to put in her 2 cents". Apparently my doctor was watching the echo somehow in her office, and sure enough, she comes in, grabs the wand, and checks the measurements.

It's sorta nice to know that I'm always getting a second opinion.

When I had my first echo, in early 1990, the vet asked, "Did they say you have mitral valve prolapse?" I knew then that my PCP's preliminary diagnosis was right.
The vet techs since then have been noncommittal.
I have the echo done, then go into a waiting room while another cardio reviews the tape & writes a report that's given to my cardio. Then I get to see my cardio.
Dunno if this is SOP in most cardiology practices.

Barbwil:
I dunno why there would have been a problem with an echo at Cleveland. Did you say anything to the Cleveland folks, other than your own PCP?
Could it be possibly an equipment error and that perhaps the same echo machine was used for both? Was it the same tech?
The cardiologist I saw in April '03 who reviewed an echo done 4/15/03 wanted me to have a TEE pronto, and he wanted a specific cardio to do it, not a tech.