Meag anxious - help with interpretation of results

[Paleowoman]

Please can someone help with interpretation of my most recent echo results last Friday, 1st November, which I've just read on the referral letter from cardiologist to cardiac surgeon:

"Her most recent echocardiogram at St Anthony's hospital on the 1st November again shows maintained left ventricular function with a calculated ejection fraction of 79%. The aortic valve was bicuspid with a systolic gradient of 68mmHg and a calculated valve area of around 0.9 sq cm. There was trivial mitral regurgitation and trivial tricuspid regurgitation suggesting a right ventricular systolic pressure of around 35 mmHg."

My ejection fraction appears to be increasing as does the pressure gradient (60 mm/Hg a month ago). My heart is pounding all the time since yesterday, before I received this letter - is that anxiety or the high ejection fraction ? This is the first time I have been told the valve area size. I've never been told the right ventricular systolic pressure.

 

[ski girl]

Well Anne you see the part where it says 'holy bejeeesus this woman is a walking time bomb'? No, me either . . .

There will be people on here who know what the EF and pressures mean (I have long forgotten!) but your valve area is not critical and the word 'trivial' is repeated twice.

Deep breaths. Glass of wine. If you were in the poo, they would have called you in to the hospital already.

It may very well be time for you to have surgery, but you're not about to keel over so there is no need to be anxious; in fact, being anxious is totally counter-productive. More deep breaths!

 

[pellicle]

Hi Anne

My heart is pounding all the time since yesterday, before I received this letter - is that anxiety or the high ejection fraction ?

my first thought was that anxiety could be it ... my heart pounds when I get anxious. I never noticed it before my mech valve but I have become more aware of it since. [Actually this has been beneficial as I now have a biofeedback indicator of my stress levels]

This is the first time I have been told the valve area size. I've never been told the right ventricular systolic pressure.

well there is some rubbery-ness to the numbers, but it shows increase. My view is that (not being an expert) if the experts thought it was dangerous that they'd call you in faster.

When I got my aneurysm identified in the first echo they called me on my phone and asked me to come in for a CAT scan, told me the paperwork will come later. I thtought this was 'irregular' ... anyway after that they called me in for an Angiogram the next week (before I even got the results of the CAT scan).

So when they think its dangerous to your health they usually act quickly.

 

[Paleowoman]

Well Anne you see the part where it says 'holy bejeeesus this woman is a walking time bomb'? No, me either . . .

Except I am seeing that because I'm thinking - and I started to think this before I saw these results - that because my ejection fraction is so strong that bits of the calcification on the valve will break off which can cause problems of the time bomb sort

I'm trying not to think things like that....not very successfully. Will take some lorazepam to calm me down and see if that stops the heart pounding as I know that must be counterproductive.

 

[ski girl]

Have you googled ejection fraction? Cos I don't think it has anything to do with bits of calcification breaking off. As pellicle says, if you were in any danger you'd be in the hospital now. Whatever it takes to calm that anxiety, do it! Personally I'd recommend a glass of red wine, bonus antioxidants

 

[big_L]

First off, I'm no cardiologist, but here goes anyway.

Your ejection fraction is normal. Your heart is strong and still doing it's job, in spite of the valve. A low EF could indicate pending heart failure. My EF's over the past 5 years have ranged from 60-80.

These tests are not perfect, there's variability from test to test, tech to tech etc.

A valve area below 1 means you are now 'critical'. RELAX, It's just a word. If the echo was redone and they measured 1.0, then you'd be 'moderate'. My areas varied from 1.2 to 0.7 the past few years.

The gradient number greater than 50 also means you may be 'critical', BUT you really need to know if this is the instant or the mean (average) gradient.

I'm not as familiar with the right ventricle measurements.

As long as you don't have the three classic symptoms - fainting, shortness of breath, or angina - you have time. Try to relax a bit about it. Yes, you will need surgery but you have time to start preparing. Talk to your doctors.

I'd guess the pounding is the anxiety.

 

[Paleowoman]

Hi everyone,

I've googled Ejection Fraction and it seems to mean the percentage of the amount of blood ejected into the left ventricle, so yes 79% would seem to be normal and good..... About the valve area size, I would think my heart actually might be of a small size since my 'trunk' is smaller than 'normal' - I have a depressed sternum and my pelvis was too small to be able to give birth normally so that might indicate that I might be smaller than normal overall - though my arms, hands, legs and feet are big the rest of me is petite. So a valve area size of 0.9 in a smaller person might not be as bad as 0.9 in a larger person, say a big man ? I might be wrong there.

I will have the wine, but it's still morning here so a bit early

 

[big_L]

This is a good document. Figure three shows the classic nomograph for the surgical decision.

http://familymed.uthscsa.edu/geriatrics/reading%20resources/Aortic%20Stenosis.pdf

 

[Midpack]

Just to add something to the already excellent answers you received:
Trivial regurgitation (on any of the four heart valves) is an usual echo finding that has no importance at all. Modern technology allows to detect minimal backward blood flow (regurgitation) that were not detected 10 or 20 years ago. But they have no significance. And if you perform an echo on normal population, you will find that MANY will have trivial/trace regurgitation on some of his valves.

Regurgitation poses a problem when it reaches the moderate level, because at this point it is likely to evolve over time (to the severe stage). But trivial regurgitation will most probably remain trivial your whole life.

I agree that your palpitations are most probably the result of your anxiety after reading the letter...

Take care.

 

[epstns]

Big_L and Anne - one correction. . . with a valve area of 1.0 cm2, Anne is in the "severe" category. Most surgeons define "critical" as an area of less than 0.8 cm2. This is just semantics, and just defines a point along a progression that will end with valve replacement.

My point, Anne, is that from what I know of your case (and I am not a doctor), you are still in the "Watchful Waiting" group on the treatment chart. You have time to make your plans, decisions and get ready for the Big Event. Try to plan and stay calm, the rest will follow smoothly.

 

[Paleowoman]

My point, Anne, is that from what I know of your case (and I am not a doctor), you are still in the "Watchful Waiting" group on the treatment chart. You have time to make your plans, decisions and get ready for the Big Event. Try to plan and stay calm, the rest will follow smoothly.

I hope you're right...and I take hope from you pros here. I'm waiting to hear from the cardiac surgeon's secretary, I spoke to her earlier and she will be showing the surgeon the referral letter today and then arrange an appoinment for the initial consultation for me.