Misdiagnosis

[chuck barton]

I wonder if anyone else has had a similar experience. Due to an extreme heart murmur, my PCP sent me for an echo and they calculated an 80mg gradient. So I was referred to a surgeon who wanted to replace the valve as soon as possible, as he said 40 was the point where an AVR would be indicated. So I went for the cath today, with the intention of going back to the surgeon to arrange the surgery. The cath measured 30, with only moderate stenosis, and the AVR would be contraindicated. I will return to the cardiologist and surgeon to discuss this but wondered if anyone had, or heard of something similar.
Prior to the diagnosis I was moderately active. I run an hour on a treadmill at 5mph, or lift weights or swim every day. BP was normal and lipids are very low. Still I have the strong murmur so I will have to be sure whether to go with surgery or not.

 

[Nancy]

I believe the cath trumps the echo. That is why they will usually ask for a cath when surgery is indicated. Echoes are just not that accurate. They are non-invasive which is why they are used more than caths. But with a serious situation, a cath is a must.

I wouldn't say it was a misdiagnosis, but rather the differences in testing results, the cath being the better and more precise test.

 

[chuck barton]

Nancy
Thanks I rely appreciate your answer. I agree that the cath should be right since it is a measured value whereas the echo calculates a value base probably on turbulent flow equations. But since the surgeon was ready to go as soon as the cath was done, I thought I rely need to look for some answers since I can't just conclude that nothing is wrong with such a strong murmur having developed recently. If there are any medical students around, whenever any doctor has heard it, he brings them in to listen since they have never heard one that loud. But I don't want to get an AVR if it is not really necessary and may not fix the problem.
The wonderful thing about this board is that the members seem to have taken their healthcare in control and try to understand what is being proposed by a physician

 

[Nancy]

You cannot forget the subjectiveness of an echo either. Different techs are better at echoes than others. When Joe was alive and getting regular echoes, we found a rather persnickety gal who did the best job, and the most accurate job. She took forever, but was not satisfied until she thought she had done everything she could do to get it right. If she wasn't available, we simply made another appt. for when she was available, it was that improtant for Joe.

I myself had a couple done. Not that I had a heart problem, but because my (not too good at the time) doctor mistook my gallbladder attacks for heart attack problems. But anyway, in the room was a fellow who was learning. So he was first doing the echo while his mentor watched him. He was very soft about doing the echo, he was afraid of hurting me. So he didn't get a very good set of readings. Then came Godzilla, the mentor to show him how it should be done. WOW, what a difference, and I told the newbie how the difference felt to me. Needless to say, the mentor got a much better set of readings, and the measurements were quite different.

Hence, my feelings about the importance of echoes. They are a great convenience and a whole lot less expensive than a cath. But the results---could be good, could be bad, you never know.

 

[Luana]

The cath trumps the echo is pretty much how my cardiologist explained it.

 

[Lily]

(I'm glad to read this thread because my last echo gradient measurements were pretty bad. But the tech did seem to have a light touch. I'm suddenly hoping the numbers were just off.)

Anyway, hope you will be fine for a long time Chuck.

 

[Johan]

I had a strong murmer all my life, was excempted from military conscription 40 years ago because of the murmer, but that was never an issue in the scheme of things, I led a very full and active life. It was only during the last 6 odd years that echo's starting showing a steeper gradient and reduced opening of the AV that surgery became a discussion point. But surgery was still postponed because caths (I had 5 in total, for various reasons such as stenting and angioplasty when the cadio took the opportunity of measuring the valve gradient and opening) showed that the situation was not so bad. Then I started developing symptoms, a-fib, shortness of breath etc and surgery was done.

Going with my own experience, I would not be overly concerned about the strong murmer (are you sure the murmer only developed recently?), provided the cath measurements indicate a moderate situation. Chuck, surgery in your case may be years away...cross fingers

 

[ALCapshaw2]

FYI, Echo 'measurements' are Highly Dependent on the skill and experience of the Echo Technician.

I see you are in Houston, Home of the Texas Heart Institute, one of the Top Rated Heart Hospitals in the country.

You would be wise to consult one of their Surgeons vs. 'smaller hospitals'.

'AL Capshaw'

 

[Nancy]

I agree with Johan on the murmur. Joe had a loud one too, all his life, well-- after he got rheumatic fever anyway. It also kept him out of the military, and he was also extremely active, playing all kinds of sports, semi-pro and local. But when his aortic valve "fish-mouthed" (when he was in his mid forties) as his cardiologist at the time told him, he had to have his first valve replacement.

 

[chuck barton]

Johan
I was told for as long as I can remember, that I had a slight murmur, or possible murmur. Then the last time I went to the doctor it reached celebrity status and if there was a medical student in the clinic they went to get them and listen to a really strong murmur. I will schedule an appointment with the surgeon 2 weeks after the cath, and discuss it with him. There were a few things that bothered me, like when I described my activity level the surgeon said I had been handling it very well. There are no coincidences so I will try to get a better explanation if the surgical route is taken.
I was also impressed by the group that did the cath, when they asked if I could walk around the block and I assured them I could run around it for at least an hour. They decided to do some additional tests on the valve which was not calcified. I am hoping to delay surgery for at least a long time, and try to learn more about valve disease and make use of the God given time to pursue those things which might otherwise not be available.

 

[sylviayasgur]

hi chuck,
i don't have much to add to what all the others have said; i agree with them. i assume that they will be watching you and monitoring your heart until the time comes when you DO need the surgery. doesn't sound like that time is here yet.
stay well,
sylvia