Questions for my cardiologist

[SusanH]

I am a 45YO female with a recent abnormal echo.

The reason for the echo is a visit to my doc for dizziness and some shortness of breath. At the visit I mentioned that was anxious about an upcoming mammorgram and some intermittent breast/chest wall pain (I have some history), so I attributed the dizziness and SOB to anxiety, but my doc ordered the echo to be thorough. I also had a complete blood and urine work-up with no abnormal findings.

(BTW - my mammogram was normal and thereafter my shortness of breath has disappeared and the dizziness is significantly diminished...makes me now wonder if the symptoms are indeed anxiety related or have to do with my heart.)

Results of my echo are:

LVIDd : 4.1 cm AV: 1.6 cm
LVIDs: 3.0 cm AO: 2.3 cm
RVIDd: 1.4 cm LA: 2.4 cm
LA/AO: 1.1

IVSd: 1.0 cm
IVSs: 1.1 cm
LVPWd: 1.0 cm
LVPWs: 1.2 cm

2-D EF: 55%
M-M EF: 62%

Interpretation:
1. The left ventricle is normal size without dilation or hypertrophy. Ejection fraction is 55-60%. No segmental wall motion abnormality is identified.
2. Normal excursion of the aortic valve without insufficency identified.
3. 1+ mitral valve regurgitation without stenosis.
4. 2+ tricuspid valve regurgitation with ESVP of 43 MMGH with mild to moderate pulmonary artery hypertension present.
5. Unremarkable appearance of the pulmonic valve.
6. No pericardial effusion, mass, or thrombus is present.

Because of the 2+ finding, PAH, and 43MMGH, my doc has referred me to a cardiologist who I see in a couple of days, but I'd like to be somewhat knowledgeable prior to the visit so that I can come up with some intelligent questions! I have searched this site and found an enormous wealth of information, but I cannot find a chart of normal readings. I did click on a few links provided, but most of the initials on those sites do not correspond with my report. I feel like such a dunce!

Sooo...what exactly is LVIDd, AV, etc.? I know...I'm such a newbie.

I'd also like to know if anyone has had valve surgery after similar findings? I see where most people wish they had not waited so late for surgery so just curious if I am catching this early or mid-stage. After reading up, I don't appear to be in an advanced state.

Finally, should the cardiologist request a 2nd echo? What if he recommends a cath...should I ask for a 2nd echo first? Any suggestions for intelligent questions I should ask the cardiologist?

Thanks!

 

[RandyL]

What does SOB mean?
Sorry I am new to this
Thanks

 

[Curtsmum]

What does SOB mean?
Sorry I am new to this
Thanks

SHORTNESS OF BREATH

 

[PJmomrunner]

I know next to nothing about Pulmonary Hypertension, but I thought I'd post to keep your thread fresh. I like your "go armed with info" approach. Soon Nancy will come along and tell you everything you want to know! Also, this looks like a really good overview to me: http://www.mayoclinic.com/invoke.cfm?id=DS00430

 

[SusanH]

Thanks, PJ!

I know next to nothing about Pulmonary Hypertension, but I thought I'd post to keep your thread fresh. I like your "go armed with info" approach. Soon Nancy will come along and tell you everything you want to know! Also, this looks like a really good overview to me: http://www.mayoclinic.com/invoke.cfm?id=DS00430

 

[PJmomrunner]

You might want to try re-posting under a new thread called "Questions about Pulmonary Hypertension" or something like that....

 

[ALCapshaw2]

Welcome Susan,

You may want to look through the "Must Have Reference Links" in the Reference Section, particularly the ACC/AHA Guidelines for Valvular Disease and the following link:
Atlas of Echocardiography
http://info.med.yale.edu/intmed/car...ents/index.html

LV = Left Ventricle
RV = Right Ventricle
ID (not sure, but suspect internal dimension)
d = diastolic
s = systolic

From my limited knowledge, it appears that your Right Heart function is OK (Aortic and Mitral Valves and EF)

The pressure gradient across your tricuspid valve seems high (43 mmhg = 43 millimeters of Mercury) so you will want to ask about the significance of that. The Left side of your heart pumps blood to your lungs and affects your pulmonary function.

Nancy is our resident Pulmonary Hypertension expert so hopefully she will check in. I agree, you would get better exposure to your question by reposting your question to include Pulmonary Hypertension or Pulmonary Function in the title. In the mean time, you may want to do a SEARCH for "PH" or "pulmonary hypertension".

'AL Capshaw'

 

[Karen]

Ph

Ph

Susan, I was first told that I had mild pulmonary hypertension in April after my annual echocardiogram. A couple of months later I did some pretty serious research into the matter and even met with my cardiologist. You might have read the thread that we had going at that time. (2 threads -- I don't know how to direct you to the thread #, but the threads started on July 19th - "Stenosis Pathology without Valve Damage" by Bob and my thread on July 20th on "Pulmonary Hypertenion.")

Last month I had another echo. My numbers, with regard to PH, were nearly identical to yours. My cardio ordered a left and right heart cath. That was done just 2 weeks ago, and although the numbers are at the high end limits of "normal" --and some one or two points higher, he said that there was NO pulmonary hypertension. If you read much about PH, you can get very worked up. I talked to the tech about PH when he did my last echo. He said it is not uncommon for there to be elevated pulmonary artery pressure with valve disorders. It's called secondary pulmonary hypertension and really is more common than I think some of us thought.

Should you have a 2nd echo before the cath? First of all, see what your cardiologist suggests. Symptoms are a big factor in that decision. A 2nd echo might give different results. On the other hand, which echo then would you assume to be more correct? My cardio felt there were sufficient factors present to warrant the double-sided cath for me. Frankly, I don't know if I would have been able to put to rest the concerns I had without it, especially with the apparent worsening of the PH numbers from April to September. But it was also more a matter of sorting out symptoms in my case.

The numbers regarding PH seem to be the only ones that your cardio is concerned about. I say, follow through with whatever recommendations the 2nd cardio gives you. Peace of mind is a worth a lot. (However, the cath does come at a hefty price tag...)

Good luck to you as you sort it all out!

Karen

 

[Karen]

"normal" values

"normal" values

Susan, one of the more helpful charts that I found for giving the normal values of tests was found on
http://chfpatients.com/ph.htm
However most of the numbers given are readings that you would get during a pulmonary cath. Be careful that you are comparing the right numbers. An echo only gives a peak pulmonary artery pressure, while a cath gives the mean pulmonary artery pressure. But some of the other values are going to be very close to what the echo report indicates.

Karen

 

[SusanH]

Thank you all!