Seeking feedback-recently diagnosed w BAV and 51mm AoRoot

[Cliffk17]

Hi! This is my first post. I have found this forum to be such a great resource for information and support that I would like to share my current situation with you and am seeking feedback.

I am a fit and active 44yr old male who completed Ironman Canada in August 2012. I have competing in triathlons for the better part of 10 years at shorter distances (Ironman distance only once). In the months following Ironman I become ill with chronic fatigue, dizziness, muscle weakness and shortness of breath on minimal exertion of any kind i.e. bending down position to standing, raking leaves etc. My GP ran various blood tests and my white cell count was consistently low but nothing was making any sense to him so he referred me to Internal Medecine at a local hospital. I was put through more tests but again no answers. All my symptoms continued, Internal Medecine could only say they thought I may have some sort of virus that would eventually run its course and clear my system. During follow ups with my GP he stated perhaps "chronic fatigue syndrome" which he said was basically a term used when they can't explain something. GP decided at this point to start looking into my heart only to rule it out. This didn't take place until about 5-6 months after I first went to him with my symptoms.

April 2013 - Holter monitor result showed an odd rhythm that my GP wanted to look further into.
June 2013 - Stress Test – normal
Aug 2013 – Echo – identified BAV, aortic root dilation range 45-49mm, LVEF 55 and mild regurgitation of 1+
Sep 2013 – CT angio – Ao Root 51mm, no coronary lesions. No Stenosis but GP mentioned something about aortic sclerosis??

Cardiologist put me on Verapamil to lower BP. BP was 150/95 range at that time. Drug brought it down to 108/70 range. Side effects of dizziness were worsened. GP removed me from the drug to conduct baseline test to see if dizziness would improve and whether I could keep BP low on my own without the drug. Dizziness improved but back to initial levels from earlier in the year. Have been able to keep BP in the 120/70 range on my own through diet, exercise. GP has kept me off the drug.
Cardiologist stated annual follow up testing, I could do aerobic exercise as intensely as I want and placed a 100lb weight lifting restriction. I am back running, swimming and using our step machine here at home. I have been doing some weight training within the restriction. My aerobic endurance is nowhere where it used to be. There is no, or little, improvement on endurance even with frequent activity which has never been the case with me. I have ALWAYS improved. I get dizzy and short of breath during runs and it happens at low HR rates, sometimes in the 120’s and other times in the 130’s. If I reach the 140’s I feel like I am sprinting and become winded and have to stop and walk. Mentioned to my GP recently about this as well as having felt some tightness in my chest during one of my runs and he basically pointed in the direction of it being psychosomatic. This got me riled up! I know my body very well and I know when something’s not right and it’s been very wrong for over a year now. I think to some degree my GP has become complacent with me. I asked him if we could look into moving up my testing with the Cardio and he hesitated and asked that I first track my HR rates during my aerobic activity and bring the data to him, then based on that he would determine whether he’d refer me back.

I am still feeling bouts of fatigue, shortness of breath at times just from bending down and tying my shoes? This is all so odd to me! I’m not sure if these are symptoms of my condition, or is something else at work here? I was shocked to receive the news last fall of the BAV and 51mm dilation and of course Cardio telling me the magic number is 55mm for replacement of aorta! At the same time what a blessing that I know this and can manage it given the alternative is not good as you all know. This forum has given me great hope and has been incredibly informative.

I am at a loss as to whether my ongoing symptoms are related? I’m not sure if an annual follow up is quick enough given we have only just established a baseline for size of dilation yet these symptoms are happening? From everything I have read, given the size of my dilation I’m not sure my professionals they are moving quickly enough? Considering a second opinion, is this a good idea?

Apologies for the very long post!

Cheers
Cliff (Canada)

 

[workmonkey]

Hi Cliff - Welcome and thanks for sharing your story. That's how most of us started here: we get the surprising news that we have BAV, an aortic aneurysm, a leaky valve (or all three), then come here to read-up and compare notes. Many of us were as surprised as you at the diagnosis, as we were equally active and fit.

Let's see what the wisdom of the crowds here get to, but I'll open the bidding by saying you 100% need to get a 2nd opinion. Your GP seems to be all over the map with his diagnosis and the speed with which he is addressing your symptoms. The fact that it took 5-6 months alone to get the necessary tests, with your symptoms, is a warning sign. Yet another warning sign is a diagnosis of a 5.1 cm aneurysm without aggressive follow-up. Most of us here (myself included) have had surgery triggered by an aneurysm over 5.0 cm. With BAV, 5.0 cm is the near-universal trigger for surgery, as it indicates higher risk for dissection. Likewise, most of us with an aneurysm were told to reduce physical activity, especially weightlifting. Are you aware of your ascending aorta measurement, or just your root? And if so, why not?

I've never heard of his description of aortic sclerosis (not sure I've heard of it on this forum - near everyone has stenosis or regurgitation ... it seems sclerosis is a thickening of the valve?). Regardless, this requires additional follow-up.

Simply put, you are not feeling well and your doctors are not doing much to address it. This should be unacceptable. Your symptoms very well could be related to the condition of your valve, yet nothing is being done to answer that. Not sure how it works for you in Victoria, but I'd demand a 2nd and/or 3rd opinion sooner than later.

Good luck and keep us updated.

 

[Cliffk17]

workmonkey thank you so much for your reply to my post.

the troubling thing is I trained for an entire year for the Ironman race I did in august 2012 and did not have any symptoms. I ran into heavy bouts of fatigue on 2 or 3 occasions throughout that year that required 2-3 days of inactivity to recover but of course simply chalked it up to the volume of training I was doing.

I am not aware of my ascending aorta measurements but I do have an email out to my cardiologist and hopefully will get a reply early this week. I'm assuming the reason I don't have those measurements, were not given them, is because they are likely of no concern. Nonetheless, I should have them as a benchmark.

 

[MrsBray]

Get a new primary care physician is my advice! Ask around, chances are good that someone you know well has someone in their family who has had a similar problem and they can point you in the right direction for a new doctor. It's your body, and you know it best!

 

[AZ Don]

I know how difficult it can be to hear a life changing diagnosis like this. But your problems can be fixed. I'll second both suggestions, consider a new primary care Dr. and definitely get a second opinion from a good cardiologist right away. I will also suggest that you take a more active role in understanding your condition. If you don't have your echo results, get them. Things to look at are aortic valve area, mean gradient, aortic jet velocity and ejection fraction. Figure 3 in the following link has an overview of how to use these values in the management of Aortic Stenosis: http://familymed.uthscsa.edu/geriatrics/reading resources/Aortic Stenosis.pdf. 3 Dr's missed my diagnosis of a dilated aorta on an unrelated test. If I had not asked for a copy of my test results, actually read it, and then followed up, I would never have known I have a BAV or that I had an aortic aneurysm.

I had to look up Aortic Sclerosis and I see that it typically does not cause symptoms, but it can lead to Aortic Stenosis. Aortic stenosis can cause symptoms such as you describe but if it reaches that point it is generally time for surgery. You are already past the general criteria for surgery for an aneurysm which is 5.0 for those with a BAV. 5.5 is the general criteria for those with a normal valve. I was identified last April with a BAV and aortic aneurysms of 5.0 and 5.1 - I had surgery in May to fix the aneurysms. As far as exercise, you should know that a follow-up study on those who suffered an aortic dissection found that over 25% of the cases were coincident with physical exertion. Intense exercise can trigger an aortic dissection which can be lethal. Although weight lifting is generally considered the more dangerous exercise for those with an aneurysm, intense cardio can trigger dissection as well. See a discussion and references here: http://www.valvereplacement.org/for...se-and-stress-with-Aortic-Aneurysm&highlight=

 

[AZ Don]

I stand corrected. I have been reviewing the new 2014 Guidelines for Valvular Heart Disease: http://content.onlinejacc.org/article.aspx?articleid=1838843. It seems that they have changed the surgical intervention criteria for aortic aneurysm from 5.0 to 5.5. I doubt that all Dr's agree with this but I think this document is now the new standard.

Operative intervention to repair the aortic sinuses or replace the ascending aorta is indicated in
patients with a bicuspid aortic valve if the diameter of the aortic sinuses or ascending aorta is
greater than 5.5 cm (113, 268, 269). (Level of Evidence: B)

Previous ACC/AHA guidelines have recommended surgery when the degree of aortic dilation is >5.0 cm at any level,
including sinuses of Valsalva, sinotubular junction, or ascending aorta. The current writing committee considers
the evidence supporting these previous recommendations very limited and anecdotal and endorses a more
individualized approach. Surgery is recommended with aortic dilation of 5.1 cm to 5.5 cm only if there is a
family history of aortic dissection or rapid progression of dilation. In all other patients, operation is indicated if
there is more severe dilation (5.5 cm). The writing committee also does not recommend the application of
formulas to adjust the aortic diameter for body size.

 

[tjay]

thanks for posting that link AZ Don. I will review that shortly.

Another related question I always wonder about is how much it matters where the aneurysm is. There seems to be a consensus in the medical community to consider it to be the same no matter where the location. But is the size of a "healthy" aorta (e.g. in normal people) same at all places (e.g. sinuses of valsalva/root, ascending aorta, arch, descending)? IFF aortic root is generally bigger than, say, ascending aorta even in a healthy state, why can't we tolerate more dilation there in a diseased state? For example, is aneurysm of 5.1 aortic-root/4.5 ascending aorta the same as the aneurysm of 5.1 ascending aorta/4.5 aortic-root? Also, does aortic root have more structural support and less balloning effect in comparison to ascending aorta?

Furthermore, why this lax in the surgical criteria as recently as 2014 (your link)? They really went agressive about 10 years back e.g. ~2002 (with 5cm criteria), associating everything in BAV to be the same as that in Marfan. Was 5.0mm based on Marfan, and BAV tagged along to it? Probably also coincidental to the fact that the aortic surgery was becoming so safe, so why not do it at 5cm. A decade later, why do they scale it back, to 5.5cm?? Do they understand BAV more now? Have they detached BAV from Marfan??? Have they finally spent more time researching BAV and aneurysm lately?? Interestingly, I recently came across another paper in which they published (based on a real population study) that aneurysms were very very common for BAV patients, but not dissections so much (relatively speaking). Let me try to find that paper, and post on forums.

Questions remain for us of course, as these researchers evolve various guidelines.

 

[ottagal]

First of all, Cliff, want to welcome you to the forum and know that you have found a great place for support. I don't have much to add to the previous posts, but want to wish you all the best.

tjay, I too have the same questions as you. We may need an expert opinion on this one.

 

[tjay]

hi Cliff,
There are 2 things you are dealing with: Aortic root of 51mm and your symptoms. The most recent reply from AZ Don (i.e. link to the new 2014 guidelines for surgical intervention of aorta) would probably give you some peace of mind on the former, while you also simultaneously focus on the latter i.e. your symptoms. As AZ Don also mentioned, your symptoms are probably related to your valve itself (not the size of the aortic-root, per se). You sent very little information about the valve. BAV diagnisos generally has 2 issues: regurgitation and/or stenosis. What's your diagnosis? You mentioned mild regurgitation so that's good. But you also mentioned stenosis here and there, so what's the status on that? AZ Don already sent you a list of things to look for (regarding stenosis) in your echo report, so the answers to your symptoms may lie in that itself.

And as you sort out the symptoms, perhaps take a BP medication (preferably ARB like Losartan), so it provides additional insurance against root dilation, even if your BP is otherwise normal (some recent studies indicate the same; can send links if needed). The medication your were previously taking (as prescribed by your cardiologist) was probably beta-blocker, which is also known as an excellent protection for dialated aortas but can make the symptoms (e.g. dizziness) you were already having even worse (and so you indicated to be the case). But take your BP/aorta medication seriously as 51mm root is nothing to brag about. And please follow the recommendation from a couple of cardiologists on aorta as well, so that you know for sure it's something you could monitor for some time.

I would've wanted you to see your cardiologist more frequently (not just GP), e.g. 6 months or even 3 months, until you have been assured that the root is stable (since this is your 1st baseline). Also please refrain from ANY exercise (in my opinion) until the dust settles.

All the best. Please keep us posted.

 

[workmonkey]

thanks for posting that link AZ Don. I will review that shortly.

Another related question I always wonder about is how much it matters where the aneurysm is. There seems to be a consensus in the medical community to consider it to be the same no matter where the location. But is the size of a "healthy" aorta (e.g. in normal people) same at all places (e.g. sinuses of valsalva/root, ascending aorta, arch, descending)? IFF aortic root is generally bigger than, say, ascending aorta even in a healthy state, why can't we tolerate more dilation there in a diseased state? For example, is aneurysm of 5.1 aortic-root/4.5 ascending aorta the same as the aneurysm of 5.1 ascending aorta/4.5 aortic-root? Also, does aortic root have more structural support and less balloning effect in comparison to ascending aorta?

Furthermore, why this lax in the surgical criteria as recently as 2014 (your link)? They really went agressive about 10 years back e.g. ~2002 (with 5cm criteria), associating everything in BAV to be the same as that in Marfan. Was 5.0mm based on Marfan, and BAV tagged along to it? Probably also coincidental to the fact that the aortic surgery was becoming so safe, so why not do it at 5cm. A decade later, why do they scale it back, to 5.5cm?? Do they understand BAV more now? Have they detached BAV from Marfan??? Have they finally spent more time researching BAV and aneurysm lately?? Interestingly, I recently came across another paper in which they published (based on a real population study) that aneurysms were very very common for BAV patients, but not dissections so much (relatively speaking). Let me try to find that paper, and post on forums.

Questions remain for us of course, as these researchers evolve various guidelines.

This report seems to be a game-changer, from what I can tell. It has moved the guidelines up to 5.5 cm, which affects more than its fair share of people on this forum. It also seems to directly attack Lars Svensson's body mass/aortic dilation formula. Moreover, it mentions exactly what you did, Tjay, regarding consideration of the location of the aneurysm (i.e. the root may naturally be 5 mm larger than other locations). In any event, as this report was just released, I wonder how it will be accepted among a medical community that has used 5.0 as the stopgap of BAV patients for over 10 years. I also wonder how long it will take to filter through.

Interestingly, being less than two weeks removed from aortic aneurysm surgery myself (5.1 cm ascending, valve-sparing), I can't say this would have affected that much. I may not have scheduled the surgery as soon as I did, but knowing the aneurysm inevitably grows, I would have always known it was in my future. I guess the one thing I may have gained by waiting is that my BAV may have been in worse shape by then (as of surgery date, it was asymptomatic with little regurgitation or calcification). So maybe that would have accelerated replacement instead of sparing. But regardless, whereas I once had an aortic aneurysm, I no longer do. The peace of mind is immeasurable.

I recently saw a speech from a member of the writing committee of this paper (Thoralf Sundt), and he seemed to be heading in this direction. Specifically, he seemed passionate about the idea that there is little to no connection in pathology between BAV patients and Marfans, although they are often grouped together. He also reiterated what this paper does, which is that the incidence of dissection among BAV really isn't much higher than the general population. I believe the paper stated 5 dissections among 642 patients in one study, and 2 dissections out of 416 patients in another.

How would that knowledge have affected your decision? Interesting question.

 

[tjay]

hi Mark,
I think this new guidance also affects you favorably. You addressed your ascending and have all the peace of mind you need. You still have your native valve with trace regurgitation/calcification. The journey from trace to severe can take decades. You aren't on coumadin and probably have no restriction. You still have your native root (4.4mm?) which gives you more than a mile on the runway there. As I earlier predicted, you are good to go for 30yr+ .
Enjoy your new and confident status. The other side of that mountain must feel awesome.

Pretty much same applies to EZ Don. Enjoy your carefree status guys. Do keep writing to guide the rest of us through.
TJ

 

[Bobbyk99]

BAV/aortic dilation and exercise

BAV/aortic dilation and exercise

Cliff,
My first post.
I encourage you to get a second opinion. Like you, I am also an athlete: crossfitter, hiit, Olympic lifter until my diagnosis 2 years ago. BAV, and dilated aorta at 48mm diameter. My cardiologist at Toronto Western said no heavy weights, 50lb limit because lifting increases blood pressure and the risk of dissection. Also told me to moderate the intensity of my workouts by 30%. I don't do hiit anymore. I monitor my exertion level carefully for cardio and limit it to 40 minutes. Also told me: No contact sports like hockey. No roller coasters; be careful not to fall downhill skiing. Sudden impacts, deceleration can have an adverse affect. Also, control of blood pressure is a critical part of managing the condition.
My cardiologist told me that for people with BAV, surgery is recommended at 50mm as most people with a bicuspid valve have a dilated aorta so there is increased risk. I get an echo every 6 months now (it was every 3 months right after my diagnosis to determine the rate of change). My aorta is steady at 48mm and perhaps it will remain so for years.
Any GP who says your shortness of breath is psychosomatic is clearly inept. A GP is not a cardiologist. Get a second opinion from another cardiologist. Your symptoms are definitely related. Ask around for a word of mouth endorsement for a local cardiologist or perhaps you can find one at a private health care clinic in Vancouver. Very best wishes.

Hi! This is my first post. I have found this forum to be such a great resource for information and support that I would like to share my current situation with you and am seeking feedback.

I am a fit and active 44yr old male who completed Ironman Canada in August 2012. I have competing in triathlons for the better part of 10 years at shorter distances (Ironman distance only once). In the months following Ironman I become ill with chronic fatigue, dizziness, muscle weakness and shortness of breath on minimal exertion of any kind i.e. bending down position to standing, raking leaves etc. My GP ran various blood tests and my white cell count was consistently low but nothing was making any sense to him so he referred me to Internal Medecine at a local hospital. I was put through more tests but again no answers. All my symptoms continued, Internal Medecine could only say they thought I may have some sort of virus that would eventually run its course and clear my system. During follow ups with my GP he stated perhaps "chronic fatigue syndrome" which he said was basically a term used when they can't explain something. GP decided at this point to start looking into my heart only to rule it out. This didn't take place until about 5-6 months after I first went to him with my symptoms.

April 2013 - Holter monitor result showed an odd rhythm that my GP wanted to look further into.
June 2013 - Stress Test – normal
Aug 2013 – Echo – identified BAV, aortic root dilation range 45-49mm, LVEF 55 and mild regurgitation of 1+
Sep 2013 – CT angio – Ao Root 51mm, no coronary lesions. No Stenosis but GP mentioned something about aortic sclerosis??

Cardiologist put me on Verapamil to lower BP. BP was 150/95 range at that time. Drug brought it down to 108/70 range. Side effects of dizziness were worsened. GP removed me from the drug to conduct baseline test to see if dizziness would improve and whether I could keep BP low on my own without the drug. Dizziness improved but back to initial levels from earlier in the year. Have been able to keep BP in the 120/70 range on my own through diet, exercise. GP has kept me off the drug.
Cardiologist stated annual follow up testing, I could do aerobic exercise as intensely as I want and placed a 100lb weight lifting restriction. I am back running, swimming and using our step machine here at home. I have been doing some weight training within the restriction. My aerobic endurance is nowhere where it used to be. There is no, or little, improvement on endurance even with frequent activity which has never been the case with me. I have ALWAYS improved. I get dizzy and short of breath during runs and it happens at low HR rates, sometimes in the 120’s and other times in the 130’s. If I reach the 140’s I feel like I am sprinting and become winded and have to stop and walk. Mentioned to my GP recently about this as well as having felt some tightness in my chest during one of my runs and he basically pointed in the direction of it being psychosomatic. This got me riled up! I know my body very well and I know when something’s not right and it’s been very wrong for over a year now. I think to some degree my GP has become complacent with me. I asked him if we could look into moving up my testing with the Cardio and he hesitated and asked that I first track my HR rates during my aerobic activity and bring the data to him, then based on that he would determine whether he’d refer me back.

I am still feeling bouts of fatigue, shortness of breath at times just from bending down and tying my shoes? This is all so odd to me! I’m not sure if these are symptoms of my condition, or is something else at work here? I was shocked to receive the news last fall of the BAV and 51mm dilation and of course Cardio telling me the magic number is 55mm for replacement of aorta! At the same time what a blessing that I know this and can manage it given the alternative is not good as you all know. This forum has given me great hope and has been incredibly informative.

I am at a loss as to whether my ongoing symptoms are related? I’m not sure if an annual follow up is quick enough given we have only just established a baseline for size of dilation yet these symptoms are happening? From everything I have read, given the size of my dilation I’m not sure my professionals they are moving quickly enough? Considering a second opinion, is this a good idea?

Apologies for the very long post!

Cheers
Cliff (Canada)

 

[Duffey]

Hi Cliff, and welcome.
I realize that living in Canada you may find it harder to find another cardiologist, but I would question the wisdom of waiting a year between exams. Regarding your GP, I think he's a silly man to suggest your symptoms are psychosomatic.
The diagnosis of aortic sclerosis is what I received when my murmur was first heard. It's the first level, so to speak, in the ascending order of aortic stenosis. It took about four years for me to move from aortic schlerosis to severe aortic stenosis and replacement.
My cardiologist told me that when we bend over it causes increased pressure on the heart which might explain your shortness of breath when you tie your shoes.
Best wishes going forward.:smile2:

 

[Tdot]

Hi cliff I'm from Toronto, not sure where in Canada you are from but if you are in the Toronto area I recommend a referal to Dr. Verma at st.mikes, he's a surgeon and scientist. He specializes in BAV and dilated aortas. A second opinion is certainly appropriate.

 

[Cliffk17]

Tdot, I am in Victoria, BC. I am currently looking at options for a second opinion. Traveling is not out of the question, I would consider it given the right circumstances. Also am awaiting on a response from my Cardiologist, I requested follow up testing and scans be done now rather than waiting for the full year.

 

[Owen]

Hi Cliff..

I, too, am new here, this is my first post.

My case is very similar to yours, actually. I am your age and was previously physically fit and active.
Began having same symptoms as you in summer/fall 2012.
Diagnosed with BAV in Jan 2013, with aneuryism from aortic root to arch of 5.2 cm.
Apparently, from reading above posts, I got lucky regarding the guidelines for surgical intervention - they pretty much rushed me into surgery. Surgery date was March 21st, 2013. Would have been about a month sooner but I had to somewhow schedule in oral surgery first due to a couple abscesses.

I would also concur that the doctor telling you it's psychosomatic is just plain ridiculous. Although I hope you don't have to travel too far for a second opinion- my surgery was at the Royal Jubilee in Victoria, and I was extremely well cared for there. Wonderful hospital. Also had a fabulous surgeon.

As soon as they found the aneuryism (on a chest x-ray), the radiololgist called me at work at absolutely insisted I get in immediately for a CT. And once they discovered the size, they pretty much went into orbit about it. I was immediately referred to the cardiac surgeon, they were very concerned about dissection at that point. I'm puzzled as to why the standards would have changed in that direction. It also concerns me that, according to your first post (and correct me if I'm just reading this wrong), yours grew from 45-49mm to 51mm in the course of a month??

Glad you came here, there's obviously some members here who are very well educated in this field. I'm hoping to find some answers myself....

It's been a year, and I'm puzzled (so is my cardiologist, at the moment..). Last summer I was back at work full-time, feeling almost normal. Very little symptoms, just a little shortness of breath and tightness in the chest upon moderate exertion. But late last fall I started getting progressively worse, and now a 10-minute brisk walk leaves me panting for breath, sweating profusely, weak and a little dizzy. Mild exertion (say,lifting 40 lbs about 4 times) brings on the same symptoms but worse than the walking.
Having all the testing re-done, we'll see what comes of it. I'm hoping someone else here may have gone through something similar and may be able to shed some light.

 

[Owen]

Just realized I didn't include this - my surgery not only corrected the aneuryism, but replaced the aortic valve, I now have a mechanical.

 

[MtBiker]

Cliff,

My case was very similar to yours except that I wasn't experiencing quite as clear symptoms. What I was experiencing was my times on bike races going steadily up over about 5 years. My aneurysm when they last measured it was around 5 cm and my left ventricle had started to decompensate. My EF was down to 55%. I would certainly get a second opinion.

 

[Cliffk17]

Hi Owen, thanks for posting. so nice to know that this condition can be addressed locally where I live rather than travel.
Just to be clear, the difference in numbers is because one is from the Echo results and the other from the CT scan. It is my understanding that the CT is more accurate when it comes to measuring so the 51 is what we've been going with.
Now granted I am no expert and anything is possible as far as growth, I suppose, but I don't believe it to be that in my case. Only additional testing can confirm or deny which I hope is coming sooner than later.

I'm puzzled as to why the standards would have changed in that direction. It also concerns me that, according to your first post (and correct me if I'm just reading this wrong), yours grew from 45-49mm to 51mm in the course of a month??

 

[Cliffk17]

UPDATE:
First off thank you to all who have taken the time to chime in! Your feedback and knowledge have been both overwhelming and thought provoking (all in a positive way!).
I definitely have heard the resounding message of searching for a new GP which is in the works currently which will lead to obtaining a second opinion of another cardiologist hopefully soon.
As my fellow Canadians will attest to, here in Canada, you must be referred to a specialist (i.e. cardiologist) by a GP and cannot go directly to the specialist. I am not sure of the process in the U.S.? I have been with my GP for 10 yrs now and it is disappointing that it has come to this but my short and long term well-being trumps over this!

I have realized that I have not been aggressive enough in understanding my current condition and the feedback received has been loud and clear. I finally obtained all reports from my Cardiologist and am posting the results here. If anyone spots anything of concern please share. I think most has been consistent with what I already posted however there are some values that I am now aware of which I clearly was not previously. Also there is much on here I have yet to understand especially “Doppler Findings listed within my Echo results below.

CT Angio – Sep 2013 (Comments from reviewing physician below)
1. “No evidence of coronary heart diseases on this slightly suboptimal study”
2. “Normal cardiac chamber size and LV thickness. Surrounding thoracic and upper abdominal structures are unremarkable”
3. “Bicuspid Aortic Valve”
4. “Dilated Aortic root (5.1cm) and ectasia of the ascending thoracic aorta (4.6cm)”

Echo – Aug 2013 (Comments and data)
1. “Estimated ejection fraction of 55%”
2. “There is nodular sclerosis but no significant stenosis, and there is trivial regurgitation. Descending thoracic aorta did not show flow acceleration to suggest coarctation”
3. “The mitral valve is normal in thickness with trivial mitral regurgitation with left atrial size measuring normal but the left atrial volume index is towards the upper range of normal to mildly increased”
4. “The mitral valve is normal in size and systolic function with mild tricuspid regurgitation and right atrial pressure is estimated at 3 mmHg and right ventricular systolic pressure is normal.

***Normal measurements in brackets***
LV Diamter – Diastole = 5.5 cm (3.8-5.6)
LV Diamter – Systole = 3.9 cm (2.5-4.0)
Fractional Shortening = 24.4% (25-45%)
IV Septum Diastole = 1.0 cm (.7-1.1/NA)
LV Post Wall Diastole =0.76cm (.7-1.1/NA)
Aortic Root = 4.9cm (2.0-3.7)
Left Atrium = 3.1cm (1.6-4.0)
Ejection Fraction = 55% (greater than or equal to 50%)
Ascending Aorta = 4.5cm

DOPPLER FINDINGS

Aortic Valve AR = 1
Mitral Valve MR = 1
Pulmonic Valve =_
Tricuspid Valve TR = 2
E Wave = 56 cm/s
A Wave = 41 cm/s
LVOT Velocity = _cm/s
TR Jet Velocity = 240 cm/s
PA Pressure = 26 mmHg
AO Velocity = 140 cm/s
PA/RVOT Velocity = 92 cm/s