Slight confusion over my recent figures ...

[Seaton]

I’ve just received a copy of the July 21st cardiology appointment report my hospital cardiologist sent to my GP.

The cardiologist in effect says everything remains stable and that he would see me again in four months. He states also I am scheduled to meet a surgeon in the meantime to allow me to hear a surgeon’s opinion on my staging, etc.

Even so, I find a data reading in the report a tad confusing. I may be misreading the figures but wondered if anyone here could clarify.

The report begins with a list of 'Diagnoses'. The parts relating to my heart reads:
Moderate aortic stenosis – functionally bicuspid valve, peak gradient 41mmHG 3.4m/s, mean gradient 25mmHG, effective orifice area 0.77 cm²
Normal LV size and function
Bicuspid aortic valve

The report continues …
‘On examination today his blood pressure 98/62mmHg and his heart rate 66bpm and regular. His transthoracic echocardiogram today demonstrates no significant change in comparison to his previous echo [April 2015] demonstrating bicuspid aortic valve with moderate stenosis, peak and mean gradients of 43 and 25mmHG respectively. His left ventricle remains normal in size with preserved LV systolic function.’

(*I note he has written a slightly different peak gradient size (41mmHg) in the ‘Diagnoses’ list compared to the peak size in the paragraph that followed which says my peak is 43mmHg. This may be a typo.)

My peak and mean in the April echo was 41mmHg peak and 21mmHg mean. The July reading infers an increase of 2mm and 4mm respectively.

That aside, my confusion lies with the ‘effective orifice area’ of 0.77 cm². My estimated orifice in April’s echo was 1.0 cm². Am I reading this correctly? Wouldn’t an effective orifice area of 0.77 cm² put my stenosis in the severe category and not the stated moderate? Or am I completely misreading what this newer ‘effective area’ reading is referring to (or what constitutes severe)? In fact, is the 0.77 cm² referring to my stenotic valve size?

The cardiologist July 21st report says nothing has changed. But surely the ‘effective orifice area' indicates something ‘effectively' different to April’s data? Or is such a figure neither here nor there relatively?

I’m not concerned, as such, just looking for greater clarity.

Onwards ...

 

[Paleowoman]

Hi Seaton - an effective orifice area of 0.77 cm2 would mostly likely put you in the severe categoary so I'm not surprised you are looking for greater clarity, espeically as your pressure gradient hasn't changed tons which doesn't make sense in a way because if your effective orifice area was so small wouldn't the pressure gradient be higher ? If your effective orifice area had reduced from 1.0 to 0.77 that would be a big change IMHO (not that I'm a cardiologist or doctor). Do you know what your Ejection Fraction is ?

Can you contact the cardiologist's secretary ? Get the print out of the echocardiogram report ? I don't put typos past secretaries and doctors. But you can never be sure it's a typo or not until you see original figures. Whether you can or not I think it would be worth asking your GP for clarity on this.

 

[Seaton]

Thank you Paleogirl!

I will call the cardiology unit tomorrow and see if it’s possible to get the figure clarified directly without having to wait weeks for my next appointment. I’ll also try and find out my Ejection Fraction, too while I’m at it. They may shoo me away as a nuisance caller, but I'll sing a song of charm and see what happens.

The cardiologist’s GP report also says: ‘… I am pleased to report that he remains stable since his last review 3 months ago. He continues to experience fatigue which has been progressively worsening over the last year but otherwise is not troubled by any undue breathlessness or exertion chest pain. There is no history of dizziness or syncope …’.

Just a thought, but was wondering if worsening fatigue alone, without ‘classic’ symptoms, could be indicating the heart has an issue?

Of course, the fatigue I’m experiencing could be the background noise of my Chronic Fatigue Syndrome. Perhaps that’s what the cardiologist is surmising (mistakenly?).

Either way, a reading of 0.77cm² from a 1.0cm² seems to belie a claim of things remaining stable over 3 months. I wonder why he would consider 0.77cm² to be moderate?

The truth will out, I’m sure.

 

[Paleowoman]

Let us know what the cardiology unit says Seaton !

 

[Seaton]

Called my cardio consultant's secretary this morning but she's out of office until Monday. Will call then and see if she can advise or pass on my query.

Thanks for your comments Anne!

 

[Seaton]

Contacted my cardiologist’s secretary at St Thomas’s Hospital. Within an hour or so my cardiologist, Dr Satpal Arri (Specialist Registrar in Cardiology) rang me. Which is pretty impressive NHS personalized service, I think, considering how busy they all are.

He said he understood my concern regarding the new effective orifice area (EOA) reading of 0.77cm² and that such a reading could infer that my stenosis was indeed decidedly severe, but that further confirming tests and discussion with a cardiac surgeon would need to be conducted before any kind of conclusive staging could be made. There were other defining factors that the team must take into account.

He said that although my gradient readings (peak and mean) had increased slightly since my last reading three months ago, the current readings were not significant to raise concern on their own. He agreed that my experience of increasing fatigue over the past six months could mean I’m possibly becoming symptomatic.

I asked about my Ejection Fraction percentage, but he seemed to think that wasn’t an important factor at this stage. He didn’t offer me a percentage reading, but I will ask for a figure at my next appointment if possible.

He said consultant cardiothoracic surgeon, Mr. Christopher Young, is due to see me at St Thomas’ Hospital either August or September. He felt the surgeon would have a clearer understanding of where I’m at and how to proceed.

The day I spoke with Dr Arri, I received a letter cancelling my November 17th four-month review appointment with the Cardiology appointment. They will be issuing a new date shortly. Called to see why cardiology had cancelled that appointment. They have referred me to a valve specialist instead: Dr Jane Hancock. They must think this is necessary from my data.

[Out of interest, I stumbled across a link from early 2014 that reports on a ‘world-first’ transcatheter mitral heart valve replacement performed on a beating heart by a cardiac team at St Thomas'’ Hospital. The team includes the surgeon I’m due to see, Mr Christopher Young, and the valve specialist, Dr Jane Hancock:

http://www.london-se1.co.uk/news/view/7454

Seems like a highly impressive team.]

*In my signature here, I’ve put severe stenosis (0.77cm²) until otherwise informed. This may be premature, but for now I think I'll err on the side of caution. Or as Alexander Pope once said: ‘to err is human; to forgive divine’. Thank you Alex.

 

[Paleowoman]

Mr Christopher Young ! Impressive ! He's one of the surgeons I looked at prior to surgery (but I didn't want to travel to St Thomas' or London Bridge when I could have surgery closer to home). Here's a link to his website: http://www.heartfix.net

 

[Seaton]

Thanks for the link Anne. Very informative!