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Forum Name: Cardiology Diagnostics

Question: Question on echocardiogram results


 maestro300 - Fri Apr 09, 2004 12:06 pm

First off-- I was born with mild pulmonary stenosis (with no progression) and I am 28 years old now, 140lbs. I have a systolic ejection murmur in the 2-3 left intercostal space.

I went for my 3rd echocardiogram (last one was in 1989, just had one in May 2003)

After my echo the cardiologist came in and told me "Good news, you have a normal heart... well as normal as it can be-- you have a stenosis but the pressure gradient is low and nothing to worry about" I asked him if it would ever get worse and he said "Probably not, if it hasn't already... but you can come back if you like in 2-3 years and we can do another follow up"

Well I went in to see my GP last week and he had the final document from the cardiologist. He told me "Yeah, looks like everything is good with your heart" then continued to say "He found the pulmonary stenosis-- also trivial regurgitation in the other three valves"

So of course after reading I find out that trivial regurgitation is normal-- but not so in the aortic valve. Is this something that can progress? Neither docs seemed to be concerned; not sure if this is just a "fluke" that the echo picks up or not.

Worried,

Mike
 maestro300 - Fri Apr 09, 2004 2:04 pm

This is unrelated but I'd thought maybe you could answer this: My overall health has been great-- no symptoms. My last lipid profile from 3 years ago was:

(when I ate ALL fast food) unrestricted diet

Total cholesterol: 214
HDL: 46
LDL: 149

I have done the diet change for the last few years and my latest was:

Total cholesterol: 185 (was 182 six-months ago)
HDL: 56 (was 65 six-months ago)
VLDL: 16
LDL: 112 (was 102 six-months ago)
LDL/HDL ratio: 2.0

So my cholesterol has remained under control since my diet change...

My GP says "maybe you should take a baby-asprin, I'd hate to see you have an early heart attack since you have two risk factors already" I asked him what my two factors were and he said "cholesterol and blood pressure" I asked him why the cholesterol since I have it LDL under 130--- he said "because it was high once before"

So is this a valid statement and still considered a risk factor if my cholesterol is within normal range? My BP uncontrolled (3 years ago) used to be 140-150 / 80-90 Now with 25mg Atenolol it is around 132/80 and sometimes as low as 124/80 if I sit for awhile (bp machine at WalMart) So is my blood pressure also a risk factor still?

My family history: Mother's side (her father died from asbestos related lung damage at 76) my mom's Mother alive and well at 84. Father's side: Both grandparents alive 87/85 years old; both parents are alive and well 52/54. There are no history of any heart attacks in our family except for my grandfather's brother (who I think is too distant to render this in family medical history)

So do you think my GP is kind of over exagerating my heart attack risk? Should I find a new GP? My heart condition shouldn't warrant him to worry-- he also orders full CBC and chem13 (also thyroid tests) each year (which always come back normal) Also he wants me to come in for lipid profiles every 6 months (I think thats a little much since I've remained relatively good for the past 3 years)

Sorry this is so long... Thanks!
 Dr. Yasser Mokhtar - Mon Apr 19, 2004 9:45 pm

User avatar Dear Maestro300,

Regarding the first question, usually trivial regurge is a "fluke", having a history of congenital heart disease, i am sure that they made sure that your aortic valve is normal and has three leaflets and not two which could give a meaning to the trivial aortic regurge that you have.

However, since you have pulmonary stenosis and you are going to be evaluated at least every couple of years, i would not worry a lot unless you start having new symptoms like new onset shortness of breath on exertion, palpitations, ect...

Regarding the baby aspirin, you have treated high blood pressure which means that you have high blood pressure but since it is under well control, the risk drops significantly but it does not mean it is not there.

Regarding the lipid profile, your ldl and hdl values are great without any medications, so keep up the good work. Of course having high lipids is one of the big risk factors in coronary disease.

The real risk of coronary disease in males starts at the age of 40 especially if they have premature coronary disease history in first degree relatives. So, currently i don't think that there is an urge to start you on a baby aspirin every day but once you hit 40, your gp will a very strong case to advice you to do so.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 maestro300 - Wed Sep 29, 2004 4:16 pm

Today I finally had the echo faxed to me in regards to earlier questions (thank you so much for answering)

1. Nothing is noted about high pulmonary pressure but is 33 mmHg considered normal provided what is listed here?

2. I never had confirmed diagnoses of "pulmonary stenosis" but do have a systolic murmur 2-3 left sternal border. Could this be an innocent pulmonic flow murmur since they found nothing wrong?

3. Is the "borderline left ventricular hypertrophy" probably related to my uncontrolled blood pressure from years ago? Is this something that could get worse?

Thank you so much!

**ECHO REPORT**
The M-Mode measurements demonstrate left atrial size of 3.9 cm, aortic root 2.6 cm. The thickness of the septum and posterior wall is 1.2 cm. End-diastolic and end-systolic dimensions are 4.9 and 3.2cm.

2-dimensional echo:

The 2-d images demonstrate unremarkable septal motion, unremarkable posterior wall motion and the left atrial size appears to be unremarkable, as does the aortic valve itself. The mitral, aortic and tricuspid valves all show good motion without thickening or abnormalities morphologically. There is no pericardial effusion noted. The aortic valve showes three leaflets in the short axis view and the tricuspid valve does not show any gross abnormalities. The pulmonary valve is not well visualized. In some views we actually do see the pulmonary valve and it shows that the leaflets move quite well. There are no obvious signs of supravalvular stenosis or infundibular stenosis from the available views. The right ventricle appears to be within normal limits, as does the right atrium.

Color Doppler:

Dopper interrogation demonstrates antegrade flows across the aortic valve are 2.1 m/sec which would give a mean gradient of 8.4 mmHg. There is trivial aortic insufficiency noted. There are antegrade flows across the mitral valve which are unremarkable, and there is trivial mitral regurgitation. There is mild tricuspid insufficiency with a pulmonary pressure estimated at around 33 mmHg. The last views across the pulmonary valve show a 1.7 m/sec velocity which would give a peak gradient of 11.6 mmHg and a mean gradient of 6.6 mmHg. These numbers are considered trivial.

Impression:

1. Preserved systolic performance of the left ventricle.
2. Unremarkable chamber dimensions
3. Borderline left ventricular hypertrophy
4. Trivial mitral and aortic valve insufficiency.
5. Mild tricuspid insufficiency.
6. Increased flows across the pulmonic valve without significant pressure gradient estimate.

This patient has an essentially unremarkable heart with borderline left ventricular hypertrophy and increased antegrade flows across the pulmonary valve without discrete significant gradient.



Thank you!
 maestro300 - Wed Sep 29, 2004 8:07 pm

In the section on the above posted echo:

What does this mean:

*Dopper interrogation demonstrates antegrade flows across the aortic *valve are 2.1 m/sec which would give a mean gradient of 8.4 mmHg.

Is there normally no gradient across the aortic valve? Does this mean I could get Aortic stenosis when older?

Also, what does antegrade flows mean? Thanks again!
 Dr. Yasser Mokhtar - Tue Oct 19, 2004 11:57 pm

User avatar Dear Maestro300,

Thank you very much for the update.

Regarding your questions.

1. A systolic pulmonary pressure of 33 is just elevated above the cut-off of what is considered high pulmonary pressure which is 30.

2. The degree of loudness of the murmur has nothing to do with how severe a lesion is if any. A murmur is caused by turbulence in the blood flow, whether this blood is flowing through a stenosed valve or not, this is a different story.

3. The left ventricular hypertrophy like you said is most probably related to hypertension. It could get worse if hypertension is not very well controlled.

4. Normally, during systole, there should not be any gradient between the left ventricle and the aorta. i don't think that i can predict whether or not you are going to develop aortic stenosis.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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