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Forum Name: Miscellaneous Cardiology Topics

Question: Decreased LV Dimensions of the Heart


 napoleon - Tue Nov 04, 2008 8:15 am

I have a Mixed Connective Tissue Disorder and I take Warfarin for an unknown blood clotting disorder which causes Atrial Fibrillation.I have had 3 Echocardiograms over the past 6 yrs and have been told my heart structure is normal ,but the LV Dimensions have been reduced each time from Diastolic 5.1,Systolic 3.1 (2001) to Diastolic 3.8 (3.5-5.6) ,Sytolic 2.3 (2.5-4.1), 2007.
Is this normal,if not what could be causing this and what affect if any does it have on heart function.
 John Kenyon, CNA - Wed Nov 05, 2008 10:31 pm

User avatar Hello -

If the size of the left ventricle has become progressively smaller over the course of six years, which appears to be the case, it has progressed fairly significantly over that period. What this means is not totally clear, but in general what it probably means is that the walls of the LV have been getting thicker, which means the volume of the interior space of the LV is getting smaller, and so has less room for blood which is to be pumped out to the body. This can be due to an inherited disorder, it can be caused by excessive athletic conditioning, and, in some cases, it can even be secondary to mixed connective tissue disease (MCTD), although the latter is fairly rare. When it does happen it usually is due to obstruction of the aortic outflow tract, which increases the pressure inside the LV and the workload, which causes the muscles to thicken. High blood pressure can also cause this development. Since there's no mention of outflow tract obstruction in your echocardiogram findings, it would seem to be due to some other factor, perhaps high blood pressure, although you don't mention this in your history.

The normal variations in interior LV dimensions are considerable, and the only oddity in your case is that the variation has been consistently toward a smaller volume. So long as your doctor is not concerned and you have no disabling or disturbing symptoms, this is probably considered normal for you, given your personal height, weight and build.

I hope this is helpful. Please follow up with us as necessary, especially if you have any further insights to offer. Best of luck to you.
 napoleon - Sat Nov 22, 2008 7:00 am

To John Kenyon,
Thank you for your most informative reply.I did not go into much detail before because it is a long & complicated story & so far the response from other specialists has not been worth the effort.I will try to make it as short as possible.I have been to many Rhumatologists & other than make a general diagnosis of possibly Sjogrens,Raynauds & Lupus ,not one had any idea what was causing my extreme pain & multitude of organ problems or took the problem as a whole to be serious.
I had high BP & pulse,pain in my chest like a tight band,intense pain in my head,extreme nausea,frequent urination of dark urine (containing protein)& pain all over my body.All of this got worse after even eating or talking.
After having 2 Transient Ischemic attacks (dismissed as nothing) after doing a little bit of walking I quickly realised that walking made the situation even more serious so I became practically bedridden.I felt as if my body was being starved of Oxygen but got ridiculed when I tried to explain this.
I went to a Cardiologist in 2003 because I had an echocardiogram showing AF
(also showed minor focal calcification).He said there was nothing structurally wrong the problem was caused by croglobulenemia or something similar. He sent me to Hematologist who was no help,so I gave up looking for a diagnosis.In 2004 I had a blood transfusion for severe anemia all my symtoms reduced to a tolerable level,BP & pulse normal.Took no medication for 12mths .Before transfusion my heart seemed to pump really hard after exertion.Now after only minimal effort I feel as if my heart cannot cope ,my BP drops 90/60,P56/min,I get pain in the left side of chest & feel dizzy.Checked last Echo (told fine)says Aortic stenosis.What could cause this? Is there any treatment?
 John Kenyon, CNA - Sat Nov 22, 2008 11:23 pm

User avatar Hello -

I'd begun to wonder if there might not be some history of autoimmune/connective tissue disease, and that does seem to be the case, which would help explain a lot of this. Sjogren's, in particular, might help explain the heart involvement, including the AF, which of course is almost certainly the cause of the TIAs. While this family of diseases, which often overlap each other and can cause an infuriating spectrum of problems, can be managed medically, it is sometimes quite a challenge.

cryoglobulenemia is an immune disorder which sometimes follows hepatitis-C infection, and blends in all too well with the other suspected culprits. I still think Sjogren's would seem to be the biggest contributor, however, and this should probably be the focus, for now, of study and management.

Aortic stenosis (the technical term for what's been happpening) is probably due to stiffening of parts of the myocardium if Sjogren's, secondary to lupus, is confirmed. While Sjogren's usually involves the tear ducts and lymph nodes primarily, lupus as an underlying cause can, of course, attack almost any organ system (or cause any system to attack itself). This is all useful information, but it requires a certain amount of clinical skill on the part of the attending physician and, of course, a great deal of patience on the part of the patient.

Please keep us updated, and thanks for adding this information, which does make everything make a little more sense. Best of luck to you and please stay in touch.
 napoleon - Thu Jan 08, 2009 9:08 am

Thank you for the informative response. My son has the same medical condition as me and has had no luck finding a knowledgeable specialist either. He has had uncontrollable BP & Pulse for the past two years ,it gets worse after activity & he gets AF and chest pain (both him & my daughter were diagnosed with heart murmur 15yrs ago).Do you think our heart problems are most likely caused by the disorder or some inherited problem? What inherited condition if any could cause these problems?. Can a stiffened myocardium be detected by any tests? Is there any treatment for aortic stenosis ?
Thank you
Napoleon
 John Kenyon, CNA - Thu Jan 08, 2009 12:34 pm

User avatar Hi Napoleon -

The disorder is definitely genetic (except in very rare instances of mutation), and since your son's symptoms match up with yours (as far as they go) it is entirely likely he's inherited this set of problems. He should at least be evaluated for the same set of problems that you have, and sarcoidosis shouldn't be taken off the table quite yet either, since these two disorders can sometimes look a lot alike.

A stiffened myocardium (which is why I mention sarcoidosis) can usually be detected by motion studies; an echocardiogram will usually pick this up cleanly, and sometimes an MUGA or gated exercise nuclear scan can help determine just how much of a problem it presents, so that exercise can be limited, adjusted, etc., to the limitations of a heart with stiffening of the muscle tissue.

Aortic stenosis, if it requires correction, is usually done in one of two ways, depending on multiple factors: either through conventional surgery (sometimes minimally invasive) to either correct the outflow tract or replace the valve; or sometimes the valve can be stretched open via percutaneous angioplasty (much like the baloon procedure done to clear a clogged artery, but using a larger balloon). Much depends upon the anatomy of the individual aortic valve and the extent of stenosis.

Hope this is helpful to you.

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