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Forum Name: Cardiology Diagnostics

Question: Lupus, concentric hypertrophy, pulmonary hypertension, effus


 BrownEyedGirl72 - Mon Jul 06, 2009 5:19 pm

I have just recently had an echo and a holter 24hr. monitor. The echo conclusions were: 1)The left ventricle estimated ejection fraction is 65%. Mild concentric hypertrophy. Normal diastolic function. 2) Right ventricle normal in size with estimated ejection fraction of 40%. 3) Left atrium is upper normal in size. 4) Aortic valve is probably tricuspid with no increased gradient or regurgitation. 5.) Mitral leaflets appear normal with no myxomatous change or prolapse. Slight regurgitation. 6) Pulmonic valve is normal. 7) Tricuspid regurgitation with pulmonary artery systolic pressure of 41 mmHg. 6) small anterior pericardial effusion.
I have no idea what the following is but it was on the report so I typed it out as well:
LVIS (35-55) 25
LVID (35-60) 47
LVPW (.6-1.0) 11
IVS (>.6-1.0) 13
LA (23-35) 46X40
RA (23-45) 35
AO (21-35) 24
RVD (22-44) 38
AVO (21-35) 14
LVOT D 25
LVOT VEL 0.73
TR GRAD 31
IVC/EXP 19
WITHOUT VALSALVA -
MVIF PK E 0.77
MVIF PK A 0.57
MV E SLOPE 4.41
MV E DECEL 174
E/A RATIO 1.35
E' M/S 0.082
WITH VALSALVA -
MVIF PK E 0.75
MVIF PK A 0.60
MV E SLOPE 3.13
MV E DECEL 208
E/A RATIO 1/25
ERO RV
E' M/S 0.071
ERO RV

The 24hr. Holter monitor report conclusions were:
1) Sinus Rhythm c rates 51-121/min.
2) PAC 636/22hrs c one couplet
3) PVC 766/22hrs
4) No ST change

SVPB Prematurity: 20%
Pause: 2000 msec
ST Segment Depression: 100
ST Segment Elevation: 200
Long RR/Pause: All Beats
Pause Excluded from HR: No
Min Rate: 51
Max Rate: 121
Mean Rate: 79
Total QRS: 108903
Monitoring Period: 22hr, 56 min
Supraventricular Ectopy:
AFib (Time%)/peak avg. rate: 0%/0BPM
Singles: 636
Couplets: 1
Runs: 0
Total: 638
Ventricular Ectopy:
Singles: 766
Couplets: 0
Runs: 0
R on T: 0
Total: 766

ST Deviation:
V1/Time
Max Depression: /
Max Elevation: 12/13:54:46
V5/Time
Max Depression: /
Max Elevation: 25/03:54:46

I have had high RBC, hemoglobin, and HCT for a while. My CRP is also high. I found out a month ago that I have low vitamin D levels and I just found out on an ER trip about two weeks ago (due to severe pain in my stomach and chest for a week that hurts all the way through to my back) that my calcium was also high along with the RBC. I have Hashimoto's Thyroiditis (diagnosed in 2002) and was diagnosed in February with Lupus. I am not sure that I agree with the Lupus diagnosis right now. But, I have a hard time expressing that to my doctor. Other tests have not been done to rule out other issues that can be misdiagnosed as Lupus (I have been reading a lot on the subject). Could Lupus explain these blood and lab results and are there other things that could cause these results? What are the issues that I should be concerned about on the echo & holter? Could these be Lupus related?

I have been sick for a long time and have went down many dead end roads with different doctors - numerous putting me on antidepressants and labeling my problems as stress. I have fatigue that is almost indescribable, numbness (especially in my face and arms), strange sensations, vertigo and balance problems, headaches and pressure in my head, I have problems with my blood pressure dropping - the lowest was 78/54 - when this happens I get really pale (white as a sheet of paper) and feel really weak and weird and my pulse rate usually drops as well. I also have problems with my heart rate going up.
I have been struggling for so long and I am now unable to work or even care for myself. I need some answers and any help that would help me to get to the bottom of this problem or help me to get the care that I need would be greatly appreciated.
Thanks so much for your time!!!
Kary


Here are some of my most recent blood test results:
ANA - 1:320
Vitamin D - 19
RBC - 5.43
HGB - 16
HCT - 47.1
Glucose - 114 (Fasting)
Calcium Total - 10.3

Urinalysis -
pH - 7.5
Protein - negative
Nitrite - negative
blood - negative
Leukocyte - moderate
WBC/hpf - 4-10
EPI Squamous - Few
Ketone - negative
 John Kenyon, CNA - Wed Jul 29, 2009 1:22 am

User avatar Hi there --

First to address your echocardiogram findings: the part which addresses the observations and findings describe an essentially normal and structurally healthy heart with nothing remarkable turning up. The long list of specific measurements would take far more room to explain than we have here, but I've looked at them and they all simply confirm the express written findings which, again, are all within normal limits. No problems there.

Regarding the Holter results, the only thing of any significance which showed up is the fact that you have occasional premature atrial and ventricular heartbeats, something for which there is no longer a true "normal", since we all have these from time to time, and some of us have huge numbers of them while others have only very occasional ones, and of course there are variations among all subjects as well, depending on various factors that influence premature beats. The number that showed up on your tracing falls somewhere in the middle of the spectrum but are still of no clinical significance.

Since you suffer from Hashimoto's disease and other autoimmune problems, it is fairly likely your lupus panel finding is suggestive of some degree of lupus, but is not the last word on this, since it is difficult to diagnose many cases of lupus based on this alone. Lupus would not at all explain your relatively good echo and Holter findings, and nothing else showed up there, so there's no current corellation between possible lupus and any cardiological problem, since there are no cardiac problems exposed by those exams.
Your blood work, while generally negative, does contain some suggestion of autoimmune problems, which would follow, since you at the least have Hashimoto's.

I hope this helps clarify things for you. Your heart currently is quite healthy, but you would appear to have autoimmune issues, and lupus may be one of them. Please feel free to follow up with us here as necessary. Good luck to you.
 BrownEyedGirl72 - Sat Aug 01, 2009 12:15 pm

Thank you so much for your reply. I feel better knowing that my heart is good - that takes a lot of stress off!
 John Kenyon, CNA - Mon Aug 03, 2009 11:04 am

User avatar Glad I could help. Take care and stay in touch with us here.

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