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Forum Name: Cardiology Diagnostics

Question: Moderate diastolic dysfunction, abnormal ECG


 wvrich - Sat Mar 12, 2005 10:47 am

I had an ECG and corotid ultrasound because I woke up with blurry vision one day. Opthalmologist found no cuase except a cataract. Blurryness subsided in a couple days.

My PCP called and said the carotids looked normal, and the ECG showed no cause for the vision change. But there was something about the walls of the heart and he wants to look at my blood pressure (which has been high at the doctor's office(145-160/85-100),but not at home (132-140/78-85).

I got the ECG results in the mail yesterday, and it sounds to me like something serious may be wrong. It says:

"Summary
Overall left ventricular systolic function was normal. Features were consistent with a pseudonormal left ventricula fillingpatter, with concomitant abnormal relaxation and increased filling pressue. Features were consistent with moderate diastolic dysfunction. There was no echocardiographic evidence for a cardiac source of embolism."

Left ventricle: - Left ventricular size was normal.
- Overall left ventricular systolic function was normal.
- Left ventricular ejection fraction was estimated in the range of 55-60%.
- There was no diagnostic evidence of left ventricular regional wall motion abnormalities.
- Left ventricular wall thicknes was normal.
- Mitral annular TDI was severely abnormal.
Doppler interpretation: - There was a normal transmitral flow pattern
- The ratio of systolic to diastolic pulmonary vein flow was reduced (diastolic predominant).
- features were consistent with a pseudonormal left ventricular fiilling pattern, with concomitant abnormal relaxation and increased filling pressure.
- Features were consistent with moderate diastolic dysfunction."

Valves all looked normal except for "trivial mitral valve regurgitation".

How worried should I be? Is this serious, should I be concerned about having a stroke or heart attack? Is this a precursor o something more serious? I don't see my PCP until 3/28 and this has my wife and I worried. I am 50 years old, and have a disk problem in my neck but am otherwise healthy. I do weights 3-4 times a week. Cn you help me understand this?

Thank you for any help you can provide!
 Dr. Yasser Mokhtar - Sat Mar 12, 2005 1:57 pm

User avatar Dear wvrich,

Your echo findings are consistent with diastolic dysfunction which simply means that your heart is not relaxing the way it should. There is no need to worry. It is not a precursor to having a heart attack or a stroke. It can be a manifestation of risk factors causing such ailments. This is not an emergency and you can safely wait till you see your doctor on the 28th of march.

Otherwise, your echocardiogram report does not show any other abnormalities.

Diastolic dysfunction can be caused by aging, high blood pressure, diabetes and coronary disease.

You don't have diabetes, so, i could be aging, having high blood pressure or coronary disease.

i recommend that you discuss having a 24 hours ambulatory blood pressure monitoring to know how does your blood pressure look around the clolck. Also, you have three risk factors for coronary disease and even though you are not having any chest pain, discuss this with your doctor and if he thinks that it is indicated, i suggest that you have a stress test.

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

Yasser Mokhtar, M.D.
 wvrich - Mon Mar 21, 2005 11:18 am

Thanks for your reply, Dr. Mokhtar.

I have been monitoring my blood pressure for the last week several times a day. It averages about 130/78. My blood pressure has generally been high (145/90 or so) when I go to see my doctor, but not at home. If my blood pressure was high when the ECG was done, would that account for the abnormal reading?

Why do they use the term "severely abnormal" for the mitral TDI if this is a moderate dysfunction?

If this is not related to "white coat syndrome" blood rpessure readings, does it indicate I have another heart problem that will need treatment?

Thanks again for your help!
 Dr. Yasser Mokhtar - Mon Mar 21, 2005 12:10 pm

User avatar Dear wvrich,

Thank you very much for the update.

One reading during the day when you are at home and may be relaxed might not reflect your blood pressure readings over the whole 24 hours period. Discuss having a 24 hours blood pressure monitor with your doctor.

This could be a case of white coat hypertension.

If this diastolic dysfunction is not secondary to hypertension, and you had a stress test to rule out coronary disease (which is a cause for diastolic dysfunction), and you are found not to be a diabetic (have a fasting blood sugar test), then most probably, this is due to aging. It could be due to rare diseases in which some substances infiltrate the heart muscle, but this should have been picked up on the echocardiogram.

One more addition, some patients will have high blood pressure during night time because of sleep apnea. So, if you snore loudly during sleep or was noticed during sleep to stop breathing, i recommend that you have a sleep study.

Diastolic dysfunction usually takes a while to develop, your blood pressure being high only at the time of the echocardiogram will not cause the echocardiogram results to be different.

tdi refers to tissue doppler imaging which describes the tissues themselves. i am not sure why it was described as severely abnormal unless you had mitral annular calcification but it was mentioned that all the valves looked normal.

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

Yasser Mokhtar, M.D.
 wvrich - Tue Mar 22, 2005 1:55 pm

Thank you for your help. Since I've been taking my blood pressure several times a day, have no evidence of sleep apnea, and am not diabetic, it sounds like I either have coronary heart disease or am just getting older.

I appreciate your help with understanding this. I am now better equipped to discuss my situation with my doctor and do what needs to be done to follow up. Thank you!

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