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Forum Name: Cardiology Diagnostics

Question: Borderline Root Dilation


 Lsbarr - Sun Mar 13, 2005 7:21 pm

Hi. My name is Lisa and I'm new to this site. I'm a 36 year old mother of 2 who was recently hospitalized for chest pain and shortness of breath. I was given nitroglycerin which helped tremendously. I was released after 4 days in the hospital and many tests. I had an upper GI which showed nothing wrong with my esophagus. I had a stress test and normal EKG although I was tachycardic and had low BP. My diagnoses was viral - bronchitis with bronchospasms. However, I did receive the results of an echocardiogram they did on me. It states: Borderline LVH with diastolic dysfunction, Right ventricle is mildly dilated, mild mitral sclerosis, no MVP, and also Borderline Aortic Root dilation. My cardiologist in the hospital said just to follow up with a chest CT in 4-6 months and not to worry. Help, I'm still worried. Should I be? Thanks. Lisa
 Dr. Yasser Mokhtar - Thu Mar 17, 2005 12:36 pm

User avatar Dear Lisa,

During a stress test, it is normal to be tachycardic, but i am not sure what do you mean by low blood pressure.

Where does your blood pressure normally run at? The borderline left ventricular hypertrophy (lvh) and the diastolic dysfunction can be caused by high blood pressure. In combination with the mild root dilatation could be caused by aortic stenosis which was not there on the echo.

What was your ejection fraction? The shortness of breath can be caused by the fact that you have diastolic dysfunction.

What was your pulmonary artery pressure on the echo? The combination of your echo picture could be secondary to obstructive sleep apnea. How were you diagnosed with idiopathic hypersomnia?

What did your cardiologist tell you the diagnosis was? Why does he want a ct of the chest as opposed to repeating the echo?

Where you taking the inhalers before or after this episode and did you feel better after taking them?

Have you taken any medications for weight loss in the past?

At the time being, i think that there is nothing to worry about, especially if the shortness of breath improved after you were started on inhalers. Please, try to take your blood pressure more often to see how high it runs.

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

Yasser Mokhtar, M.D.
 Lsbarr - Thu Mar 17, 2005 8:15 pm

Thank you so much for your reply. Here are the answers to your questions:
My blood pressure normally runs at 110/80. I believe my ejection fraction was 72%. I'm not sure about my pulmonary artery pressure. What is the code for that on an echo? I was diagnosed with idiopathic hypersomnia after a night in a sleep clinic and an MSLT the next day. I do not have sleep apnea. I feel asleep within 9 minutes of all 5 naps. I was not diagnosed with narcolepsy. This is the first time I have ever taken inhalers for anything. My shortness of breath is gone. However, I do still continue to have chest and back/left shoulder pain. I have never taken medication for weight loss. Is it possible to have hypertrophy with diastolic dysfunction in a woman my age with normal blood pressure? Could any of this be the cause of my fatigue? Should I be concerned about the aortic root dilation. Could all of this be just normal for me? Thank you so much for your help.
 Dr. Yasser Mokhtar - Thu Mar 17, 2005 11:32 pm

User avatar Dear Lisa,

It is possible to have hypertrophy with diastolic dysfunction with normal blood pressure. Usually diastolic dysfunction and left ventricular hypertrophy occurs with normal blood pressure in the elderly population and you are not that old.
However, other causes include
1. Having a condition called hypertrophic cardiomyopathy and it should be easily diagnosed with echocardiography.
2. Athlete hypertrophy. Some patients develop mild hypertrophy if they exercise on regular basis. This category does not need treatment. Once exercise is stopped, the process is reversed.
3. Some conditions called infiltrative diseases, where some substances that are not supposed to be there, accumulate in the muscle of the heart itself. These could be diagnosed by echocardiography and they could be diagnosed by other imaging techniques such as ct scans and mri scans.

Other factors that may help in the development of lvh:
1. Obesity. Are you obese?
2. Age.
3. High dietary sodium intake. Try to decrease your salt intake.
4. Diabetes. Were you checked for diabetes?.
5. Insulin resistance.

Pulmonary pressure is called pulmonary pressure on the echo.

The lack of sleep is the cause of your fatigue. i am not an expert in sleep disturbances but these signs are very close to sleep apnea. Sometimes, sleep apnea occurs on some nights only and it is sometimes difficult to diagnose. i am not sure about the effects of primary hypersomnia on the heart, but the echo profile can be one of a sleep apnea patient. i recommend that you talk to your sleep doctor about the echo findings and see whether primary hypersomnia can have such effects on the heart.

Root dillatation for the time being (mild) does not pose any danger and can be safely monitored.

The chest pain could be due to neck problems, if you have not had any neck x-rays or ct scans, i suggest that you do to exclude neck spine problems. And even though your upper gi series were ok, try an over the counter antiacid medication and see whether it helps with the pain.

lvh has to be treated even in the absence of hypertension. You should be taking high blood pressure medications that reverse this process. Most probably, you will have to take them in small doses, unless this is due to athlete hypertrophy (no need for treatment as mentioned earlier).

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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