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Does The ECHO Report Indicate Mitral Valve Prolapse?
Question: My first indication of the heart problem came from Life Screening EKG report on 09/18/2012:
“A possible abnormality has been identified. At the time of your atrial fibrillation screening, your heart rhythm indicated a possible conduction abnormality”. I didn’t pay much attention to it as my heart didn’t bother me at that time.
On 2/2104 I wanted to do the weight loss program which required EKG. I still didn’t have any major pain except sometimes, but that did go away quick. I was denied to participate in the program due to the Right Bundle Branch Block diagnosis.
On 3/2014 I went to Dr. XXXXXXX (Novant Huntersville NC) with the results from weight clinic EKG. Dr. XXXXXXX ordered (results should be in my file):
1. Telemetry monitoring
2. Cardiac Event monitoring
3. Echocardiogram 2D
4. Lower extremity ABI
5. Pulse oximetry, overnight
6. Corus CAD gene expression test – result 1%( lowest risk)
Nothing definite was decided at that time. I still didn’t have any major pain except sometimes, but that did go away quick.
6/2014 I was on the flight to Europe to my father funeral. I was taken to Inova Hospital in Leesburg VA from XXXXXXX Dulles airport. On the plain I experienced symptoms, which I never had before: chest pain, numbness of both arms, and legs, numbness of the left side of the chin, shortness of breath, inability to sit still.
Hospital Diagnosis:
Vent Rate 54 bmp Sinus Bradycardia with 1st degree A-V Block
PR interval 196ms Right Bundle Branch Block
QRS duration 146ms Abnormal ECG
QT/QTc 440/417ms
P-R-T axes 78 23 28
When I came back on 6/16/2014 I had Stress Echocardiogram (ordered by Dr. Garcia my family physician). Results:
Normal biventricular size and systolic function. Normal biatrial size. Trace mitral and tricuspid insufficiency. No pericardial effusion.
On 8/2014 my other labs:
Cholesterol 181 TSH 1,571
Triglycerides 103 T3 111.5
HDL 52 Eos 7 % (high!)
LDL Calculated 108
Also deficiency in Zinc and Coenzyme Q-10 (which I am taking the supplement).
Now my symptoms lasted almost a year without a resolution. The chest pain, left shoulder blade pain, pounding chest, shortness of breath stays constantly with me now and affect my quality of life!
I am generally healthy, female, 55, 5'8" and 170lbs. My resting heart rate goes from very low 54 - 60's. I don't have any pain with exercise. I go up stairs fine, but after I get to the top, then I am huffing and puffing.
Several few days I had nausea, painting and chest pain, lightheadedness, in the car on the way to work and that scared me to death. I took Lorezapam and that helped. also I have a hard time sitting at my desk the symptoms accelerates.
My questions are:
Could it just be anxiety?
Looking at my echo, can I develop mitral valve prolapse?
Should I be worried about my heart or the leaky valves progressing into something serious?
Should I do the CT coronary angiogram?
Can I develop arrhythmia?
What can be done to manage the pain?
Thank you!
“A possible abnormality has been identified. At the time of your atrial fibrillation screening, your heart rhythm indicated a possible conduction abnormality”. I didn’t pay much attention to it as my heart didn’t bother me at that time.
On 2/2104 I wanted to do the weight loss program which required EKG. I still didn’t have any major pain except sometimes, but that did go away quick. I was denied to participate in the program due to the Right Bundle Branch Block diagnosis.
On 3/2014 I went to Dr. XXXXXXX (Novant Huntersville NC) with the results from weight clinic EKG. Dr. XXXXXXX ordered (results should be in my file):
1. Telemetry monitoring
2. Cardiac Event monitoring
3. Echocardiogram 2D
4. Lower extremity ABI
5. Pulse oximetry, overnight
6. Corus CAD gene expression test – result 1%( lowest risk)
Nothing definite was decided at that time. I still didn’t have any major pain except sometimes, but that did go away quick.
6/2014 I was on the flight to Europe to my father funeral. I was taken to Inova Hospital in Leesburg VA from XXXXXXX Dulles airport. On the plain I experienced symptoms, which I never had before: chest pain, numbness of both arms, and legs, numbness of the left side of the chin, shortness of breath, inability to sit still.
Hospital Diagnosis:
Vent Rate 54 bmp Sinus Bradycardia with 1st degree A-V Block
PR interval 196ms Right Bundle Branch Block
QRS duration 146ms Abnormal ECG
QT/QTc 440/417ms
P-R-T axes 78 23 28
When I came back on 6/16/2014 I had Stress Echocardiogram (ordered by Dr. Garcia my family physician). Results:
Normal biventricular size and systolic function. Normal biatrial size. Trace mitral and tricuspid insufficiency. No pericardial effusion.
On 8/2014 my other labs:
Cholesterol 181 TSH 1,571
Triglycerides 103 T3 111.5
HDL 52 Eos 7 % (high!)
LDL Calculated 108
Also deficiency in Zinc and Coenzyme Q-10 (which I am taking the supplement).
Now my symptoms lasted almost a year without a resolution. The chest pain, left shoulder blade pain, pounding chest, shortness of breath stays constantly with me now and affect my quality of life!
I am generally healthy, female, 55, 5'8" and 170lbs. My resting heart rate goes from very low 54 - 60's. I don't have any pain with exercise. I go up stairs fine, but after I get to the top, then I am huffing and puffing.
Several few days I had nausea, painting and chest pain, lightheadedness, in the car on the way to work and that scared me to death. I took Lorezapam and that helped. also I have a hard time sitting at my desk the symptoms accelerates.
My questions are:
Could it just be anxiety?
Looking at my echo, can I develop mitral valve prolapse?
Should I be worried about my heart or the leaky valves progressing into something serious?
Should I do the CT coronary angiogram?
Can I develop arrhythmia?
What can be done to manage the pain?
Thank you!
Brief Answer:
Cardiac neurosis vs. organic heart disease
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
1st degree A-V Block with complete (QRS duration 146ms) Right Bundle Branch Block (RBBB) is benign and often physiological. RBBB does not necessarily imply serious heart disease;it may occur in a normal individual.With slow heart rates (sinus bradycardia) the P-R interval (196msl may be prolonged.You are not having high-grade AV block.
You are also not having any evidence of mitral valve prolapse. Trivial mitral and tricuspid insufficiency are age-related (degenrative ) and is of no clinical significance.
Your thyroid function test particularly TSH value is not clear. It is necessary to know the correct unit with laboratory reference range.
You can undergo CT coronary angiogram as it is non-invasive and your LDL cholesterol is borderline high. A normal CT coronary angiogram will allay your anxiety.
A mild anxiolytic like clonazepam (0.5 mg) will relieve your panic symptoms.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Cardiac neurosis vs. organic heart disease
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
1st degree A-V Block with complete (QRS duration 146ms) Right Bundle Branch Block (RBBB) is benign and often physiological. RBBB does not necessarily imply serious heart disease;it may occur in a normal individual.With slow heart rates (sinus bradycardia) the P-R interval (196msl may be prolonged.You are not having high-grade AV block.
You are also not having any evidence of mitral valve prolapse. Trivial mitral and tricuspid insufficiency are age-related (degenrative ) and is of no clinical significance.
Your thyroid function test particularly TSH value is not clear. It is necessary to know the correct unit with laboratory reference range.
You can undergo CT coronary angiogram as it is non-invasive and your LDL cholesterol is borderline high. A normal CT coronary angiogram will allay your anxiety.
A mild anxiolytic like clonazepam (0.5 mg) will relieve your panic symptoms.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by :
Dr. Raju A.T
Does CT coronary angiogram consider to be dangerous as its approximately 600 x-rays at once?
Brief Answer:
Coronary angiography - more radiation, but safety is acceptable
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
CT scan shows details much better but give a radiation dose 3-400 times greater than conventional x-ray.
CT scan coronary angiography is performed with 64- slice technique .
The main contraindications are allergy to iodine contrast and severe renal insufficiency
The technique is 95 % specific and sensitive with 85 % positive predictive value and negative predictive value is 99 %.
CT scan coronary angiography is safer than conventional coronary angiography, which involves cardiac catheterization (semi-invasive procedure) and cine angiography-has its own risk(though low at expert hands).
Each cardiac CT scan carried out is equivalent to approximately 100-600 chest X-rays or over 3 years of background radiation.
The significance of radiation doses in the diagnostic imaging range has not been proven, although the possibility of inducing an increased cancer risk across a population is a source of significant concern.
This potential risk must be weighed against the competing risk of not performing a test and potentially not diagnosing a significant health problem such as coronary artery disease.
Coronary angiography remains the 'golden test'.
Since in your case stress echo-cardiography does not show evidence of ischemic or valvular heart disease ,you can skip the test for the time-being and keep it pending.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Coronary angiography - more radiation, but safety is acceptable
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
CT scan shows details much better but give a radiation dose 3-400 times greater than conventional x-ray.
CT scan coronary angiography is performed with 64- slice technique .
The main contraindications are allergy to iodine contrast and severe renal insufficiency
The technique is 95 % specific and sensitive with 85 % positive predictive value and negative predictive value is 99 %.
CT scan coronary angiography is safer than conventional coronary angiography, which involves cardiac catheterization (semi-invasive procedure) and cine angiography-has its own risk(though low at expert hands).
Each cardiac CT scan carried out is equivalent to approximately 100-600 chest X-rays or over 3 years of background radiation.
The significance of radiation doses in the diagnostic imaging range has not been proven, although the possibility of inducing an increased cancer risk across a population is a source of significant concern.
This potential risk must be weighed against the competing risk of not performing a test and potentially not diagnosing a significant health problem such as coronary artery disease.
Coronary angiography remains the 'golden test'.
Since in your case stress echo-cardiography does not show evidence of ischemic or valvular heart disease ,you can skip the test for the time-being and keep it pending.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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