Done Echo. Stress Test Negative For Exercise Inducible Ischemia. History Of Alcoholism. Taking Medicine For Hypertension

Posted on Wed, 10 Apr 2013

Question: hi
my echo cardiography shows
* normal left ventricular systolic function,
* no resting regional wall motion abnormalities,
* trileaflet aortic valve with grade 2 ar'
.. tmt has following
* good effort tolerance, normal hr and bp response.
* no angina/arrhythmias
*no significan st -t changes during excercise or recovery,
imp; stress test negative for excercise inducible ischemia''
i could not complete tmt test due to fatigue, time 9; 41 m.s, work level XXXXXXX meters; 10.80, resting heart rate '72bpm.. XXXXXXX to maxm 157bpm. reaching 82percentage of maximal age-predicted heart rate. resting bp is 110/70 which XXXXXXX to a maximum pressure of 130/70
- for past one month i am under medication for chronic br. allergy
pft test came as insignificant reversibility after bd therapy.
am i suffering from cardiac problem.

i was a chronic alchoholic for past 10 years and i stopped drinking 3 months with librium detox program
i am working on quitting smoking,
* for the past 4 years i am under medication for hypertension and cholestrol.

Answered by Dr. Venkat Sivayogi (32 minutes later)

Hello XXXXXXX

Welcome to health care magic.

As per your detailed clinical data, I am outlining the results of your lab tests as follows,

1. the ECHO test : It is normal except, that you have problem with one valve in the heart namely AORTIC VALVE - you have grade-II Aortic regurgitation , means that valve is not closing properly, that’s why some amount of the blood is leaking back into the left ventricular chamber during each contraction heart while pumping.

2.TMT test is absolutely normal.

In this regard, I would like to get some more clinical history from you.

Are you having any breathlessness while on exertion?

Are you having any palpitations?

Finally, I want you to go through the echo report once again and check whether the aortic valve information that you have given is correct or not and also check the ejection fraction of your left ventricle.

Come back with above-mentioned details.

Regards
dr.sivayogi

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Venkat Sivayogi (19 hours later)

Dear dr,

for the past 3 months i am having shortness of breath while exerting. i was having palpitation but i thought it was due to anxiety neurosis for which i am taking medicine sertaline and after quitting drinking, anxiety is under control.

for past 3 months i had dry cough and after check up doctor suggested chronic brnochallergy which is causing shortness of breath. he told me to follow up with a tmt and echo in order to reduce/quit REVELOL xl 50 - which i have been taking for hypertension fir past 4 years - after quitting drinking my bp is consistantly 110/70 .
doctor mentioned REVELOL will cause breath related problem and wanted to change/cut it down.
according to his suggestion i have done pft test with broncho dialater and result is showing as ''insignificant reversibility after bd therapy''.

echo result i am typing it below.

M-Mode:
IVSd - 1.0cm, LVIDd - 4.6cm,LPWd - 1.0cm, IVSs - 1.2cm, LVIDs - 3.0cm, LPVWs - 1.4cm, EDV (Teich) - 97ml, ESV (Teich) - 35ML, EF (Teich) - 65%, %FS - 35%, SV (Teich) - 62ML, Ao Diam -3.0cm, La Diam - 4.0cm, La/Ao - 1.32, D-E Excursion - 2.2cm, E-F slope - 0.05m/s

DOPPLER:

MV E Vel - 1.07m/s, MV DecT - 168m/s , MV Dec Slope - 6.3m/s^2 , MV A Vel - 0.58m/s, MV E/A Ratio - 1.83 , E' - 0.12M/S, E/E' - 9.23 , AV Vmax - 1.25m/s, AV maxPG - 6.28 mmHg , PV Vmax - 0.99m/s , PV maxPG - 3.91mmHg

2d and doppler findings;
Rhythum - sinus rhythm
Aortic valve - trileaflet with grade 2 AR
Mitral valve, tricuspid valve and pulmonic valve are normal
Left ventricle XXXXXXX dimensions, volume and wall thickness are normal
Left atrium , right ventricle and right atrium are normal
intact inter atrial and inter ventricular septum
NO LV/LA masses,vegetations or thrombus.
Main pulmonary artery and aorta are normal.
NO pericardial thickening and/or effusion

ECHO DIAGNOSIS:

Normal left ventricular systolic function
No resting regional wall motion abnormalities
Trileaflet aortic valve with grade 2 AR

TMT CONCLUSIONS:

GOOD EFFORT TOLERANCE
NORMAL HR AND BP RESPONSE. NO ANGINA/ARRHYTHMIAS
NO SIGNIFICANT ST-T CHANGES NOTED DURING EXCERCISE OR RECOVERY
IMP - STRESS TEST NEGATIVE FOR EXCERCISE INDUCIBLE ISCHEMIA

My regular doctor will only available on wednesday. Is it better to consult a cardiologist in between? or can i wait
For AR problems, only cure is surgery?

Have a nice day.

Regards, XXXXXXX

Answered by Dr. Venkat Sivayogi (1 hour later)

Hello, XXXXXXX

Thanks for the query. Now I got complete clinical data from your side.
I have been through all the investigations, but what I finally conclude is you are otherwise normal except that problem with the aortic valve- it's not closing properly - AR (aortic regurgitation).

Coming to the treatment of aortic regurgitation ,
1. Most patients who are a symptomatic with AR doesn't require any treatment
2. Patients with symptoms like breathlessness and palpitations should be treated with medically or surgically depending on the severity of symptoms .
But in your case , I see the ejection fraction of your left ventricle is 65% which is normal.
So my advise is that , propably you are having a mild severity , which can be managed with medical therapy. So consult a cardiologist and discuss the treatment options , after being examined clinically.

Hope this answer will clear your doubts,
If you need any further clarification get back to us,
Regards
DR.sivayogi

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Prasad