Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I carefully passed through your niece's medical history and would like to explain that her current health condition (low heart rate, mildly dilated RV) needs further clinical investigations.

- Her decreased heart rate may be just a simple sinus bradycardia not rarely encountered in physically very active normal young athletes.

Also such a low heart rate may occur in the presence of certain cardiac conductance disturbances. In order to clarify this issues would be necessary to review a resting ECG.

Could you upload any ECG of your niece here for a direct review and a more detailed professional opinion?

In addition, for a more thorough clinical investigation of her heart rhythm and the day-night trends of her heart rate, an ambulatory 24 t o48 hours ECG monitoring (Holter) is advisable.

- Regarding her mildly dilated RV, I would explain that first, it is necessary to carefully review an accurately performed cardiac ultrasound (ECHO) and confirm if it is really dilated (in relation to her age and body size).

Such a RV pattern may be due to several pathophysiological conditions:

a) athlete's heart, a condition seen in very active athletes. It is associated with some degree of heart chambers dilation and also hypertrophy.

It is not considered a pathological condition and no increased cardiac risk is revealed.

But before concluding athlete's heart syndrome it is necessary to exclude other pathological conditions, as follows:

b) a congenital heart disorder, which leads to blood shunt between right and left heart chambers, volume overload and chamber (ventricular) dilation. Also, congenital valve disorders (such as pulmonary valve stenosis may lead to RV dilation).

c) arhythmogenic right ventricular dysplasia, is associated with fibro-fatty replacement of RV muscle cells, leading to RV dilation and right heart failure. It is a serious heart condition and needs to be properly explored.

An accurate cardiac ultrasound (ECHO) and cardiac magnetic resonance imagine (MRI) would be helpful in determining such a disorder.

d) sometimes, though it is a very rare condition, idiopathic pulmonary artery hypertension may appear with some nonspecific complains and a mild RV dilation.

In such case, a careful cardiac ultrasound for confirming the increased systolic pulmonary artery hypertension, in the absence of a left heart dysfunction and other congenital heart disorders would help in clarifying the diagnosis.

Also, cardiac catheterization may be necessary should be performed, if sufficient suspicions in this regard are raised.

I recommend discussing with her attending doctor on the above mentioned
issues.

Meanwhile, I remain at your disposal for any further uncertainties and reviewing any available uploaded medical reports (ECG, ECHO, etc.).

Kind regards,

Dr. Iliri

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