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What Causes Different EF Level In Different Reports?
Question: Hi, I am 44yr male non smoker. I was diagnosed for DCMP and with EF 37%, based on echo test in the local hospital on 2014 feb (attached). Having the 2nd opinion doctor from different hospital, I had another echo with contrast in Singapore. The later echo told me that my EF 30% and WMSI 2.18 (attached). Which echo result do I need to trust? Please explain what made the result gap I received from these 2 different hospitals objectively.
Last night, I had another follow up echo test in the local hospital and the result told me that my EF 62% (which is, I think, normal and I am already cured). Should I trust this? Should I stick to which opinion? Please advise
Last night, I had another follow up echo test in the local hospital and the result told me that my EF 62% (which is, I think, normal and I am already cured). Should I trust this? Should I stick to which opinion? Please advise
Brief Answer:
please see below
Detailed Answer:
Dear sir
The reason for different EF in different reports could be either the EF has definitely changed over period of time or improper methodology in calculating EF.
Usually improvement in EF is associated with decrease in size of left ventricle and improvement in symptoms.
It may be prudent to get your serial ECHOs done from same cardiologist. Since there is a marked variation in reports, you may repeat the ECHO from the place where EF was given lowest, i.e. 30%.
Hope this helps.
Sincerely
Sukhvinder
please see below
Detailed Answer:
Dear sir
The reason for different EF in different reports could be either the EF has definitely changed over period of time or improper methodology in calculating EF.
Usually improvement in EF is associated with decrease in size of left ventricle and improvement in symptoms.
It may be prudent to get your serial ECHOs done from same cardiologist. Since there is a marked variation in reports, you may repeat the ECHO from the place where EF was given lowest, i.e. 30%.
Hope this helps.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Prasad
Dear doc,
I have 2 silly questions here:
1. Do you think, from your professional perspective, the increment of EF from 37% to 62% in 3 months is something reasonable? Do you see any possible errors made by either machine or the operator?
2. Should I follow your recommendation to do another echo in Singapore and receive big gap between the two, which one to trust?
3. The cardiologist is Singapore has asked me to consider addition CT angiogram a/heart MRI and ICD implantation, as explained in the different question before, would it wiser to hold these first until I get #2 above solved?
Please advise.
Thanks and regards,
I have 2 silly questions here:
1. Do you think, from your professional perspective, the increment of EF from 37% to 62% in 3 months is something reasonable? Do you see any possible errors made by either machine or the operator?
2. Should I follow your recommendation to do another echo in Singapore and receive big gap between the two, which one to trust?
3. The cardiologist is Singapore has asked me to consider addition CT angiogram a/heart MRI and ICD implantation, as explained in the different question before, would it wiser to hold these first until I get #2 above solved?
Please advise.
Thanks and regards,
Brief Answer:
plesse see below.
Detailed Answer:
Dear sir
It is possible both ways. You can have increase in EF from 30 to 60% as a part of natural history of disease or it may be a human error (not machine). Hence a clarification from a good cardiologist will help most.
Yes. Definitely, you should hold plans of ICD, CTAngio and MRI till the issue is sorted out.
Sincerely
Sukhvinder
plesse see below.
Detailed Answer:
Dear sir
It is possible both ways. You can have increase in EF from 30 to 60% as a part of natural history of disease or it may be a human error (not machine). Hence a clarification from a good cardiologist will help most.
Yes. Definitely, you should hold plans of ICD, CTAngio and MRI till the issue is sorted out.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doc,
I visited my cardiologist in jakarta 2 days ago (the one conducted the echo test recently) and he changed the medications as follow:
Furosemide 20mg 1xdaily
Trimetazidine 2 hcl 35mg 2xdaily
Spironolactone 25mg 1xdaily
Clopidogrel 75mg 1xdaily
Irbesartan 150mg 1xdaily
Bisoprolol hemifumaraten 5mg 1xdaily
Isosorbide mononitrate 60mg 1xdaily
L-carnitine fumarate 500mg coenzym Q10 100mg 1xdaily
I feel my BP is eventually going lower to 92/56 pulse 74bpm from normally 130/90. Also, I feel light shortness of breath, especially during rainy days (humid air).
I also asked about the clopidogrel and he insisted for me to keep taking them.
I'd like to know which medication causing my BP going lower? Should I stop taking them, as I feel some dizziness?
Please advise
Thanks and regards,
I visited my cardiologist in jakarta 2 days ago (the one conducted the echo test recently) and he changed the medications as follow:
Furosemide 20mg 1xdaily
Trimetazidine 2 hcl 35mg 2xdaily
Spironolactone 25mg 1xdaily
Clopidogrel 75mg 1xdaily
Irbesartan 150mg 1xdaily
Bisoprolol hemifumaraten 5mg 1xdaily
Isosorbide mononitrate 60mg 1xdaily
L-carnitine fumarate 500mg coenzym Q10 100mg 1xdaily
I feel my BP is eventually going lower to 92/56 pulse 74bpm from normally 130/90. Also, I feel light shortness of breath, especially during rainy days (humid air).
I also asked about the clopidogrel and he insisted for me to keep taking them.
I'd like to know which medication causing my BP going lower? Should I stop taking them, as I feel some dizziness?
Please advise
Thanks and regards,
Brief Answer:
please see below.
Detailed Answer:
Dear sir
The lowering of blood pressure may be caused by irbesartan , bisoprolol, furosemide and mononitrate. Hence it has to be modified as per the main intent of physician. If he wants to keep waterpill effect, then furosemide has to be kept. If heart failure is main concern then irbesartan will have to be kept.
The shortness of breath associated with humid weather is possibly due to your airway problem.
I don't advise you to change any medication on your own. Since you are having dizziness, you must discuss with your doctor.
Sincerely
Sukhvinder
please see below.
Detailed Answer:
Dear sir
The lowering of blood pressure may be caused by irbesartan , bisoprolol, furosemide and mononitrate. Hence it has to be modified as per the main intent of physician. If he wants to keep waterpill effect, then furosemide has to be kept. If heart failure is main concern then irbesartan will have to be kept.
The shortness of breath associated with humid weather is possibly due to your airway problem.
I don't advise you to change any medication on your own. Since you are having dizziness, you must discuss with your doctor.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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