Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Do My Lab Test Reports Indicate?
Question: Very concerned my EF is falling after latest echo showed various EF readings from 56 to 60 when prior echoes just in last couple of months read 60 and a nuclear stress test 7 weeks ago showed EF of 63.
Also frightened I could be retaining water because my BNP last week was 12 but proBNP was 67. I know they are not the same test but I read the number is similar in healthy people. I'm afraid every time I drink water, thinking I'll retain the water.
I had a PVC-induced cardiomyopathy last year which reversed with an ablation. I was on lisinopril 5 mg and carvedilol 9.375 twice a day but lisinorpril was withdrawn almost 4 months ago and carvedilol is being tapered off- currently down to 6.25 twice a day.
Reports are attached. I'm particularly frightened that most recent echo with 3 different EF readings shows a decline in EF as previous echoes just say 60. Is it likely unchanged as newest echo still has a reading of 60 in one view?
I know anxiety is playing a huge role but I was so sick with cardiomyopathy and yet really had no symptoms so I'm terrified of EF decline.
Also frightened I could be retaining water because my BNP last week was 12 but proBNP was 67. I know they are not the same test but I read the number is similar in healthy people. I'm afraid every time I drink water, thinking I'll retain the water.
I had a PVC-induced cardiomyopathy last year which reversed with an ablation. I was on lisinopril 5 mg and carvedilol 9.375 twice a day but lisinorpril was withdrawn almost 4 months ago and carvedilol is being tapered off- currently down to 6.25 twice a day.
Reports are attached. I'm particularly frightened that most recent echo with 3 different EF readings shows a decline in EF as previous echoes just say 60. Is it likely unchanged as newest echo still has a reading of 60 in one view?
I know anxiety is playing a huge role but I was so sick with cardiomyopathy and yet really had no symptoms so I'm terrified of EF decline.
Brief Answer:
Good results, no deterioration is possible
Detailed Answer:
Dear Mrs,
I went thoroughly through your history and documents attached; good news, you are absolutely healthy with very good results of examinations. I would like emphasize some points;
1. about the ejection fraction, usually there are variations on ejection fraction from physician to physician, from technique to technique, even the same physician, when measuring ejection fraction can have up to 3 % differences in the same patient. There are differences in ejection fractions, when measured with different techniques, such as 2D echocardiography, 3D echocardiography, SPECT, CMR, ventriculography, etc. 5% deviations are normal. A study was conducted recently in experienced European and US hospitals, which found out such variations even among the most experienced sonographers.
So you have nothing to worry, you have excellent ejection fraction. Usually we look not only to ejection fraction, but also another parameters, as a entirety. And as a physician who performs many echos a day, I would say, you have quite good parameters.
2. You have excellent treadmill results, which rules out any heart failure.
3. You know that BNP and NT-pro BNP have different cut off values, and your results are within normal ranges, so heart failure and any deterioration is excluded.
4. In arrhythmia induced cardiomyopathies after cessation of arrhythmias, heart can return to it's normal dimensions and function.
As a conclusion I would say, that based on all the examinations provided, I would say, that you are healthy. Even if you had a cardiomyopathy in the past, now everything is OK with your heart and there will be no deterioration.
Take care
Regards,
Good results, no deterioration is possible
Detailed Answer:
Dear Mrs,
I went thoroughly through your history and documents attached; good news, you are absolutely healthy with very good results of examinations. I would like emphasize some points;
1. about the ejection fraction, usually there are variations on ejection fraction from physician to physician, from technique to technique, even the same physician, when measuring ejection fraction can have up to 3 % differences in the same patient. There are differences in ejection fractions, when measured with different techniques, such as 2D echocardiography, 3D echocardiography, SPECT, CMR, ventriculography, etc. 5% deviations are normal. A study was conducted recently in experienced European and US hospitals, which found out such variations even among the most experienced sonographers.
So you have nothing to worry, you have excellent ejection fraction. Usually we look not only to ejection fraction, but also another parameters, as a entirety. And as a physician who performs many echos a day, I would say, you have quite good parameters.
2. You have excellent treadmill results, which rules out any heart failure.
3. You know that BNP and NT-pro BNP have different cut off values, and your results are within normal ranges, so heart failure and any deterioration is excluded.
4. In arrhythmia induced cardiomyopathies after cessation of arrhythmias, heart can return to it's normal dimensions and function.
As a conclusion I would say, that based on all the examinations provided, I would say, that you are healthy. Even if you had a cardiomyopathy in the past, now everything is OK with your heart and there will be no deterioration.
Take care
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much! So given the 60 in one view on newest echo would it be accurate to say that EF is still about 60 even understanding that this can vary as you have pointed out? And it is normal to have different results on BNP and proBNP without any significance if both are normal? I read that proBNP is optimally below 50 and mine was 67. But does normal echo rule out heart issues causing a rise in BNP?
My anxiety is so high because even at EF 25-30 I didnt have many symptoms so I feel
Like I wouldn't know if I got sick
Again unless I keep getting many many tests frequently.
My anxiety is so high because even at EF 25-30 I didnt have many symptoms so I feel
Like I wouldn't know if I got sick
Again unless I keep getting many many tests frequently.
Brief Answer:
Welcome back
Detailed Answer:
Dear Mrs,
If a patient has normal heart dimensions, normal heart valve function, ejection fraction more than 55%, not elevated BNP, or NT BNP levels, which is in your case, then heart failure is excluded. We can consider rise in BNP, then it exceeds the upper limit of normal range, but you have normal values, and variations within these normal ranges are not significant.
From all your examinations, I could conclude your ejection fraction is nearly 60%, very good.
It is normal to have different values of BNP and NT pro-BNP, in your case they both are within normal ranges.
There is no risk of developing heart failure in your case.
Don't worry so much, there is no need for so frequent examinations.
Regards,
Welcome back
Detailed Answer:
Dear Mrs,
If a patient has normal heart dimensions, normal heart valve function, ejection fraction more than 55%, not elevated BNP, or NT BNP levels, which is in your case, then heart failure is excluded. We can consider rise in BNP, then it exceeds the upper limit of normal range, but you have normal values, and variations within these normal ranges are not significant.
From all your examinations, I could conclude your ejection fraction is nearly 60%, very good.
It is normal to have different values of BNP and NT pro-BNP, in your case they both are within normal ranges.
There is no risk of developing heart failure in your case.
Don't worry so much, there is no need for so frequent examinations.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much. So changes cannot happen overnight so no need to recheck proBNP or worry that EF is declining? I get so frightened if I feel a single PVC (I had 65,000 a day before ablation) or or if it seems I am not urinating enough in case I am retaining water. It was such a shocking diagnosis and most of my doctors have never encountered PVC cardiomyopathy before so they are not in agreement about if I need to be maintained on medication and how carefully I need to be monitored. I know it's irrational but I only can be reassured with tests. Thank you for your reassurance that I am stable.
Brief Answer:
Welcome back
Detailed Answer:
Dear Mrs,
In your case the only test than I would recommend is holter monitoring once in a six months for 2 years, if PVCs and PACs are less than 1,000 a day, after 2 years once a year. Echo can be repeated once a year, but if it is normal now, I think it will not deteriorate.
In case there are PVCs more than 200 a day, you can continue with beta blocker, but there is nothing to worry.
You recovered without any sequelae, so have very good prognosis.
Regards,
Welcome back
Detailed Answer:
Dear Mrs,
In your case the only test than I would recommend is holter monitoring once in a six months for 2 years, if PVCs and PACs are less than 1,000 a day, after 2 years once a year. Echo can be repeated once a year, but if it is normal now, I think it will not deteriorate.
In case there are PVCs more than 200 a day, you can continue with beta blocker, but there is nothing to worry.
You recovered without any sequelae, so have very good prognosis.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much, doctor. You seem very knowledgeable about pvc-induced cardiomyopathy. Because my doctors have had limited experience with it, I have been overwhelmed with anxiety.
So I shouldn't worry about infrequent PVCs? On holters since ablation I've had about 20-50. My EP says it will only be a problem if I get over 20,000 and he would do another ablation only if it got that bad.
I appreciate your explaining that there is more to consider than just the EF. I am so afraid of cardiomyopathy returning that I imagine it can happen overnight. I know I need to relax and I even worry that my fear will make cardiomyopathy come back.
One last question- one of my cardiologists had told me that cardiomyopathy is never curable and that I would always need to be vigilant about drinking water and fluid retention so I'm always worried about drinking and not urinating enough. If my heart, kidneys, and liver are all functioning normally is this impossible? It has made my life very difficult.
Thank you so much. I wish my doctors were as knowledgebable as you are about my condition.
So I shouldn't worry about infrequent PVCs? On holters since ablation I've had about 20-50. My EP says it will only be a problem if I get over 20,000 and he would do another ablation only if it got that bad.
I appreciate your explaining that there is more to consider than just the EF. I am so afraid of cardiomyopathy returning that I imagine it can happen overnight. I know I need to relax and I even worry that my fear will make cardiomyopathy come back.
One last question- one of my cardiologists had told me that cardiomyopathy is never curable and that I would always need to be vigilant about drinking water and fluid retention so I'm always worried about drinking and not urinating enough. If my heart, kidneys, and liver are all functioning normally is this impossible? It has made my life very difficult.
Thank you so much. I wish my doctors were as knowledgebable as you are about my condition.
Brief Answer:
Welcome back
Detailed Answer:
Dear Mrs,
You should know that PVC induced cardiomyopathy has favorable outcome if treated on time. Once there is a recovery, it can worsen only in case of relapse of arrhythmias. You doctor is right, you need more than 20.000 PVCs, to develop another cardiomyopathy. But if you have only 20-50 PVC a day, it is not likely.
You should know that we lose liquid not only with urination, but also with sweating and respiration. In summer we lose much liquid with sweating, so we have less urine.
Just relax and don't worry.
Take care,
Welcome back
Detailed Answer:
Dear Mrs,
You should know that PVC induced cardiomyopathy has favorable outcome if treated on time. Once there is a recovery, it can worsen only in case of relapse of arrhythmias. You doctor is right, you need more than 20.000 PVCs, to develop another cardiomyopathy. But if you have only 20-50 PVC a day, it is not likely.
You should know that we lose liquid not only with urination, but also with sweating and respiration. In summer we lose much liquid with sweating, so we have less urine.
Just relax and don't worry.
Take care,
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
