Brief Answer:
I would explain as follows:

Detailed Answer:
Hello XXXX!

Welcome and thank you for asking on HCM!

First of all I would like to congratulate you for the results of the nuclear stress test. it is a good news that despite you have coronary risk factors (hypertension, dyslipidemia, overweight, etc) you resulted normal in that provocative cardiac test for investigation of probable myocardial ischemia.

The advice for this above topic would be to keep properly controlling your blood pressure, treat dyslipidemia (through a healthy diet [I would recommend Mediterranean diet] and therapy [like statins]), control body weight, have a daily physically active life, avoid close smoking contacts, and always be aware of your glucose metabolism [check your fasting glucose and HbA1c periodically], etc). These measurements will lead you to longer and healthy life.


Now, let's turn to your principal concern: that cardiac echo report.

First of all, I would like to see an uploaded copy of the report to review the exact prescription and measurement numbers.

But, generally speaking, I could say that, in your case, there are several components explaining that echo report.

Your mild left atrial enlargement is explained with prolonged (for many years) systemic arterial hypertension which leads to left ventricular diastolic dysfunction and consequently to increased left atrial pressure during ventricular filling. This explains why left atrial enlargement occurs.

If your blood pressure is optimally controlled hereinafter, the left atrial enlargement will stop its obvious progression. This issue will not affect your life expectancy. So relax!

Regarding your moderate right ventricular enlargement it may be explained by several factors:

- sleep apnea, which leads to increased pulmonary arterial vascular resistance and hence to increased pulmonary artery pressure. This leads to right ventricular pressure overload and consequently to RV dilation. This may lead to eventual development of cor pulmonale and right heart failure. Proper treatment of sleep apnea with continuous positive pressure support (CPAP), treating obstruction with specific ENT procedures, and relieving bronchial and arterial components with underlying dilators with stop the progression of this disorder and its adverse implication on RV. If your RV dilation and dysfunction is not important, this entire scenario will not affect your daily physical performance and overall life expectancy.

But, it is important to properly quantify your RV overall performance (ejection fraction, myocardial performance index [MPI]). That's why a careful cardiac ultrasound for these measurements, coupled with estimation of pulmonary artery pressure are very important. Also, an arterial blood gas analysis and pulmonary function test are necessary. I believe that after the transesophageal echo and additional tests everything will be better clarified.

- Alcohol abuse for a prolonged period of time [several years] may lead to alcoholic cardiomyopathy. This is characterized by cardiac chamber dilation and decreased cardiac performance. Several arrhythmias may also be present. Atrial enlargement (coupled with possible atrial arrhythmia) is one of the most common finding in this clinical scenario. Also right ventricular dilation is frequently seen by several observation studies. If the etiological factor (that is alcohol) is avoided, and no important changes have occurred so far, then generally, the pathological progress will become attenuated. Sometimes a complete resolution of those adverse changes has been seen.

- overweight has been shown to adversely affect right heart chambers as well as the left ones. Right ventricular dilation has been reported in obese individuals, and has been a marker of potentially adverse complications. Concomitant pulmonary embolism bouts should be excluded by a pulmonary angio CT. If body weight comes properly controlled then these adverse effects will be largely avoided.

If you have performed additional tests, please upload them for a review!

I believe that, as you lack important clinical symptomatology and no clear evidence of increased pulmonary hypertension has been noted on the performed cardiac ultrasound, probably non significant changes have occurred. So, no important adverse implication in life expectancy as a consequence.

Nevertheless, I could give a better professional opinion, if you would be able to provide me with concrete medical information (uploaded data).

I hope to have been helpful in explaining you possible uncertainties.

In case of further dilemmas do not hesitate to contact me directly (see the underlying option).

Best regards,

Dr. Iliri

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Brief Answer:
Please try to upload again!

Detailed Answer:

Hi again, dear XXXX!

I couldn't find any uploaded files, though I have tried to re-open our discussion several times. Probably anything has gone wrong while uploading. Please try again to upload your test results, when you can!

You can also ask me directly, whenever you need on this link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Regards,

Dr. Iliri

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Brief Answer:
Just follow a healthy life profile!

Detailed Answer:

Hi XXXX!

I reviewed your uploaded echo report, nuclear stress test and primary care physician summary.

- Regarding your nuclear stress test report, I would say that it has concluded a perfectly normal coronary circulation physiology, a normal cardiac structure and function.

- Your echo report doesn't provide any further information regarding your right heart and pulmonary artery pressure quantification (in fact, I expected that these details would be clarified on the final report).

No values of RV diameter and trans-tricuspid pressure gradient are confirmed.

I hope that your transesophageal cardiac ultrasound will overcome this lack of evidence.

If you have a future detailed echo report, please send it to me for a professional review.

- Meanwhile your lab tests seem perfect, except for your blood lipid profile. I want to encourage you following a healthy diet, body weight control, an active life, and if that lipid profile persists (after about three months), I would recommend starting a lipid lowering therapy (a statin).

Wishing you good health!

Regards,

Dr. Iliri

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