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What Do These Following MRI Findings Indicate?
Question: Question for Dr. XXXXXXX Makode if possible.
Please have the Dr. review all the past communication before answering these questions.
Recap- my wife developed a major problem with ectopics approx. 6 weeks ago. Tests showed she was having hundreds of them.
Since my last communication she spent 5 days in the hospital under observation. She has had multiple tests- holter monitor, echo cardio gram, XXXXXXX test, etc.
Her problem is that she cannot take the beta blockers of 25 mg. twice a day as the Dr. Prescribed. When she did her already low BP went down to 90/50 and her pulse dropped to 37 at times.
For the last 4 days the Dr. Has had her self medicating- taking 25mg. If she develops ectopics. She took them 3 times in 5 days and only once a day. Since doing that her pulse rate has come up to over 50 most of the time. She still has the problem of numbness in both arms and hands. When her pulse rate is up over 50 that seems to improve somewhat but has not gone away.
NEW TEST- her specialist sent her for an MRI of the heart- here are the results.
The thoracic aorta arises to the right of themain pulmonary artery and descends left sided. There is normal ventricular atrial concordance.There is normal drainage of the pulmonary veins into the left atrium and normal drainage of the superior inferior vena cava into the rt. Atrium. No identified atrial or ventricular septal defect.
The left ventricular myocardium is loosely trabeculated, but does not quite meet in the MRI criteria for no compaction syndrome.
The non-compacted myocardium is diffusely thinned at 2.4mm thickness in the mid intraventricular septum. There is dilation of the left ventricular chambers as given below with a normalised left ventricular and diastolic volume of 115ml/m2. There is very mild global hypokinesia with ejection fracture preserved at 53%.
Normal resting perfusion of the myocardium. No ventricular or atrial thrombus.
No focus of enhancement to suggest myocardial scar or an infiltrative cardiomyopathy.
There is trace mitral regurgitation. Normal closure of the remainder of the cardiac valves. Normal contraction and size of the right ventricle with no right ventricular regional wall motion abnormality. No pericardial thickening or pericardial effusion.
Left ventricle. Normal reference in females: mean range.
Parameter value > 60 yrs.
EDV(ml)----120. (78-162)
EDV/BSA. (Ml/m2)---69. (52-86)
ESV(ml). --- 38. (19-57)
ESV/BSA. (Ml/m2)------- 22. (13-31)
SV. (Ml). ------82. (54-110)
EF(%)--------69. (60-78)
Myocardial mass----- 110. (74-146)
Myocardial mass/BSA. (g/m2) ---------73. (56-90)
IMPRESSION-
1. No focus of enhancement to suggest myocardial scar or infiltrative cardiomyopathy.
2. Diffuse thinning of the left ventricular myocardium and increased chamber size suggests an idiopathic dilated cardiomyopathy.
END OF REPORT
My questions for the Dr. -
1. On a scale of 1-10. how serious is #2 above in comparison to an average 67 yr. old.
Will this problem continue to get worse if she looks after herself? Tough question I know.
The specialist says that if she can continue with the meta prolol-25mg. at night only that it will help to improve her heart . Do you agree with that?
Please answer my questions to your best knowledge-as you can imagine my wife is very concerned and needs to know if these problems usually advance with age or is it controllable.
3. Do you agree with the Dr. Concerning the meta prolog usage only at night and if she is able to do that do you feel it will affect her pulse rate and BP DURING THE DAY- as it is only supposed to last for 12 hrs.
Lots of question I know- thanks for your consideration.
Dr. XXXX
Please have the Dr. review all the past communication before answering these questions.
Recap- my wife developed a major problem with ectopics approx. 6 weeks ago. Tests showed she was having hundreds of them.
Since my last communication she spent 5 days in the hospital under observation. She has had multiple tests- holter monitor, echo cardio gram, XXXXXXX test, etc.
Her problem is that she cannot take the beta blockers of 25 mg. twice a day as the Dr. Prescribed. When she did her already low BP went down to 90/50 and her pulse dropped to 37 at times.
For the last 4 days the Dr. Has had her self medicating- taking 25mg. If she develops ectopics. She took them 3 times in 5 days and only once a day. Since doing that her pulse rate has come up to over 50 most of the time. She still has the problem of numbness in both arms and hands. When her pulse rate is up over 50 that seems to improve somewhat but has not gone away.
NEW TEST- her specialist sent her for an MRI of the heart- here are the results.
The thoracic aorta arises to the right of themain pulmonary artery and descends left sided. There is normal ventricular atrial concordance.There is normal drainage of the pulmonary veins into the left atrium and normal drainage of the superior inferior vena cava into the rt. Atrium. No identified atrial or ventricular septal defect.
The left ventricular myocardium is loosely trabeculated, but does not quite meet in the MRI criteria for no compaction syndrome.
The non-compacted myocardium is diffusely thinned at 2.4mm thickness in the mid intraventricular septum. There is dilation of the left ventricular chambers as given below with a normalised left ventricular and diastolic volume of 115ml/m2. There is very mild global hypokinesia with ejection fracture preserved at 53%.
Normal resting perfusion of the myocardium. No ventricular or atrial thrombus.
No focus of enhancement to suggest myocardial scar or an infiltrative cardiomyopathy.
There is trace mitral regurgitation. Normal closure of the remainder of the cardiac valves. Normal contraction and size of the right ventricle with no right ventricular regional wall motion abnormality. No pericardial thickening or pericardial effusion.
Left ventricle. Normal reference in females: mean range.
Parameter value > 60 yrs.
EDV(ml)----120. (78-162)
EDV/BSA. (Ml/m2)---69. (52-86)
ESV(ml). --- 38. (19-57)
ESV/BSA. (Ml/m2)------- 22. (13-31)
SV. (Ml). ------82. (54-110)
EF(%)--------69. (60-78)
Myocardial mass----- 110. (74-146)
Myocardial mass/BSA. (g/m2) ---------73. (56-90)
IMPRESSION-
1. No focus of enhancement to suggest myocardial scar or infiltrative cardiomyopathy.
2. Diffuse thinning of the left ventricular myocardium and increased chamber size suggests an idiopathic dilated cardiomyopathy.
END OF REPORT
My questions for the Dr. -
1. On a scale of 1-10. how serious is #2 above in comparison to an average 67 yr. old.
Will this problem continue to get worse if she looks after herself? Tough question I know.
The specialist says that if she can continue with the meta prolol-25mg. at night only that it will help to improve her heart . Do you agree with that?
Please answer my questions to your best knowledge-as you can imagine my wife is very concerned and needs to know if these problems usually advance with age or is it controllable.
3. Do you agree with the Dr. Concerning the meta prolog usage only at night and if she is able to do that do you feel it will affect her pulse rate and BP DURING THE DAY- as it is only supposed to last for 12 hrs.
Lots of question I know- thanks for your consideration.
Dr. XXXX
Brief Answer:
See the description
Detailed Answer:
hello,
Now, the Mri reports show that her mitral valve is ok, and she has trace MR. According to mri it's idiopathic DCM. She has very mild LV systolic dysfunction with slight thinning which is expected, rest of the parameters are Normal, not to be worried about.
Regarding prognosis, overall prognosis is good. We cant quantify it on 1 of 10, but nearly 1/3 patients deteriorate, have downhill course and in remaining 2/3, heart functions improve and have good life expectancy. So hope she ll fall into those 2/3, also her heart function is good, so likely she ll have good prognosis. Since we have caught it earlier stage, I think prognosis should be good only.
Secondly, regarding treatment, the heart function preserving drugs are beta blockers and ace inhibitor, which we have start and they are very important. Definitely, they will cause low bp, but we should begin them gradually and up titrate those. First, regarding Metoprolol xr or sustained release, doctor is right. Even if it's a sustained release the effect will be more pronounce in first 12 hrs, although it persists for 24 hrs but in next 12 hrs effect is very less. So taking it at night should help. I would suggest, start tab Metoprolol xr 25 mg at evening 8 O clock, 1-2 hr prior to sleep so that maximum effect will be during night time. Don't worry regarding low pulse rate, say even 40 during sleep is ok. If she is still symptomatic with that we will go on 12.5 mg.
Once she tolerated this, we ll have to add ace inhibitor like tab Ramipril 1.25 mg once a day. She ll need six monthly echo to monitor for function.
So overall, I think you should not worry much, she ll have a good course. We should definitely keep our efforts going. Hope this helps you and get back if you have any doubts. All the best.
See the description
Detailed Answer:
hello,
Now, the Mri reports show that her mitral valve is ok, and she has trace MR. According to mri it's idiopathic DCM. She has very mild LV systolic dysfunction with slight thinning which is expected, rest of the parameters are Normal, not to be worried about.
Regarding prognosis, overall prognosis is good. We cant quantify it on 1 of 10, but nearly 1/3 patients deteriorate, have downhill course and in remaining 2/3, heart functions improve and have good life expectancy. So hope she ll fall into those 2/3, also her heart function is good, so likely she ll have good prognosis. Since we have caught it earlier stage, I think prognosis should be good only.
Secondly, regarding treatment, the heart function preserving drugs are beta blockers and ace inhibitor, which we have start and they are very important. Definitely, they will cause low bp, but we should begin them gradually and up titrate those. First, regarding Metoprolol xr or sustained release, doctor is right. Even if it's a sustained release the effect will be more pronounce in first 12 hrs, although it persists for 24 hrs but in next 12 hrs effect is very less. So taking it at night should help. I would suggest, start tab Metoprolol xr 25 mg at evening 8 O clock, 1-2 hr prior to sleep so that maximum effect will be during night time. Don't worry regarding low pulse rate, say even 40 during sleep is ok. If she is still symptomatic with that we will go on 12.5 mg.
Once she tolerated this, we ll have to add ace inhibitor like tab Ramipril 1.25 mg once a day. She ll need six monthly echo to monitor for function.
So overall, I think you should not worry much, she ll have a good course. We should definitely keep our efforts going. Hope this helps you and get back if you have any doubts. All the best.
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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