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What Do These Following Lab Reports Indicate?
Question: I am 53 yrs old male, non smoker, non drinker and healthy.I have been having some PVC's lately. I recently went for stress test, echo and holter monitor and blood tests.
Stress Test was good with 17 min. XXXXXXX protocol
Holter monitor shows sinus rhythm and 2% PVc's and no runs (quite stressed at night with holter on)
Blood tests are normal.
Here is Echo:
Aorta: 27mm, LA: 34mm, LVd: 38mm, VS: 7mm, PW: 7mm, LV mass: 72g, LVMI(g/m2): 44
LV E(cm/s) :63, LV A (cm/s): 59, LV E/A : 1.1, DT(ms): 206
LVEF: 58% ( sinus rhythm and I was quite relaxed.)
Report says Left and right ventricle sizes are normal, LV systolic function is mildly depressed (EF 58%). Right is normal and Atrial size is normal. Right atrial pressure is 3 mmHg. Left atrial volume index 25ml/m2.
My previous echo 10 yrs ago had almost same readings except LVd: was 40mm compared to 38mm and PW was 8mm compared to 7mm. My LVEF was 75% with sinus tachycardia ( I was extremely anxious).
I had meeting with cardiologist and he says my EF is mildly depressed and should be over 60%. I may have mild dilated cardiomyopathy and we should get MRI. I am ok with. I asked another cardiologist and he said 58% is perfectly normal and EF increases with stress and anxiety.
My question is: If I have cardiomyopathy, should my chamber sizes not increase or enlarge. In fact it shows slightly smaller than before (it was 40mm and now 38mm, wall thickness was 8mm and now 7mm). I was 17 min. on tread mill with no Ischemia.
Need some input as I was a bit confused and nervous.
Stress Test was good with 17 min. XXXXXXX protocol
Holter monitor shows sinus rhythm and 2% PVc's and no runs (quite stressed at night with holter on)
Blood tests are normal.
Here is Echo:
Aorta: 27mm, LA: 34mm, LVd: 38mm, VS: 7mm, PW: 7mm, LV mass: 72g, LVMI(g/m2): 44
LV E(cm/s) :63, LV A (cm/s): 59, LV E/A : 1.1, DT(ms): 206
LVEF: 58% ( sinus rhythm and I was quite relaxed.)
Report says Left and right ventricle sizes are normal, LV systolic function is mildly depressed (EF 58%). Right is normal and Atrial size is normal. Right atrial pressure is 3 mmHg. Left atrial volume index 25ml/m2.
My previous echo 10 yrs ago had almost same readings except LVd: was 40mm compared to 38mm and PW was 8mm compared to 7mm. My LVEF was 75% with sinus tachycardia ( I was extremely anxious).
I had meeting with cardiologist and he says my EF is mildly depressed and should be over 60%. I may have mild dilated cardiomyopathy and we should get MRI. I am ok with. I asked another cardiologist and he said 58% is perfectly normal and EF increases with stress and anxiety.
My question is: If I have cardiomyopathy, should my chamber sizes not increase or enlarge. In fact it shows slightly smaller than before (it was 40mm and now 38mm, wall thickness was 8mm and now 7mm). I was 17 min. on tread mill with no Ischemia.
Need some input as I was a bit confused and nervous.
just for information c-reactive protein on blood test was .3 mg/L
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I carefully reviewed all your uploaded medical reports and would like to explain that there are no evidences of any obvious cardiovascular disorders.
Your Holter monitoring reveals clinically nonsignificant (rare) isolated ectopic beats, without any complex arrhythmia events.
Also your cardiac stress test results normal without any signs of cardiac ischemia.
Regarding your cardiac ultrasound (ECHO), no abnormalities in cardiac structure and function are revealed. Those slight variations in dimensions (wall thickness, LV diameter) are just a consequence of interobserver variations which represents the level of measurement accuracy. It is quite acceptable to see some slight variations in ECHO reports.
But, in both cardiac ECHO, the diameters are within normal ranges and a dilated cardiomyopathy is categorically excluded (even a mild one). Your measured LV diameted are quite small even if you have a small body surface area. With those ECHO reports you don't need cardiac MRI to investigate a possible mild dilated cardiomyopathy, as it is quite nonlogical and impossible.
Now, returning to your LVEF values (58% and 75%), I would explain that their estimation is made only visually (as it is declared in echo reports), so they represent potential inaccuracies inhereted by the utilised method (visual estimation). Probably the real LVEF value may be somewhere in the middle of those two values.
Instead, either LV diameters or volumes (diastolic and systolic) should have been measured for an exact estimation of LVEF.
Nevertheless, both visually estimated LVEF values (58% and 75%) are within normal ranges (according to the current clinical guidelines), so you shouldn't worry about.
Coming to this point, I would advise you just to relax!
Your cardiac tests have resulted normal!
You look a healthy normal individual.
Hope you will find this answer helpful!
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I carefully reviewed all your uploaded medical reports and would like to explain that there are no evidences of any obvious cardiovascular disorders.
Your Holter monitoring reveals clinically nonsignificant (rare) isolated ectopic beats, without any complex arrhythmia events.
Also your cardiac stress test results normal without any signs of cardiac ischemia.
Regarding your cardiac ultrasound (ECHO), no abnormalities in cardiac structure and function are revealed. Those slight variations in dimensions (wall thickness, LV diameter) are just a consequence of interobserver variations which represents the level of measurement accuracy. It is quite acceptable to see some slight variations in ECHO reports.
But, in both cardiac ECHO, the diameters are within normal ranges and a dilated cardiomyopathy is categorically excluded (even a mild one). Your measured LV diameted are quite small even if you have a small body surface area. With those ECHO reports you don't need cardiac MRI to investigate a possible mild dilated cardiomyopathy, as it is quite nonlogical and impossible.
Now, returning to your LVEF values (58% and 75%), I would explain that their estimation is made only visually (as it is declared in echo reports), so they represent potential inaccuracies inhereted by the utilised method (visual estimation). Probably the real LVEF value may be somewhere in the middle of those two values.
Instead, either LV diameters or volumes (diastolic and systolic) should have been measured for an exact estimation of LVEF.
Nevertheless, both visually estimated LVEF values (58% and 75%) are within normal ranges (according to the current clinical guidelines), so you shouldn't worry about.
Coming to this point, I would advise you just to relax!
Your cardiac tests have resulted normal!
You look a healthy normal individual.
Hope you will find this answer helpful!
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. lliri. You are right, I am not a big man. I am about 165cm tall and 57 kg. I am quite active and play badminton three times a week and tread mill a couple of times a week. In my last echo 10 yrs ago PAP was 41and my cardiologist who has retired now told me to ignore that because echo is not reliable test for that and it is clinically insignificant. This time my PAP is 37. I am quite anxious by nature when it comes to going for any test. I believe it is white collar syndrome and my adrenaline level shoots up. In last echo I was quite anxious as my report shows sinus tachycardia. my heart rate was probably 130-140. This time somehow I was quite relaxed with heart rate probably 60-70. My normal at rest is around 60. I believe due to that tachycardia last echo had high EF readings. Due to my anxious nature even small variation makes me nervous. I believe I need to work on it.
Thank you again and I will be in touch if I have any other question.
Thank you again and I will be in touch if I have any other question.
Brief Answer:
You are welcome!
Detailed Answer:
Hello again,
As your medical tests have concuded normal findings without any clinical significant disorders, you shouldn't worry about.
The only advice to consider is to keep following a healthy life-style and diet.
I remain at your disposal for any further discussion (you can ask me directly).
Wishing you good health!
Regards,
Dr. Iliri
You are welcome!
Detailed Answer:
Hello again,
As your medical tests have concuded normal findings without any clinical significant disorders, you shouldn't worry about.
The only advice to consider is to keep following a healthy life-style and diet.
I remain at your disposal for any further discussion (you can ask me directly).
Wishing you good health!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. IIir:
Sorry I forgot to ask you something. As you have seen my echo reports and I am not a man with big BSA, are my ventricular sizes normal ( ie 38mm LV d and LV mass 72 g).
I understand that even with small variation in wall thickness of 1mm the calculation changes. I find that my size is in normal range with what has been set up for women. I have not read anything that says slightly smaller than normal range is not good. In my last echo 10 yrs ago LV d was 40mm and LV mass was 86g and PW thickness was 8mm compared to 7mm this time.
Also, since my holter shows 2% ectopic, is there any way to prevent them or treat them without medication.
Thanks for your help.
Sorry I forgot to ask you something. As you have seen my echo reports and I am not a man with big BSA, are my ventricular sizes normal ( ie 38mm LV d and LV mass 72 g).
I understand that even with small variation in wall thickness of 1mm the calculation changes. I find that my size is in normal range with what has been set up for women. I have not read anything that says slightly smaller than normal range is not good. In my last echo 10 yrs ago LV d was 40mm and LV mass was 86g and PW thickness was 8mm compared to 7mm this time.
Also, since my holter shows 2% ectopic, is there any way to prevent them or treat them without medication.
Thanks for your help.
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
Regarding your concern, I would explain that your ventricular size is quite normal for your BSA.
This is just a inter-observer variability.
So you have nothing to worry about it!
Regarding your ectopic heart beats, I would recommend some tips which can help reduce or prevent them:
1- reduce caffeine intake
2- Yoga
3- Meditation. If you experience palpitations, you can try to close your eyes and take a deep breath. It will help.
4- Perform a lot of physical activity (walking, aerobics, recreational sports, etc.).
I would also recommend avoiding straining physical activity.
Hope to have been helpful!
Regards,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
Regarding your concern, I would explain that your ventricular size is quite normal for your BSA.
This is just a inter-observer variability.
So you have nothing to worry about it!
Regarding your ectopic heart beats, I would recommend some tips which can help reduce or prevent them:
1- reduce caffeine intake
2- Yoga
3- Meditation. If you experience palpitations, you can try to close your eyes and take a deep breath. It will help.
4- Perform a lot of physical activity (walking, aerobics, recreational sports, etc.).
I would also recommend avoiding straining physical activity.
Hope to have been helpful!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you.
I have read several articles stating that Magnesium, D-Ribose, and L-Cartinine are helpful in palpitations. What is your opinion on this.
I have read several articles stating that Magnesium, D-Ribose, and L-Cartinine are helpful in palpitations. What is your opinion on this.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
I would like to explain that all these supplements have shown to be helpful in reducing palpitations.
Let me explain as follows:
1- Magnesium imbalance can lead to palpitations, especially when it is associated to calcium imbalance. That is why magnesium supplements have shown to reduce palpitations when there is a deficiency in magnesium. for this purpose, I would recommend checking plasma levels of magnesium and calcium, before taking these supplements.
2- D-Ribose is an energy source that the body makes from food. There is some evidence that supplemental ribose might prevent muscle fatigue in people with genetic disorders that prevent sufficient energy production by the body. It might provide extra energy to the heart during exercise in people with heart disease. But there is no clear data evidence that it can calm palpitations.
3-L-carnitine is beneficial for the heart since it receives almost 70 percent of its energy from the breakdown of fatty acids. Studies have shown that l-carnitine also helps to improve problems of the heart such as high blood pressure, angina and hardened arteries.
However, these supplements should not be used as a replacement for medications.
So, based on this information, it is up to you to decide if you want to try one of these drugs and see if they have a noticeable effect on your palpitations. They do not have any adverse effects. So you can easily try them and feel if it makes any difference.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
I would like to explain that all these supplements have shown to be helpful in reducing palpitations.
Let me explain as follows:
1- Magnesium imbalance can lead to palpitations, especially when it is associated to calcium imbalance. That is why magnesium supplements have shown to reduce palpitations when there is a deficiency in magnesium. for this purpose, I would recommend checking plasma levels of magnesium and calcium, before taking these supplements.
2- D-Ribose is an energy source that the body makes from food. There is some evidence that supplemental ribose might prevent muscle fatigue in people with genetic disorders that prevent sufficient energy production by the body. It might provide extra energy to the heart during exercise in people with heart disease. But there is no clear data evidence that it can calm palpitations.
3-L-carnitine is beneficial for the heart since it receives almost 70 percent of its energy from the breakdown of fatty acids. Studies have shown that l-carnitine also helps to improve problems of the heart such as high blood pressure, angina and hardened arteries.
However, these supplements should not be used as a replacement for medications.
So, based on this information, it is up to you to decide if you want to try one of these drugs and see if they have a noticeable effect on your palpitations. They do not have any adverse effects. So you can easily try them and feel if it makes any difference.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Sharka.
I am trying to ask as many questions as I can as part of my subscription.Just a couple more questions.
1.When you say that straining activity to be avoided. Is weight training straining?
I am trying to do some weight training to build some muscles.
2. Also, I read a couple of articles that sildenafil(viagra) may be associated with dilated cardiomyopathy since it promotes relaxation of blood vessels and dilation. What are your thoughts on this.
Thank you for your patience in answering my questions.
I am trying to ask as many questions as I can as part of my subscription.Just a couple more questions.
1.When you say that straining activity to be avoided. Is weight training straining?
I am trying to do some weight training to build some muscles.
2. Also, I read a couple of articles that sildenafil(viagra) may be associated with dilated cardiomyopathy since it promotes relaxation of blood vessels and dilation. What are your thoughts on this.
Thank you for your patience in answering my questions.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
With straining physical activity, I meant weight training too. So I would not recommend heavy weight lifting. But you can exercise yourself with small weights.
Regarding Sildenafil, it is true that it promotes relaxation of blood vessels and dilation. It produces favorable vasodilation in both pulmonary and systemic vascular beds with decrease in left ventricular filling pressures, in stable patients with dilated cardiomyopathy.
There is no any data based clinical evidence to support any related to sildenafil and dilated cardiomyopathy. But as I mentioned before, it can also be used in these patients. So, it is safe.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
With straining physical activity, I meant weight training too. So I would not recommend heavy weight lifting. But you can exercise yourself with small weights.
Regarding Sildenafil, it is true that it promotes relaxation of blood vessels and dilation. It produces favorable vasodilation in both pulmonary and systemic vascular beds with decrease in left ventricular filling pressures, in stable patients with dilated cardiomyopathy.
There is no any data based clinical evidence to support any related to sildenafil and dilated cardiomyopathy. But as I mentioned before, it can also be used in these patients. So, it is safe.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
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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