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What Does My Echocardiogram Test Report Indicate?
Question: i have several questions about previous heart tests i wanted a 2nd opinion of how these results should be interpreted...here is my report from the initial stress test in 2014 i am very concerned about the present health of my heart and function particularly dilated cardiomyopathy - i am tired all the time, can't do a flight of stairs without heavy exertion, limited mobility and i can't exercise very long. Should i be worried about my heart specifically based on this test below? i am obese 5'11 370 lbs (bmi>50) former smoker, family history of heart disease, type 2 diabetic, hypertensive, have copd, asthma and severe sleep apnea. I'm concerned that the tests in 2014 seemed to show definite issues while the later test and imaging did not agree to some extent, results were interpreted as "better". although my symptoms have gotten much worse over that time period.
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est: STRESS ECHOCARDIOGRAM
Resulted Date: 6/23/2014 Status: Final Result
Addendum:Narrative
Exercise Stress Echocardiogram Report
Name: RAINWATER, XXXXXXX Study Date: 06/23/2014 Height: 71 in
MRN: 0000 Patient Location: PMCADIKA Weight: 333 lb
DOB: 07/26/1969 Gender: Male BSA: 2.6 m2
Age: 44 yrs
Ordering Physician: TAO, XXXXXXX Performed By: XXXXXXX Harper
Interpretation Summary
1. No clear echocardiographic evidence of exercise-induced ischemia. However very poor functional capacity with ischemic ECG changes
2. Normal resting LV systolic function
3. Mild left ventricular hypertrophy with mild left atrial enlargement
Protocol: The patient exercised for 3:36 min. using the XXXXXXX protocol.
Reason for Stopping: The test was stopped secondary to leg fatigue.
Parameters: The maximal heart rate achieved was 152 bpm. The maximal predicted heart rate achieved was 176 %. The METS achieved was 4.6.
Blood Pressure: The patient had normal resting blood pressure and normal response to stress.
Arrhythmia: PVCs including and patterns of ventricular trigeminy in recovery.
ECG Rest: Baseline ECG shows LVH voltage with repolarization abnormality.
ECG Stress: 1.5 mm horizontal ST depression in the inferolateral leads. Specificity of this finding is reduced to do to the baseline repolarization abnormality.
Rest Echo: The ejection fraction estimate is 65-70%. The left ventricular wall motion is normal.
Stress Echo: The ejection fraction estimate is >70%. Post stress all segments improve.
Baseline 2-D/ Doppler: Mild left ventricular hypertrophy. The left atrium is mildly dilated.
MMode/2D Measurements & Calculations
IVSd: 1.4 cm Ao root diam: 3.4 cm
Ao root area: 8.9 cm2
ACS: 2.1 cm
LA dimension: 4.1 cm
------------------------------------------
the 2nd exam i had was a stress test the following year in 2015 but was not conclusive so they ordered an imaging SPECT. here is that report:
Test: NM Myocardial Perfusion Scan
Resulted Date: 1/27/2015 Status: Final Result
Addendum:Narrative:
Myocardial perfusion scan (Rest/Stress single isotope SPECT imaging)
Procedure:
The patient received 6.6 mCi of Tc-99m sestamibi at rest IV on 1/27/15. The patient then exercised for 4 minutes 30 seconds on a XXXXXXX protocol. One minute before peak exercise, the patient received 32 mCi of Tc-99m sestamibi.
The ECG during the exercise stress study shows no evidence of ischemia.
SPECT images were performed on the stress and rest portions of this study. Polar map images were assessed with a normal patient data base using the Cedar Sinai software.
Gating was performed on the stress portion of the study for assessment of LVEF, wall motion and wall thickening. Analysis was with the QGS software.
Findings:
The overall quality of study is fair.
Gated SPECT images demonstrate that the left ventricular ejection fraction was calculated to be 61% (>50% is normal). The wall motion and wall thickening are normal. The left ventricle does not dilate with stress.
The perfusion images show normal myocardial perfusion at rest and with stress.
The summed stress score was 0 (summed stress score >13 is severely abnormal, 8-13 moderately abnormal, 5-8 mildly abnormal and 3 or less is normal). This was done using the Cedar Sinai 20 segment method. Summed rest score was 0.
Impression:
1. Normal myocardial perfusion scan with no evidence of ichemia.
2. The left ventricular ejection fraction is 61%, with normal wall motion.
Dictated and signed by: XXXXXXX S XXXXXXX MD 1/27/2015 6:02 PM
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thanks! XXXXXXX
--------
est: STRESS ECHOCARDIOGRAM
Resulted Date: 6/23/2014 Status: Final Result
Addendum:Narrative
Exercise Stress Echocardiogram Report
Name: RAINWATER, XXXXXXX Study Date: 06/23/2014 Height: 71 in
MRN: 0000 Patient Location: PMCADIKA Weight: 333 lb
DOB: 07/26/1969 Gender: Male BSA: 2.6 m2
Age: 44 yrs
Ordering Physician: TAO, XXXXXXX Performed By: XXXXXXX Harper
Interpretation Summary
1. No clear echocardiographic evidence of exercise-induced ischemia. However very poor functional capacity with ischemic ECG changes
2. Normal resting LV systolic function
3. Mild left ventricular hypertrophy with mild left atrial enlargement
Protocol: The patient exercised for 3:36 min. using the XXXXXXX protocol.
Reason for Stopping: The test was stopped secondary to leg fatigue.
Parameters: The maximal heart rate achieved was 152 bpm. The maximal predicted heart rate achieved was 176 %. The METS achieved was 4.6.
Blood Pressure: The patient had normal resting blood pressure and normal response to stress.
Arrhythmia: PVCs including and patterns of ventricular trigeminy in recovery.
ECG Rest: Baseline ECG shows LVH voltage with repolarization abnormality.
ECG Stress: 1.5 mm horizontal ST depression in the inferolateral leads. Specificity of this finding is reduced to do to the baseline repolarization abnormality.
Rest Echo: The ejection fraction estimate is 65-70%. The left ventricular wall motion is normal.
Stress Echo: The ejection fraction estimate is >70%. Post stress all segments improve.
Baseline 2-D/ Doppler: Mild left ventricular hypertrophy. The left atrium is mildly dilated.
MMode/2D Measurements & Calculations
IVSd: 1.4 cm Ao root diam: 3.4 cm
Ao root area: 8.9 cm2
ACS: 2.1 cm
LA dimension: 4.1 cm
------------------------------------------
the 2nd exam i had was a stress test the following year in 2015 but was not conclusive so they ordered an imaging SPECT. here is that report:
Test: NM Myocardial Perfusion Scan
Resulted Date: 1/27/2015 Status: Final Result
Addendum:Narrative:
Myocardial perfusion scan (Rest/Stress single isotope SPECT imaging)
Procedure:
The patient received 6.6 mCi of Tc-99m sestamibi at rest IV on 1/27/15. The patient then exercised for 4 minutes 30 seconds on a XXXXXXX protocol. One minute before peak exercise, the patient received 32 mCi of Tc-99m sestamibi.
The ECG during the exercise stress study shows no evidence of ischemia.
SPECT images were performed on the stress and rest portions of this study. Polar map images were assessed with a normal patient data base using the Cedar Sinai software.
Gating was performed on the stress portion of the study for assessment of LVEF, wall motion and wall thickening. Analysis was with the QGS software.
Findings:
The overall quality of study is fair.
Gated SPECT images demonstrate that the left ventricular ejection fraction was calculated to be 61% (>50% is normal). The wall motion and wall thickening are normal. The left ventricle does not dilate with stress.
The perfusion images show normal myocardial perfusion at rest and with stress.
The summed stress score was 0 (summed stress score >13 is severely abnormal, 8-13 moderately abnormal, 5-8 mildly abnormal and 3 or less is normal). This was done using the Cedar Sinai 20 segment method. Summed rest score was 0.
Impression:
1. Normal myocardial perfusion scan with no evidence of ichemia.
2. The left ventricular ejection fraction is 61%, with normal wall motion.
Dictated and signed by: XXXXXXX S XXXXXXX MD 1/27/2015 6:02 PM
-----
thanks! XXXXXXX
Brief Answer:
No dilated cardiomyopathy, shown by both tests
Detailed Answer:
Greetings, Mr. XXXXXXX and welcome to HCM. I understand your concern. Thank you for your question.
I can see that your heart was tested and evaluated in resting state and in increased workload state, both by exercise and using radionuclides with imaging. So far, from the data I carefully went through, there is no any sign of dilated cardiomyopathy, explained by the normal ejection fraction of the left ventricle. The mild hypertrophy of the left ventricle is found at least in half of people of the world, at your age. It is merely a long-standing compensatory mechanism which heart exerts due to various types of physical and psychological stress in a lifetime. Your coronary arteries also seem to be clean with no blockages, because if there were blockages, stress test with exercise and imaging would show changes in EKG and/or exercise capacity.
Indeed, the listed accompanying disorders you have are risk factors for coronary artery disease, but, in your case, and I am saying this based on your age (because you are not a 75 year old), the only "true" risk factor is the genetic factor for heart disease. The other disorders you listed are closely related to the morbid obesity you have, including diabetes and hypertension. Therefore, it is mandatory to reduce several pounds in your weight, and it is only than when may compare these parameters with the ones when you lose weight, so that we can conclude if these disorders are present and not related to obesity. My opinion is that obesity is causing these. Although, nothing to be worried about, as weight can be dropped. I can reassure you once more, that the heart problems you are concerned about, are not present. At this point, I would recommend you to seek attention and consults with two specialities:
- an endocrinologist - to properly evaluate and treat the obesity, whether it is coming by a "hidden" endocrine system disorder, and whether a detailed diet change carefully described by a dietitian;
- a pulmonologist - to properly treat your sleep apnea, which is a result of morbid obesity, and probably being helped by oxygen supplement during sleep.
I hope I am helpful with my answer. I am happy to help, if you have follow-up questions.
Best regards,
Dr. Meriton
No dilated cardiomyopathy, shown by both tests
Detailed Answer:
Greetings, Mr. XXXXXXX and welcome to HCM. I understand your concern. Thank you for your question.
I can see that your heart was tested and evaluated in resting state and in increased workload state, both by exercise and using radionuclides with imaging. So far, from the data I carefully went through, there is no any sign of dilated cardiomyopathy, explained by the normal ejection fraction of the left ventricle. The mild hypertrophy of the left ventricle is found at least in half of people of the world, at your age. It is merely a long-standing compensatory mechanism which heart exerts due to various types of physical and psychological stress in a lifetime. Your coronary arteries also seem to be clean with no blockages, because if there were blockages, stress test with exercise and imaging would show changes in EKG and/or exercise capacity.
Indeed, the listed accompanying disorders you have are risk factors for coronary artery disease, but, in your case, and I am saying this based on your age (because you are not a 75 year old), the only "true" risk factor is the genetic factor for heart disease. The other disorders you listed are closely related to the morbid obesity you have, including diabetes and hypertension. Therefore, it is mandatory to reduce several pounds in your weight, and it is only than when may compare these parameters with the ones when you lose weight, so that we can conclude if these disorders are present and not related to obesity. My opinion is that obesity is causing these. Although, nothing to be worried about, as weight can be dropped. I can reassure you once more, that the heart problems you are concerned about, are not present. At this point, I would recommend you to seek attention and consults with two specialities:
- an endocrinologist - to properly evaluate and treat the obesity, whether it is coming by a "hidden" endocrine system disorder, and whether a detailed diet change carefully described by a dietitian;
- a pulmonologist - to properly treat your sleep apnea, which is a result of morbid obesity, and probably being helped by oxygen supplement during sleep.
I hope I am helpful with my answer. I am happy to help, if you have follow-up questions.
Best regards,
Dr. Meriton
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your thorough review of my test results and feedback - this is certainly relieving. One of my primary motivations in getting this feedback from you is that I am considering bariatric surgery - in fact I am meeting with the surgeon to begin phase 2 of the process next week. I just want to be as well informed as I can when I go see him, to be able to ask the best questions. Yes, I need to lose almost 200 pounds. I gained 150 lbs from 2004-2007 when taking Seroquel for bipolar disorder and I haven't been able to manage my weight since, it's like it just went nonlinearly out of control. The loss of capacity to be active has been very frustrating - before the extreme weight gain i was an all star high school & college athlete in 3 sports and lived on a farm so I never had problems with fitness - but since it has been a real struggle. I'm optimistic about the bariatric procedure potential and now knowing my heart should be OK to survive gastric bypass surgery and recovery is really what I needed to be sure of. Well, there are always risks but at least now I'm more well informed about the heart condition. My surgeon will certainly take every precaution before doing it, but this gives me advanced peace of mind. I do appreciate your review and thoughtful response. Thanks again and best wishes to you! Wish me luck!!
Brief Answer:
I am glad I was helpful
Detailed Answer:
Hi again, Mr. XXXXXXX
Of course I will wish you the best of luck with your procedure. Although there are no surgical procedure without risks, I have faith that everything will go well.
Once again, I am glad I was of help. Kindly, close the discussion and rate my answer.
Good luck and best regards,
Dr. Meriton
I am glad I was helpful
Detailed Answer:
Hi again, Mr. XXXXXXX
Of course I will wish you the best of luck with your procedure. Although there are no surgical procedure without risks, I have faith that everything will go well.
Once again, I am glad I was of help. Kindly, close the discussion and rate my answer.
Good luck and best regards,
Dr. Meriton
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Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
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