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What Does My Lab Test Report Indicate?
Question: We have a family history of HCM on my paternal side. My father 56, myself 28 and my brother 26 years old got tested although we did not have any symptoms or problems through echocardiogram and our reports were all normal. No left ventricular hypertrophy and everything else normal.
However, my brother's report also mentioned sigmoid septum without left ventricular outflow obstruction and no LVH.
I looked sigmoid septum up and it seems to be normal in the elderly and my brother is only 26 years old ? How come ?
However, my brother's report also mentioned sigmoid septum without left ventricular outflow obstruction and no LVH.
I looked sigmoid septum up and it seems to be normal in the elderly and my brother is only 26 years old ? How come ?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would explain that you are right to be worried about your familiary history of hypertrophic cardiomyopathy, because HCM has a strong hereditary component.
It is true that the most specific and sensible cardiac tests for investigating HCM are : echography and additional imaging tests ( like cardiac MRI, cardiac CT scan, etc).
But in order to confirm any possible hereditary implication of a potential future HCM in family offsprings (when at least one of the parents is affected), it is necessary to perform genetic tests (when available in your reference hospital).
Now, returning to your brother's case, I would explain that the presence of sigmoid interventricular septum is not a diagnostic criteria of HCM.
In your brother's case it may be explained by an observer inaccuracy ( echo technician) in obtaining the proper investigational planes during cardiac ultrasound examination.
In such case, if enough suspicions are raised, a repeated echo test is recommended.
Another explanation for that echo finding may be a subtle myocardial fibers disrangement, but not sufficient enough to lead in HCM clinical scenario.
In this later case, additional imaging tests( cardiac MRI, etc) coupled with genetic testings are needed.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would explain that you are right to be worried about your familiary history of hypertrophic cardiomyopathy, because HCM has a strong hereditary component.
It is true that the most specific and sensible cardiac tests for investigating HCM are : echography and additional imaging tests ( like cardiac MRI, cardiac CT scan, etc).
But in order to confirm any possible hereditary implication of a potential future HCM in family offsprings (when at least one of the parents is affected), it is necessary to perform genetic tests (when available in your reference hospital).
Now, returning to your brother's case, I would explain that the presence of sigmoid interventricular septum is not a diagnostic criteria of HCM.
In your brother's case it may be explained by an observer inaccuracy ( echo technician) in obtaining the proper investigational planes during cardiac ultrasound examination.
In such case, if enough suspicions are raised, a repeated echo test is recommended.
Another explanation for that echo finding may be a subtle myocardial fibers disrangement, but not sufficient enough to lead in HCM clinical scenario.
In this later case, additional imaging tests( cardiac MRI, etc) coupled with genetic testings are needed.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Everything else on his report was normal except for trivial mitral reguiration that doctor said is nothing. He also said that the sigmoid septum is how his heart wall is shaped and some people have that and its normal.
As a cardiologist, do you see young healthy adults with sigmoid septum or its only in the elderly ?
As for myocardial disarrangement would that mean he has HCM but without hypertrophy ??
My brother is a heavy smoker but otherwise healthy and athletic no symptoms.
As a cardiologist, do you see young healthy adults with sigmoid septum or its only in the elderly ?
As for myocardial disarrangement would that mean he has HCM but without hypertrophy ??
My brother is a heavy smoker but otherwise healthy and athletic no symptoms.
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again dear Fatima!
I reviewed the uploaded cardiac ultrasound report and would explain that no any significant abnormality is present.
Trivial mitral regurgitation has no clinical significance and is frequently seen in normal young adults.
So, nothing to worry about!
Regarding sigmoid interventricular septum, though it predominates in elderly individuals, it may be seen also in younger adults.
In your brother's case, it doesn't seem to be a marker of any obvious cardiac disorder (cardiac wall thickness is normal, there is no left ventricular outflow obstruction).
In the presence of sigmoid septum, it has been shown that the left ventricular long axis and the ascending aorta is smaller than is other on sigmoid septum individuals.
Regarding myocardial disarrangement, we can not speculate on that matter.
As I explained you above, additional medical tests (cardiac imagine tests like cardiac MRI & CT, etc. coupled with specific genetic tests) could definitely clarify this issue.
Remember that slight and subtle myocardial fibers disarrangement (when present alone) is not a marker of HCM.
So, relax and don't worry about!
Hope I have clarified some of your major uncertainties.
In case of any further questions don't hesitate to ask me again.
Kind regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again dear Fatima!
I reviewed the uploaded cardiac ultrasound report and would explain that no any significant abnormality is present.
Trivial mitral regurgitation has no clinical significance and is frequently seen in normal young adults.
So, nothing to worry about!
Regarding sigmoid interventricular septum, though it predominates in elderly individuals, it may be seen also in younger adults.
In your brother's case, it doesn't seem to be a marker of any obvious cardiac disorder (cardiac wall thickness is normal, there is no left ventricular outflow obstruction).
In the presence of sigmoid septum, it has been shown that the left ventricular long axis and the ascending aorta is smaller than is other on sigmoid septum individuals.
Regarding myocardial disarrangement, we can not speculate on that matter.
As I explained you above, additional medical tests (cardiac imagine tests like cardiac MRI & CT, etc. coupled with specific genetic tests) could definitely clarify this issue.
Remember that slight and subtle myocardial fibers disarrangement (when present alone) is not a marker of HCM.
So, relax and don't worry about!
Hope I have clarified some of your major uncertainties.
In case of any further questions don't hesitate to ask me again.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for the detailed response.
How is myocardial fiber disrangement diagnosed is it by ultrasound ? And if so does my brother's report state if there is any sign of that ?
If young people can have sigmoid septum and as elderly will have sigmoid septum with time, would that mean my brother's septum will bulge further into the LV as he ages ?
How is myocardial fiber disrangement diagnosed is it by ultrasound ? And if so does my brother's report state if there is any sign of that ?
If young people can have sigmoid septum and as elderly will have sigmoid septum with time, would that mean my brother's septum will bulge further into the LV as he ages ?
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
Regarding myocardiac fiber disarrangement I would explain that imaging modalities like cardiac MRI are the best techniques for its clinical investigation.
Nevertheless, you should know that some degree of myocardiac fiber disarrangement are also seen in healthy normal individuals.
In addition, I would clarify that sigmoid septum is not a marker of future hypertrophic cardiomyopathy.
So, it would be impossible to scientifically predict a potential evolution toward septal bulging and left ventricular outflow tract abstraction in the future.
Hope to have been helpful to you!
Wishing all the best,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
Regarding myocardiac fiber disarrangement I would explain that imaging modalities like cardiac MRI are the best techniques for its clinical investigation.
Nevertheless, you should know that some degree of myocardiac fiber disarrangement are also seen in healthy normal individuals.
In addition, I would clarify that sigmoid septum is not a marker of future hypertrophic cardiomyopathy.
So, it would be impossible to scientifically predict a potential evolution toward septal bulging and left ventricular outflow tract abstraction in the future.
Hope to have been helpful to you!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Last question.
The same ultrasound tech did both mine and my brother's echo on the sane appointment. She did not mention sigmoid septum in mine. Is it possible that only in his case the investigational plane was improper to misinterpret straight as sigmoid ?
Based on your experience, is it common for a tech to have inaccurate image plane and state sigmoid septum ?
And as a cardiologist, roughly what percentage of young adults with normal hearts that you see have sigmoid septum ?
Thank you for the help.
The same ultrasound tech did both mine and my brother's echo on the sane appointment. She did not mention sigmoid septum in mine. Is it possible that only in his case the investigational plane was improper to misinterpret straight as sigmoid ?
Based on your experience, is it common for a tech to have inaccurate image plane and state sigmoid septum ?
And as a cardiologist, roughly what percentage of young adults with normal hearts that you see have sigmoid septum ?
Thank you for the help.
Brief Answer:
I would explain:
Detailed Answer:
Hello again, Fatima!
Theoretically speaking, there exists a possibility that sometimes a misinterpretation due to an improper measurement accuracy occur.
It is difficult for me to give an opinion on a tech accuracy, as in my institution cardiac ultrasounds are performed by certified cardiologists.
Regarding sigmoid septum in young adults, I would say that it is a rare finding in this age group (< 0.2%).
Best regards,
Dr. Iliri
I would explain:
Detailed Answer:
Hello again, Fatima!
Theoretically speaking, there exists a possibility that sometimes a misinterpretation due to an improper measurement accuracy occur.
It is difficult for me to give an opinion on a tech accuracy, as in my institution cardiac ultrasounds are performed by certified cardiologists.
Regarding sigmoid septum in young adults, I would say that it is a rare finding in this age group (< 0.2%).
Best regards,
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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