Hi all,

I'm a little confused.

I asked my cardiologist for copies of my medical records today, because I am moving. In a report he wrote last October, he indicated that my echocardiogram showed increased wall thickening and "borderline left ventricular hypertrophy", but that my diastolic function was well within normal range.

In December, although I do not have these records, they did an echocardiogram, and I remember the cardiologist informing me that my heart walls were within normal range (I believe the range was .6 to 1.1, and mine was .9 for both heart walls). He said this was "normal", and on a follow up appointment, mentioned that the echo cardiogram done in October could have been a mixed reading and/or the machine could have been off.

He asked to see me in a year, and said keep exercising and losing weight. Is this a possible major problem? It seems left ventricular hypertrophy is a serious thing. I've had hypertension since I was 17, and am now 23, and I've been on medicine for it.

I had an EKG done today, and although normal by my doctor, she did say there was high voltage on V4 and V5, but that that can be normal for an athlete (I run a lot).

Why would these doctors ignore a possible borderline hypertrophy? And if it isn't a big deal, why write "borderline hypertrophy" in the first place?

Also, if the echocardiogram I had in December (3 months later) came back with normal heart wall thickness (I know the left ventrical was .9 or .09, I forget which, but he said this was normal range), does that mean I didn't have LVH at that point?

Thanks for any suggestions. I am moving to Boston next week and starting with a whole new set of doctors, and I'd prefer to know the truth to this. Are they just being nice and telling me not to worry so that I'll continue to lose weight and this won't be an issue, or is this a real problem?

Thanks,

Matt

MJ,

I have a feeling you posted on the wrong board. There are some of us here with cardiological issues resulting from our hypertension. Your question is more suitable for the heart disorders board. I don't know if the moderator will let it stand or move your post to the appropriate board.

Be happy that the thickness of your walls is normal. If they were abnormally thick, your cardiac output would be measurably worse and there would be at least some remodelling of your left ventricle. You would definitely know about it! Your normal ventricular function is also something to be happy about. Did the report evaluate your biventricular systolic function specifically? And, most importantly, what is your EF? That is a good indicator of damage, though not always. You would have been told about a lower than normal EF. You should find all this information in your echo report. Does your echo mention any remodelling of your LV? With your heart walls being normal, are your chamber sizes also normal?

Ventricular remodelling often reverses itself. Plenty of exercise and a heart healthy diet should help with that. With remodelling there's not a lot the doctors can do. At this point, yours is not a life threatening condition though it could potentially become one if your hypertension goes uncontrolled. I am glad to hear you are taking good care of yourself. :)

You can find a lot of information of the heart disorders board. There are some very knowledgable guys & gals there! The main thing is to KEEP your hypertension controlled to prevent further damage.

P.S. Maybe the machines gave an ""off"" reading? Or there might have been some slight damage initially which has since reversed itself?

Flowergirl

I originally posted in high blood pressure because that's what would cause this LVH :) I've had it since I was 19.

Anyway, I had an EKG done this morning. The nurse practioner who took it says it didn't look like anything was wrong, but i took it into my own hands.

Although my V4 looked higher (17-18mm), I followed the instructions for determining LVH that I found online.

"Take the wave of V1 and the wave of V5 and add them together. If the total is >= 35mm, this is a sign of LVH"

My total was 27mm-28mm .... is this "borderline", or can this be said as normal?

Either way, my OLD total was 32mm, so yes, this has come down.

But what's a normal V1/V5 QRS?

Thanks all,

Matt

Can anyone comment?

BTW, I should say that this is all because of hypertension. I've had hypertension since I was 19, I am now 23

mj,

I tried to make sense out of it all, but I'd need WEEKS to learn to read an EKG well; sorry.

If it's of any help, for precordial leads, an S wave in V1 exceeding 24 mm, an R wave in V5 or V6 exceeding 26 mm, or a sum of R wave in V5 or V6 and S wave in V2 of more than 35 mm are generally considered sufficient for diagnosis of left ventricular hypertrophy.
I am going to presume that anything less is "normal."

Nothing you have posted seems to be much reason for you to worry.
Good luck with the move, Boston is a lovely city...and you can train for the Marathon. :D

I originally posted in high blood pressure because that's what would cause this LVH :) I've had it since I was 19.

Anyway, I had an EKG done this morning. The nurse practioner who took it says it didn't look like anything was wrong, but i took it into my own hands.

Although my V4 looked higher (17-18mm), I followed the instructions for determining LVH that I found online.

"Take the wave of V1 and the wave of V5 and add them together. If the total is >= 35mm, this is a sign of LVH"

My total was 27mm-28mm .... is this "borderline", or can this be said as normal?

Either way, my OLD total was 32mm, so yes, this has come down.

But what's a normal V1/V5 QRS?

Thanks all,

Matt

Hi Matt,

Measurement of walls are somewhat subjective with an echo due to tech's inability to clearly define borders to a moving heart wall (fuzzy representation). An EKG is unreliable with a sensitivity rating of about 50% or less for chamber size... Critical geometrics resulting from the interaction of wall thickness and chamber dilation to appear on the EKG output is necessary for LVH.

IVS (interventrical septal thickness) normality is 0.6-1.1 cm. And LV wall is the same. For some athletes the septal measurement is higher, and normal left ventrical chamber dimension is 3.5-5.7 cm or 35-75 mm...27 mm is smaller than normal for men. Adult females have a smaller chamber size than men. Could be the measurement of a very small man?! Can't say it is normal or abnormal.

Voltage criteria for LVH is "R" or "S" in limb leads greater than 20 mm; S in V1 or V2 greater than 30 mm; R in V5 greater than 35mm. Correct calibration is 1 mv=10mm on the vertical axis...horizontal is msec. Additionally, there would be an ST-T abnormality and QRS interval of 0.9 sec.

I understand the rationale for a long duration of the QRS as appropriate to measure size (i.e. takes longer for the impulse to go from point A to point B). QRS complex and segments are wave form's amplitude and is variable from lead to lead, and the proximity of chest electrodes (leads) to the heart the greater the voltage. Very precisely measured an enlarged heart would be milli seconds closer thereby producing higher amplitude. Different leads produce different angles to the area in question and obviously different amplitues.

EKG software should do the calculations and produce the results.

Hi Matt,

Measurement of walls are somewhat subjective with an echo due to tech's inability to clearly define borders to a moving heart wall (fuzzy representation). An EKG is unreliable with a sensitivity rating of about 50% or less for chamber size... Critical geometrics resulting from the interaction of wall thickness and chamber dilation to appear on the EKG output is necessary for LVH.

IVS (interventrical septal thickness) normality is 0.6-1.1 cm. And LV wall is the same. For some athletes the septal measurement is higher, and normal left ventrical chamber dimension is 3.5-5.7 cm or 35-75 mm...27 mm is smaller than normal for men. Adult females have a smaller chamber size than men. Could be the measurement of a very small man?! Can't say it is normal or abnormal.

Voltage criteria for LVH is "R" or "S" in limb leads greater than 20 mm; S in V1 or V2 greater than 30 mm; R in V5 greater than 35mm. Correct calibration is 1 mv=10mm on the vertical axis...horizontal is msec. Additionally, there would be an ST-T abnormality and QRS interval of 0.9 sec.

I understand the rationale for a long duration of the QRS as appropriate to measure size (i.e. takes longer for the impulse to go from point A to point B). QRS complex and segments are wave form's amplitude and is variable from lead to lead, and the proximity of chest electrodes (leads) to the heart the greater the voltage. Very precisely measured an enlarged heart would be milli seconds closer thereby producing higher amplitude. Different leads produce different angles to the area in question and obviously different amplitues.

EKG software should do the calculations and produce the results.


Well, my ECG last year said "Minimal voltage criteria for LVH, may be normal variant".

Lately, they've all been saying "Normal ECG"

I know that my V1 is 10 mm, my V5 is about 17mm, and my V6 is about 15mm. So my V1 + V5 = 27mm, which is less than 35mm, which seems to make me okay, no?

Prior post ref briefly Cornell product that considers voltage times QRS duration for LVH.

To begin and referring to your more complicated calculation. But there is an easier method. LVH can be a positive (above the horizontal plane) in leads 1 or a VL (high lateral leads) greater than 11 mv. OR another method and the criteria you incompletely reference.

A value greater than 35 mv when you add the absolute value of the more negative of V1 or V2 (anterior leads) plus the more positive of V5 or V6 (low lateral leads).

For this more complex method, you will have to look at the Q or S in leads V1 and V2 and see which is more negative. Referenced in prior post. Take the absolute size of that complex and add it to the larger of and add it to the larger of R in V5 or V6. It goes something like that...complex. One criteria is sufficient to diagnose LVH.

See if "high lateral leads" are greater than 11 mv. Use conversion of mv to mm listed in prior post. I agree with Flowergirl, the probability is slim that you have LVH based on your age, history and present condition.

I'll be sending an invoice.:)

Wow...

"See if "high lateral leads" are greater than 11 mv. Use conversion of mv to mm listed in prior post. I agree with Flowergirl, the probability is slim that you have LVH based on your age, history and present condition."

That was originally different :) I almost flipped.

Alright, so with my current ECG, I'd say its safe to go to Boston.

You guys are pretty confident that working out, eating right, and losing weight, while maintaining a blood pressure constantly below (say 135/85), but mostly 120/80, should keep my heart in OK shape?

I'm down from 260 to 200, I still want to get to 170 which is where I should be. Hopefully that will help. And I'm also a complete vegetarian now too......

Any final comments on this would really help. I have to make my decision about Boston tonight, and to be honest, this paranoia about my heart and blood pressure is holding me back :(

-Matt