Need your thoughts, I received a copy of my echo from last week and everything looks good within normal range with the exception of my left atium which was enlarged to 4.9 cm. No one seemed concerned and explained it could just be due to my daily exercise program. Even the LVH that they made a point of telling me about on the phone was only borderline and not a problem. EF is 63%, normal wall motion throughout, all other chambers and walls within normal size and function, all valves good except trace leakage in my tricuspid valve, everything else normal. I am a 49 yearl old male, non smoker, no early onset CAD history in family, blood pressure and cholesterol controlled.

How big of a deal is an enlarged LA?

Thanks in advance for your input.

Tony

Need your thoughts, I received a copy of my echo from last week and everything looks good within normal range with the exception of my left atium which was enlarged to 4.9 cm. No one seemed concerned and explained it could just be due to my daily exercise program. Even the LVH that they made a point of telling me about on the phone was only borderline and not a problem. EF is 63%, normal wall motion throughout, all other chambers and walls within normal size and function, all valves good except trace leakage in my tricuspid valve, everything else normal. I am a 49 yearl old male, non smoker, no early onset CAD history in family, blood pressure and cholesterol controlled.

How big of a deal is an enlarged LA?

Thanks in advance for your input.

Tony

Tony, apparently from your posted results it appears there is no mitral valve stenosis or any other condition that would cause LAE. The cause may be unknown (ideopathic) and sometimes an athlete has an enlarged atrium. Normal dimension is 1.9-4.0.

The concern would be the risk of atrial fibrilation with LAE. An EKG would be helpful to determine "P" wave duration. A long duration (120 msec) would be a sign of a conduction delay and that can cause arrhythmia. Was there an EKG prior to the echo?

An arrhythmia risk aside the other concern would be an increase in left ventricle size and a falling EF percentage. That appears to be under control. My source comments blood pressure should be controlled and a good heart failure regimen (if there is a concern)?.

kenkeith,

There is no concern of CHF. I just had not had an echo in the last 18 months and when I saw my cardiologist a couple of weeks ago for my annual check up for my blood pressure meds, she thought it would be a good idea to have an echo to "make sure my heart was as strong as it was last year". As part of my visit, I also had a normal EKG and even asked her about chamber size and she said nothing she saw on the EKG would lead to any enlargement diagnosis. Based on my weight loss through exercise and no symptoms she did not feel there was any need to repeat a stress test.

So I really don't know what to think, both my family doctor who received a copy of the report and the PA from the cardiologist that called me seemed completely unconcerned about the LA enlargement. The only thing they wanted to point out was the LVH at 1.2 cm, which is borderline/mild. The comments on the report concerning my mitral valve were "normal appearing mitral valve, significant insufficiency was not identified" so I assume that's good.

Any other thoughts?

Tony

kenkeith,

There is no concern of CHF. I just had not had an echo in the last 18 months and when I saw my cardiologist a couple of weeks ago for my annual check up for my blood pressure meds, she thought it would be a good idea to have an echo to "make sure my heart was as strong as it was last year". As part of my visit, I also had a normal EKG and even asked her about chamber size and she said nothing she saw on the EKG would lead to any enlargement diagnosis. Based on my weight loss through exercise and no symptoms she did not feel there was any need to repeat a stress test.

So I really don't know what to think, both my family doctor who received a copy of the report and the PA from the cardiologist that called me seemed completely unconcerned about the LA enlargement. The only thing they wanted to point out was the LVH at 1.2 cm, which is borderline/mild. The comments on the report concerning my mitral valve were "normal appearing mitral valve, significant insufficiency was not identified" so I assume that's good.

Any other thoughts?

Tony


You have a DILATED left atrium and atrium's CAVITY is enlarged and discussed in the prior post.

The left ventricle at 1.2 cm relates to heart wall thickness (norm 0.6-1.1). The most common myocardiomyopathy is dilated LV (norm 3.3-5.7). You haven't provided that measurement so I assume that is within the normal range.

What you have is LV hypertrophy and that is an increase in heart muscle mass (wall thickness). The hypertrophy can obstruct blood flow from the LV. Also it can distort one leaflet of the MV (often hereditary) and cause regurgitation as well.

At the present time your LVH does not obstruct blood flow as your heart wall motion is normal and a normal EF. Your MV is structually normal and no MV insufficiency (leakage). That is good.

Kenkeith,

You are correct, my LV is fine with a LVID of 4.7 cm. Is 4.9 cm for the LA a huge number?

Thanks,
Tony

Kenkeith,

You are correct, my LV is fine with a LVID of 4.7 cm. Is 4.9 cm for the LA a huge number?

Thanks,
Tony

It is higher than statistically normal, but it may be normal for you, and how well you feel. If it were a medically problem, you would begin to have shortness of breath, fatigue, etc.

The valve is ok. And an enlarged atrium can obstruct blood flow to the LV during diastole phase (filling), but that should show with the echo. Is there a history of your chamber dimensions?

Kenkeith,

My left atrium has always been enlarged, I went from being "estimated" at 4.2 to 4.9 (different imaging facilities) on this latest echo in about 18 months. My left ventricle has remained the same throughout the years. In fact, on the echo 18 months ago they listed mild distolic disfunction and it has resolved on this latest echo. This echo also list "normal left ventriculay function".

FYI, this is also the time period that I got into exercise and dropped a significant amount of weight. I feel great and have absolutely no symptoms and my exercise tolerence is growing every day it seems. The only thing holding me back is arthritic knees. I do a 500 calorie burn in 45 minutes each day on a treadmill and push over an hour on most nights as my conditioning gets better. I get no symptoms when exercising either. Maybe 4.9 cm is just what works for me, I don't know................. maybe this is why neither my doctor or my cardiologist is concerned.

Tony

The only thing holding me back is arthritic knees.

Toneman,
You might consider swapping the treadmill for a ELLIPTICAL TRAINER. I have two bad knees and in a week or two order they begin screaming with treadmill work but nary a whimper with the same 40 minute 450 calorie workout on the ELLIPTICATOR (my pet name! :D)

Kenkeith,

You were correct, I had my followup appointment with my cardiologist to review my echo results as well as my blood tests. She said what you said, my LA is statistically larger than what they see in most people, but only slightly and it is just normal for me. Also, she said that an echo is not the most accurate way to measure an LA, especially in people like myself that have lost considerable weight, it causes a left shift in the orientation of the heart and can overstate the size of the LA and the only accurate way of measuring the LA size is by measuring the LA volume, but it is not "prognostically significant enough" to undertake unless the patient has AFIB issues, which I don't. Also, the LVH was normal at 1.2 cm, mild LVH starts at 1.3 cm so it is not a concern.

As a matter of fact, I was told that based on the strength of my test results and the fact that my heart is completely normal structurally and that the few issues I had 18 months ago, mild diastolic disfuntion, trace mitral and tricuspid valve leakage and high pulmonary pressures have all resolved, she no longer feels the need to do annual workups. I was told to let my doctor know if I wanted to repart the echo in two or three years, but other than that she did not feel I needed a cardiologist anymore, good feeling. Just said they would be there for me if anything changed.

Thanks for your help, you have a great way of relaying information.
Tony

Tony, good news! Thanks for the feedback.