Septal knuckle?? - Heart Disorders Message Board

browneyedsusie · 10-12-2005, 03:26 PM

Back in January of this year I posted on here alot after my husband was treated for two M.I's. It turned out after an angio that they felt a virus had attacked the heart muscle. First of all , I want to Thank every one for all the great advice given at that time.
Last week he had another echo to see how things were (clicking on my name gives info on his last one. On his April one he showed an EF of 55% or a grade 2. His most recent one showed it was up to 65% a grade 1. On this most recent echo there is a comment " there is a prominent septal knuckle".Does anyone know what this means??? Of course I panic!
Anyone with any advice is appreciated...
Thanks..L

browneyedsusie · 10-13-2005, 07:24 PM

Anybody have any ideas?? please.

started04 · 10-20-2005, 01:52 PM

Hi Susie,

The septum is the muscular structure that separates the heart's left and right ventricles. The structure is not uniform in thickness, and usually with age the proximal (center part) septum enlarges and this localized hypertrophy is clinically referred to as a "knuckle".

The significance is in context of evaluating heart-wall motion during contraction.

browneyedsusie · 10-21-2005, 01:04 PM

Thanks Ken .....He had an echo back in April of this year where it showed "mild septal hypertrophy" . His LV diastole was 48 normal is between 37-56. His EF was grade 2 at 55%.
His latest echo in September showed "prominent septal knuckle" a LV diastole of 56 and his EF is back up to a grade 1 at 65%.
We are from a small town where the doctors hate to send you to any specialists!! His doctor said this past echo is good, although did not compare the two. Everything else on the echo is within normal range. it does comment on his Sept one " no segmental wall motion abnormalities, No dialstolic dysfunction,No outlet obstruction, no thrombi, no pericardial effusions. There is overall LV dimension is at the upper limits of normal and LV mass index normal at 98.
Back in January , I remember you helped me out ALOT when we were going through so much. I appreciate your time and experience. It was such a scary time.
Any comments on his echo comments are again...appreciated. I am just wondering if there is any worry with his April echo showing mild hypertrophy and LV diastole beomg 48 and now 6 months later is shows prominent septal knuckle and an LV d . of 56.
Thank you ...and take care.
Lesley

started04 · 10-24-2005, 12:27 PM

Everything else on the echo is within normal range. it does comment on his Sept one " no segmental wall motion abnormalities, No dialstolic dysfunction,No outlet obstruction, no thrombi, no pericardial effusions. There is overall LV dimension is at the upper limits of normal and LV mass index normal at 98.

Hi Lesley,

Measurements of the heart are not very accurate with an echo. The sonographer manually (wih transducer) outlines the border of the heart walls when fully relaxed and again at the peak before contraction, and echo software makes the calculations. The borders are fuzzy and the outlining is somewhat subjective, and there will or could have a margin of error of 10 to 15% between the two procedures and not be a problem. This was explained to me by the sonographer during my echo.

The septum varies in size with different segments and aren't easily recognized due to fuzzy borders and not much of consequence in view of the report and data.

What is important is heart wall motion, and it can be easily seen on the screen during the echo contractions and filling of the left ventricle. There is a "fluttering" or incomplete movement of the wall. I saw mine, and there was a problem at the distal end.

The test you refer to states no motion abnormalities. This can almost rule out any wall thickness, stiffness or muscle damaged of the heart that would be of concern.