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Old 09-10-2012, 03:40 PM   #1
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Please help interpret this

My doctor didnt do much but tell me "it was not good" and refer me to another clinic for more tests.

Background

52 yr old male - 160 lbs 5' 08" about 13% bodyfat Typical BP 115/70 resting heart rate 75-80 non smoker 15 yrs healthy diet - weightlift 3-4x weekly, treadmill (max incline slow rate 3 mph) 3x weekly. Intermittent chest discomfort (pressure - kind of bubbling or fluttering feeling ) esp noticable if stressed.

Went in for diagnostic tests in 2008 - changed diet / exercise to improve cholesterol and blood pressure rather than taking statins and Ace inhibitors. LBBB and some small issues with perfusion noted - thought was I may have had a very minor heart attack at some time.

Follow up tests last month not very pretty despite perfect bloodpressure and HDL/LDL numbers. Ejection fraction of 0.21 - but my left ventricle is huge so ejection volume around normal of 70 mL. LBBB - but report does not seem to be able to categorize my condition - any help here ??

Diagnostic Test Results

I typed these in from a scan of a fax - so may be some errors.

Myocardial Perfusion Imaging Including post stress and rest injection images with ECG gating and attenuation correction using TCT.

Stress Test

Pharcologic stress with Pipyrimadole, followed by low level exercise for 3:00 minutes. No Chest Pain but ECG changes cannot be assessed in the presence of left bundle branch block

This is a challenging study to interpret due to Hereogeneity of Myocardial perfusion in a markedly dilated left ventrical. Myocardial perfusin imaging shows Moderate to severe fixed decreased perfusion in the inferior to inerolateral septal walls, much of which corrected after the application of atennuation correction with residual moderate fixed defect in the periapical region, uncertain if a true reading as attenuation correction introdcued demonstrate decreased perfusion to the anterior wall that is not present with filtered back reconstruction technique. Moderate fixed decreased perfusion in the mid cavity to basal septal wall and basal anterior wall. No definite reversible perfusion defect is seen. Perfusion to the lateral wall is best preserved. Global Hypokinesis.

Using the Emory Cardiac Toolbox, the left ventrical ejection fraction on the post stress injection images measures 0.21, based on an end-diastolic volume of 331 ml and an end systolic volume of 262 ml.

Impression

Challenging study to interpret but this is an abnormal study. Several areas of fixed decreased perfusion including periapica inferior, inferolaterla wall and basal anterior wall may represent ares o fsevere ischemia or nontransmural infarct. Fixed decreased perfusion in the mid cavity to basal septal wall may be of similar etiology but it can also be do to the left bundle branch block. Thallium scan may be helpful to assess for viability.

Markedly dilated left ventricle with markedly decreased systolic function raises prossibility for superimposed nonischemic causes including cardiomyopathy and valvular disease. CLinical and echocardiographic correlations may be helpful.

ULTRASOUND

Left Ventricle is moderately dilated with global moderate to severe systolic dysfunction

Details

Patient is in sinus rhythm with a wide QRS complex
The left ventricle is moderately dilated. There is norm left ventricular wall thickness. Left ventricular systolic function is moderate to severely reduced in global patter (minor segmental variation is seen but predominant appearance is of global hypokinesis) Septal modon (sp- ineligible) is consistent with conduction abnormaity. There is no thrombus.

the right ventricle is normal in size and function.

The left atrium is borderline dilated. Right atrial size is normal. The IVC? is normal in size with normal respiratory response. Image quality is inadequate to exclude a minor inter cardiac shunt at the atrium level.

The mitral valve is normal in structure and function. There is trivial mitral regurgitation that is within normal limits. An accurate RVSP could not be obtained due ta poor tricuspid regurgitation signal.

The aortic valve is trileaflet. The aortic valve leaflets are thickend but not restricted in mobility. Ho Hemodynamically significant valvular aortic stenosis. There is no aortic regurgitation present.

The pulmonic valve is not well seen but is grossly normal in structure.

The aortic root is normal size. There is aortic root sclerosis/calcification. The pulmonary artery is normal size.

There is no pericardial effusion

 
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Old 09-11-2012, 08:41 AM   #2
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Re: Please help interpret this

Quote:
Originally Posted by Haritec View Post

Markedly dilated left ventricle with markedly decreased systolic function raises prossibility for superimposed nonischemic causes including cardiomyopathy and valvular disease. CLinical and echocardiographic correlations may be helpful.

ULTRASOUND

Left Ventricle is moderately dilated with global moderate to severe systolic dysfunction
  • weightlift 3-4x weekly, treadmill (max incline slow rate 3 mph) 3x weekly.
It surprises me that you can weight lift and use the treadmill without breathing problems and fatigue.

When my "diastolic" heart failure was much worse, the slightest physical exercise, like turning a screw driver, was too much for me. I could barely get out of bed.

After you weight lift, or do the treadmill, does your heart race or beat erratically? Do you get breathing problems, or suffer from frequent fatigue or tiredness? How about during the night?
__________________
CHF, A-Fib, HBP, Diabetes, Asthma doing great

⇒ Avoid allergic & non-allergic irritants/triggers
⇒ Low calorie ovo-vegetarian diet
⇒ Power walk, weight lifts, pushups
⇒ Coreg 25mg bid

Last edited by Machaon; 09-11-2012 at 08:43 AM.

 
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Old 09-11-2012, 09:00 AM   #3
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Re: Please help interpret this

I am surprised too when I read about my ejection fraction. I weight lift pretty intensely - ( I weigh 156 LBs and squat 165 for 4 sets of 12 reps, Deadlift 225 lbs, benchpress body weight etc)

I feel good when weight lifting - I suck a bit of wind but no chest pain or sense of heart racing. Cardio is harder - I can do a fast uphill walk OK but running I feel a bit of chest pressure.

I think in part it is because my left ventricle is so enlarged - even though ejection fraction is small it pumps a reasonable amount of blood due to large size - but I don't know if that is the case or not. I also don't know if my exercise is what is forcing it to enlarge.

 
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Old 09-11-2012, 09:47 AM   #4
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Re: Please help interpret this

Quote:
Originally Posted by Haritec View Post
I am surprised too when I read about my ejection fraction.
During the time when my left atrium was enlarging, I had symptoms of fast heart rate and breathing problems when lying down. I did not realize what was going wrong with me. I thought that it was due to my asthma.

Quote:
I weight lift pretty intensely - ( I weigh 156 LBs and squat 165 for 4 sets of 12 reps, Deadlift 225 lbs, benchpress body weight etc)
Goodness! That's a lot of weight! Good for you! You must be in good physical shape. That is a big advantage for dealing with an enlarged ventricle.

I am not a health professional, merely a fellow heart patient, but you might consider reducing your weight lifting. It may not be a good idea for you to put any additional stress on your heart.

I've dealt with diastolic heart failure, permanent atrial fibrillation, insulin resistance, valve problems, thickening heart ventricle and septum walls, etc. for over 25 years. Now that my heart has significantly improved, at age 70 I can do over 100 full pushups; 300 curls with two ten pound hand weights; 60 side curls; 12 minutes stepper; 20 minutes bike; one hour power walk, per day; but I had to gradually work up to these exercise levels as my heart improved and was able to support the exercise levels.

Quote:
I feel good when weight lifting - I suck a bit of wind but no chest pain or sense of heart racing. Cardio is harder - I can do a fast uphill walk OK but running I feel a bit of chest pressure.
I am amazed at what you can lift and do, without significant increases in symptoms, but, then again, I am just a fellow heart patient.

My heart failure symptoms increased significantly when I hit my late 50s. You are still young and probably in great physical shape and well toned. That is a big plus for you!

What types of meds are you on? I take 25mg Coreg twice a day; and .125mg digoxin once a day. Coreg, a beta blocker, has been shown to improve an enlarged heart, plus it has all kinds of other great health benefits, although it tires the hell out of you!
__________________
CHF, A-Fib, HBP, Diabetes, Asthma doing great

⇒ Avoid allergic & non-allergic irritants/triggers
⇒ Low calorie ovo-vegetarian diet
⇒ Power walk, weight lifts, pushups
⇒ Coreg 25mg bid

Last edited by Machaon; 09-11-2012 at 09:51 AM.

 
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