Echo Impression - Baffled.. Can someone explain?

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H0pe
New Member


Date Joined Nov 2012
Total Posts : 9
   Posted 1/13/2016 11:33 PM (GMT -6)   
Hi,

My mom had a MI 4 years back, and she recovered well with angioplasty, taking medication regularly. Just after the MI, her LV ejection fraction was 42%.

Now she is 76 years old, developed phlegm and lung edema recently...when we went to the cardiologist, he asked to take the echo again.. after looking at the report, the cardiologist was saying, she need to be very careful, should not do any routine work, asking her to sit in one place, quite and calm, and take rest.

By looking at this report, he also told her that she might have undergone a very mild attack few months back, unnoticed.. Interestingly, we see the LV ejection fraction showing a considerable improvement of 45% in this new echo. Not clear, why the cardiologist is saying she need to be much more careful now.. Can anyone see if there is anything specific in this impression for the Cardiologist to give us a warning, and asking her to take rest? How can the doctor say that she might have gone through a second attack by looking at the echo?

Now she is very nervous, and scared.

Latest echo impression:

LVEF: 45%
Septum and Lv apex thinned out.
Apical mid spetum hypokinetic.
Lv Apex Apical septum anterolateral wall hypokinetic.
Moderate lv dysfuntion.
Type 1 lv diastolic function.
Aortic valve sclerosis with mild gradient of 17 mm of hg. Trivial AR.
Mitral valve prolapse.
Mild MR.

Thanks.

Post Edited (H0pe) : 1/13/2016 11:58:23 PM (GMT-7)


H0pe
New Member


Date Joined Nov 2012
Total Posts : 9
   Posted 1/14/2016 5:09 AM (GMT -6)   
Can anyone answer to the above question? This is the only reason I'm baffled - How can the cardiologist say that she "might have" gone through another mild attack when actually the LV ejection fraction is showing as improved at 45% in the echo we took few days back, unlike how it was 4 years back with 42%?

LaurieD
Regular Member


Date Joined Jan 2014
Total Posts : 56
   Posted 1/14/2016 2:27 PM (GMT -6)   
That's great that her EF improved. 50% is normal.

Have you asked her cardioligist these questions? He would be the most knowledgable person to ask since he is her MD and is familiar with her history and her previous tests and procedures.

I am a CICU RN so I can tell you only what I know from my education and experience and just based off what I see on this report.

It mentions that she has several areas of hypokinesis, which is decreased muscular activity. This happens when the heart muscle is damaged from a heart attack. Do you know if her previous echo mentioned areas of hypokinesis?

Did she have an EKG? An EKG can also indicate a possible unnoticed heart attack.

Aso, you said that he said that she only *might* have had another minor heart attack. My best guess is that he said this because, even though she had an angioplasty from her last one and is taking her medications as she should, none of this can restore dead heart muscle back to normal function. An angioplasty can only prevent new heart muscle death by restoring blood flow that was lost. When heart muscle tissue dies, it is replaced with scar tissue, and scar tissue doesn't really do much at all but fill the space.

Again, your best answers will com directly from her cardioligist. I don't interpret echo reports as a part of my job and I cannot give medical advice. I can only tell you what I have learned in time.

Sorry for your worries. Many times patients and families are too overwhelmed or scared to ask the right questions to get the answers the need. Write everything down you want to ask, and bring them to the MD. Write down his answers if you have to and don't be afraid to ask him to clarify.

Post Edited (LaurieD) : 1/14/2016 1:48:53 PM (GMT-7)


LaurieD
Regular Member


Date Joined Jan 2014
Total Posts : 56
   Posted 1/14/2016 2:29 PM (GMT -6)   
And also, this is the very same advice I would give to my own patients in the hospital. Hang in there.
-28 year old female
-Diagnosed with UC January 2014 while 7 weeks pregnant
-2 weeks in hospital
-Started Remicade in hospital
-Current meds remicade and colazal
-one flare up since remission while 3 months post partum, acheived remission with increase in colazal, rowasa enemas, and next infusion.
-beautiful healthy remicade baby, Declan Michael

LaurieD
Regular Member


Date Joined Jan 2014
Total Posts : 56
   Posted 1/14/2016 2:52 PM (GMT -6)   
I apologize for the typos, I am using a horrible keyboard. I went back and edited just one typo that I thought may really be hard to understand.
-28 year old female
-Diagnosed with UC January 2014 while 7 weeks pregnant
-2 weeks in hospital
-Started Remicade in hospital
-Current meds remicade and colazal
-one flare up since remission while 3 months post partum, acheived remission with increase in colazal, rowasa enemas, and next infusion.
-beautiful healthy remicade baby, Declan Michael

H0pe
New Member


Date Joined Nov 2012
Total Posts : 9
   Posted 1/16/2016 7:20 AM (GMT -6)   
Thank you Laurie. The new cardiologist din't ask for EKG. I wonder how he came to the conclusion about a 2nd minor attack.

As I mentioned when she had the first MI 4 years back, the ejection fraction was 42%, now the echo he asked to take is showing 45%.. which makes me think as improvement, and why is scaring.

The urine report shows urinary infection, and this doctor is not prescribing any antibiotics. Is it not true or not safe to take antibiotics for those are having this heart failure. Is this true?

Thanks.

LaurieD
Regular Member


Date Joined Jan 2014
Total Posts : 56
   Posted 1/16/2016 9:38 PM (GMT -6)   
Did the cardiologist say that he won't prescribe antibiotics because of her heart failure? I honestly have never heard that before, and we treat UTIs in CICU in heart failure patients quite frequently.

I would delve into this a bit deeper with her MD, as an untreated UTI can lead to a much more serious infection, such as a kidney infection, or if it travels even further, it can cause sepsis. Please clear this up with him!
-28 year old female
-Diagnosed with UC January 2014 while 7 weeks pregnant
-2 weeks in hospital
-Started Remicade in hospital
-Current meds remicade and colazal
-one flare up since remission while 3 months post partum, acheived remission with increase in colazal, rowasa enemas, and next infusion.
-beautiful healthy remicade baby, Declan Michael

theHTreturns...
Elite Member


Date Joined Mar 2009
Total Posts : 20164
   Posted 1/17/2016 1:59 AM (GMT -6)   
yes, off to the doc. keep strong.
THE HAPPY TURTLE.

A QUOTE FROM THE HAPPY TURTLE THAT REFLECTS ME.

"COMPLEXITY IS MY WAY OF EXPRESSING MY NEEDS IN A MANNER THAT IS NEITHER DESTRUCTIVE, NOR NEGATIVE"
'

H0pe
New Member


Date Joined Nov 2012
Total Posts : 9
   Posted 1/17/2016 7:42 AM (GMT -6)   
I'm not convinced with the cardiologist she met her in a different city.. I wonder why he is scaring the patient instead of encouraging her.

I'm planning to get her back to my city, and take a secondary opinion, or visit the first cardiologist who did the angioplasty during her first MI.

Thanks.

LaurieD
Regular Member


Date Joined Jan 2014
Total Posts : 56
   Posted 1/17/2016 4:39 PM (GMT -6)   
Warm thoughts to you and your mom, H0pe
-28 year old female
-Diagnosed with UC January 2014 while 7 weeks pregnant
-2 weeks in hospital
-Started Remicade in hospital
-Current meds remicade and colazal
-one flare up since remission while 3 months post partum, acheived remission with increase in colazal, rowasa enemas, and next infusion.
-beautiful healthy remicade baby, Declan Michael

H0pe
New Member


Date Joined Nov 2012
Total Posts : 9
   Posted 1/17/2016 6:37 PM (GMT -6)   
Thanks Laurie.
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