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Echo says mild pulmonic valvular regurgitation, left atrium mildly dilated. Should I be worried ?

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Posted Tue, 22 May 2012 in Hypertension and Heart Disease
Follow-up: Echo says mild pulmonic valvular regurgitation, left atrium mildly dilated. Should I be worried ? 1 hour later
In my latest Echo shows- Mild pulmonic valvular regurgitation, left artium is mildly dilated, study was techincally limited. ,pulmonic valve is not well seen,but is grosly normal in structure, Aortic root 4.2cm, Ledt artium 4.3cm, L.V Diastole 5.6 cm, L.V Ststole 3.8cm, Fract short 32.7%,IV Septum 0.81 cm, Posterior wall 0.86cm,
LV Mass CdI 79.7 GRAMS/M2, MV E XXXXXXX VEL 61.3 CM/SEC, ASC ARORTA DIA 3.8CM, MV A XXXXXXX VEL- 70.7 CM/SEC, MV E/A 0.87, MV DEC TIME 0.91 SEC.
MED PEAK E' VEL- 6.1 CM/SEC, LAT PEAK E' VEL 8.1CM/SEC,LV VI XXXXXXX 93.7 CM/SEC, Ao V2 XXXXXXX 104.4cm/sec, Aomax PG 4.4MM/hG, TR XXXXXXX PG 15.8 MMHG, LAT E/E'RATIO 7.6, MEDIAL E/E' RATIO 10.1, RELATIVE WALL THICKNESS 0.30,
Mentioned -There is trivial mitral regurgitation that is with in normal limits,
Last year Echo shows Aortic root- 39 mm,left atrium 44mm--REPORT CAN BE SENT.
THELIUM TEST SHOWS-
LIMITING SYMTOM- DYSPNEA, REST EKG SINUS RHYTHUM, LEFT ANTERIOR HEMIBLOCK, EKG CHANGE WITH EXERCISE -NO SIGNIFICANT ST DEVIATION, LUNG HEART RATIO 40, POST EXERCISE LVEF 75, LV DILATIONB WITH EXERCISE NO,
SEVERE FIXED DEVREASE IN INFERIOR AND POSTERIOR COUNTS WHICH RESOLVES TO A SIGNIFICANT DEGREE WITH ATTENUATION CORRECTION MOST CONSISTENT WITH DIAPHRAGMATIC ATTENUATION ARTEFACT, RAPID APICAL WASHOUT, ,ABNORMAL EKG AT REST, NO DIAGNOSTIC CHANGE WITH EXERCISE.
FEELING VERY TIRED,STIFFNESS IN BODY, SWALLING ON ANKLES AND LEGS, HAS HEMATURIA ,KIDNEY DOCTOR NOTICED DYSMORPHIC RED BLOOD CELLS IN URINE, STARTED BY HIM CANDESARTAN TB 8 MG ONE DAILY, TSH WAS 6.40 ,FREE T4 WAS 11.2-THEN sYnthroid 25cmg was started one daily few days back then again TSH tested came out to be 4.76, Thyroid proxidase antibody 7.2, free T4 10.9, doctor asked to continue synthroid,
Warmness in body feeling, even with small work gets tired.feeling confused. headache on both sides. large stricuture in bulbous urethera noticed in cystoscopy. no stone , tumor,cancer noticed in CT scan.
ESR and CRP always high for three years, biopsy for temporal artiries goes negative.
Reports will be sent in next few days.
 
 
Answered by Dr. Prasad 16 hours later
Hi,

Thanks for the detailed query.

As per your description, you been suffering with generalised tiredness and easy fatiguability, pedal edema, confusion, hematuria and on and off bilateral headache. You had been investigated extensively.

1. I would be able to interpret your ECHO reports had you mentioned the final impression on the Echo cardiogram / thallium stress test. You mentioned fraction short is 32.7 %, do you mean ejection fraction is 32.7 % ?

2. The Thalium Stress test reading typed were confusing and misleading. One line EKG says normal and the other line it says as abnormal. No ST changes on exercise with normal LVEF is not suggestive of disease. I suggest you to upload the scan copy of the report.

2. Thyroid function test revealed hypothyroidism. These can explain your generalised weakness and easy fatiguability. It is good to know that your values were improved. And I agree with your doctor’s suggestion to continue you on synthyroid. Once a fixed dose is set you should continue to take for several years with follow up.

3. Presence of dysmorphic red blood cells in the urine is concerning. Though the Computed Topography (CT) scan of abdomen seems normal, you need to be reviewed to rule out renal disease. It can be a defective filter (kidney) or plumbing system ( urethra or bladder). If I were to be your treating doctor, I would consider repeating urine microscopy first. Further tests and renal biopsy are needed if necessary.

4. Elevated Erythrocyte Sedimentation Rate (ESR) and C Reactive Protein (CRP) is a non specific marker of inflammation. Their assessment can be confusing for you.

5. Headache with normal temporal arteries rules out temporal arteritis which is good. If the headache is recurring, you might need prophylactic medication like amitriptyline to manage them.

The bottom line is your symptoms are concerning. Based on the details provided, it is probably related to renal disease or hypothyroidism or both. My best suggest is to follow with a single primary physician ( XXXXXXX Medicinist) and take necessary referrals with Nephrologist, Cardiologist while he treats Hypothyroidism.

Hope this helps you to take an informed consent. Let me know if you have any queries.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Echo says mild pulmonic valvular regurgitation, left atrium mildly dilated. Should I be worried ? 3 hours later
Dear Doctor XXXXXXX
Reports are enclosed.
Follow-up: Echo says mild pulmonic valvular regurgitation, left atrium mildly dilated. Should I be worried ? 2 hours later
Reports has been attached. please
 
 
Answered by Dr. Prasad 11 hours later
Hello Mr. XXXXXXX
Thanks for enclosing the reports.

I have gone through them and would like to make the following comments:
a. As far as your Echocardiogram reports are concerned, there are largely normal. The ejection fraction of the left ventricle, which is a reflector of how well the heart is able to do its function, is normal and not something you need to worry about.
The dilation of aortic root is commonly seen in people with high blood pressure. I would like to know if you have high blood pressure and if yes, whether it is under control.

b. The thallium stress test is normal and you do not have any coronary artery disease at present. So you don't need to worry on that front.

Your fatigue and the swelling in your feet need evaluation by a nephrologist. With respect to the other reports, my comments remain the same.
Awaiting your reply.
Regards
Above answer was peer-reviewed by
 
Follow-up: Echo says mild pulmonic valvular regurgitation, left atrium mildly dilated. Should I be worried ? 2 minutes later
Ok I will send more reports-
 
 
Answered by Dr. Prasad 9 hours later
Hi XXXXXXX
Thanks for writing in.
I wanted to know if you have ever been told that you have high blood pressure. Also, when I was going through your reports, I noticed that you would need to lose some weight. The size of the aortic root increases with age and size of the body. Weight reduction would be possible through a mix of dietary interventions and exercise. Dietary interventions would include small, regular meals; having an early dinner; avoiding refined food; and avoiding sweets. This will also help you control your diabetes better.
Once you see the recommended specialists, we can take this ahead.

Hope this helps.
Regards
Above answer was peer-reviewed by
 
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