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Dr. Andrew Rynne

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Exp 50 years

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Is a TTE test advisable before a TEE test?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6436 Questions

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Posted on Thu, 29 Oct 2015 in General Health
Question: Hi, Dr. Sharka, I greatly appreciate your follow up. You must be a very good doctor. I spoke to another cardiologist who said pretty much the same thing you did. More information is needed from the initial echo report before deciding next step or seeing if transesophagael is necessary. She said she would have liked to have seen from initial echo report actual size of RV, estimated pulmonary pressure, and if they found any holes or defects in heart. She said all of these things should have been listed on initial echo report, which I believe is what you said as well. Do you agree? Anything else you can add to that? She said if it were her should would perform a 2nd resting echo test before she would recommend a transesophagael test to confirm any abnormal findings on first test.
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Answered by Dr. Ilir Sharka 7 hours later
Brief Answer:
I advise to repeat a transthoracic echo before.

Detailed Answer:
Hello XXXXXXX !

Thank you for asking on HCM!

I am glad to hear from you again on HCM!

I agree with your doctors opinion, because as I explained before in our previous discussing your performed cardiac ultrasound didn't address right heart detailed.

So it would rational to repeat a transthoracic echo before continuing with a transesophaeageal echo.

Anyway, you should not worry about it, because based on your previous echo were not defined any serious cardiac disorders and almost all other medical tests are normal.

Hope to have been helpful!

I am at your disposal for further questions, whenever you need.

You can feel free to ask me directly in the link below at any time if you have other uncertainties:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Best regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 2 days later
You say above not to worry about previous echo report because it did not define any serious cardiac disorders, and other heart and blood tests were almost all normal, yet isn't a moderately enlarged right ventricle a serious disorder? That is pretty much everything I am reading from my internet research as well. So I just can't figure this thing out. From everything I am reading a moderately enlarged right ventricle is a serious issue. Yet I am getting so many different answers from various cardiologist ranging from don't worry about it, it's no big deal, to, it might be a big deal, to, it's a very big deal and you need to find out underlying cause. I will repeat the echo as you suggested, but if it still says right ventricle is enlarged, but finds nothing else seriously wrong, then what do i do? Just not worry about it because I am otherwise leading much healthier life and not drinking anymore? Or is this enlarged ventricle eventually going to kill me if I don't find underlying cause and either fix it or address it as best as I can?
doctor
Answered by Dr. Ilir Sharka 5 hours later
Brief Answer:
Your previous echo report is inconsistent.

Detailed Answer:

Dear XXXX!

I think that there is a misunderstanding of my opinion. I am not speculating about the importance of a possible RV dilation.

In our previous thread, I have tried to thoroughly explain any implications of several possible disorders in RV dilation.

Instead, I am advising you not to worry too much, as your last cardiac ultrasound is inconsistent regarding right heart qualifications (RV diameter, pulmonary artery pressure, etc).

So, as your doctor has advised you, a new transthoracic cardiac ultrasound is necessary to address the missing direct quantifications (at least on the final echo report coupled with underlying films)

As I have explained you before a possible right ventricular dilation may be caused in your case by several reasons (please review our last discussion).

But, first an unequivocal evidence of RV dilation should be confirmed.

That's why additional investigation is necessary.

Wishing you a good health!

Regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 2 days later
Just want to tell you I think you are a good doctor. I have spoken, e-mailed or met with 6 different cardiologist and you seem to make the most sense. And you converse with me like you care. Most doctors these days just want to rush you right through appointments and give half ass explanations for everything. I wish you lived near me so that you could be my cardiologist. Anyway, I will let you know how repeat echo goes (taking 10/15) and then maybe you will have some good further advice. Thanks again and wish me luck. I do want to ask you one question though. Do you find it unusual that a cardiologist would put on my echo report that I have moderately enlarged RV without further explanation? He actually told my primary care physician that I am fine and everything is normal. Does that sound right when documenting on report that I have moderately enlarged RV? Is it even possible to be ok heart health wise assuming moderately enlarged RV is correct?
doctor
Answered by Dr. Ilir Sharka 5 hours later
Brief Answer:
We have to wait the next cardiac ultrasound for clarifying this issue.

Detailed Answer:
Dear XXXX!

I am glad to hear I have been of some help to you. I would like to assure you that I will be at your disposal for further explanations if it is necessary.

Regarding your concern, I would explain that, as a general rule, if the doctor suspects of any deviations, he should prescribe clear evidence.

When an important RV dilation is confirmed, there is clear evidence of other clinical symptomatology (a pulmonary disorder, cardiac arrhythmia, valvular dysfunction, etc) which may have led to such a dilation.

Nevertheless, if we consider correct the conclusion about the right ventricle in the last echo report (though it is not associated with printed views and written quantification), as you have a normal physical performance, without clinical symptomatology of heart failure, no detection of pulmonary hypertension, there is nothing to worry too much.

As long as no triggering factors for right ventricular dysfunction (failure) are actually active and uncontrolled, nothing to consider about any adverse ongoing cardiac implications.

Just wait the next cardiac ultrasound, and we will discuss again when more specific information is provided.

Kind regards,

Dr. Iliri







Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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