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Stent Angioplasty Done. What Does LV RWMA - Localized Inferior Wall Scar Mean?
Question: The stent angioplasty was done on me on 13th Sept 2008. While doing the routine check-up yesterday i.e. 2D Cardiogram the doc invistigated the LV RWMA - Localized inferior wall scar. My doc suspect about mild heart attacke. Request you to advice me about what is LV RWMA - Localized inferior wall scar. My LVEF is 55 % and ECG is normal. I feel concerned about my family doc's statement about mild heart attack. I am also a diabetic patient since last one year.Please advice.
Hello XXXXXXX,
Thanks for writing in to heart care WWW.WWWW.WW
I am a medical specialist with an additional degree after training in clinical & invasive cardiology. I read your question with diligence.
I assume you are narrating about the echo-cardiogram before the stent was put or it is the recent echocardiography: my interpretation is unrelated to the timing?
For LVRWMA is an acronym for Left Ventricular Regional Wall Motion Abnormality. It reflects that there is inability of heart to contract in synchronous manner: in your case when inferior wall was to move anteriorly it did not do so rather there was some movement in opposite direction (Dyskinesia). It means that there is demand of blood by heart muscle but supply is not adequate. That would mean Right Coronary Artery or Left Circumflex artery disease. When there is no supply there is scar and no movement of wall (akinesia: scarred muscle can not contract) the later means heart attack where as dyskinesia goes with angina and means reversibility. If stent was put then, most of akinetic segment persist as such, where as dyskinetic segment improves in motion may become completely normal. The sum total of contractrality is reflected by ejection fraction therefore 55% (which is normal) it could have been recent echo even. Your family doctor can be right you might have suffered inferior wall heart attack before the stent was able to re establish the blood supply to your heart. Your EKG is normal is reassuring. It is difficult for me to complete the picture unless I know the full report before stent was implanted and one now. But with normal EKG and normal ejection fraction, I can say that there is absolutely no need to panic. However, there is concern because of echocardiographic findings. So, if you can narrate the story beginning from the decision to do coronary angioplasty and stent(medicated or non medicated) implantation to present time, I can clarify points of doubt in your mind. Good Luck.
Looking forward to get a mail from you.
With best wishes.
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Thanks for writing in to heart care WWW.WWWW.WW
I am a medical specialist with an additional degree after training in clinical & invasive cardiology. I read your question with diligence.
I assume you are narrating about the echo-cardiogram before the stent was put or it is the recent echocardiography: my interpretation is unrelated to the timing?
For LVRWMA is an acronym for Left Ventricular Regional Wall Motion Abnormality. It reflects that there is inability of heart to contract in synchronous manner: in your case when inferior wall was to move anteriorly it did not do so rather there was some movement in opposite direction (Dyskinesia). It means that there is demand of blood by heart muscle but supply is not adequate. That would mean Right Coronary Artery or Left Circumflex artery disease. When there is no supply there is scar and no movement of wall (akinesia: scarred muscle can not contract) the later means heart attack where as dyskinesia goes with angina and means reversibility. If stent was put then, most of akinetic segment persist as such, where as dyskinetic segment improves in motion may become completely normal. The sum total of contractrality is reflected by ejection fraction therefore 55% (which is normal) it could have been recent echo even. Your family doctor can be right you might have suffered inferior wall heart attack before the stent was able to re establish the blood supply to your heart. Your EKG is normal is reassuring. It is difficult for me to complete the picture unless I know the full report before stent was implanted and one now. But with normal EKG and normal ejection fraction, I can say that there is absolutely no need to panic. However, there is concern because of echocardiographic findings. So, if you can narrate the story beginning from the decision to do coronary angioplasty and stent(medicated or non medicated) implantation to present time, I can clarify points of doubt in your mind. Good Luck.
Looking forward to get a mail from you.
With best wishes.
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Respected Dr XXXXXXX
Thank You very much for the prompt response and some what I am relieved now.For more clarity. The angioplasty was done on 13th Sept 2008 of which the reports have been uploaded. As a routine check up the 2D Echo was done recently i.e. on 22nd Oct.2o12 of which the reports are also uploaded. The LV RWMA - Localized inferior wall scar has been observed in 2D Echo.While going thru the 2D Echo report my family doc feels there could have been a mild heart attack.
Hope I have cleared the points as above and by uploading all the reports. I guess now you will be able to give more clarity.
Thanks in advance.
With Best Regards,
XXXXXXX
Thank You very much for the prompt response and some what I am relieved now.For more clarity. The angioplasty was done on 13th Sept 2008 of which the reports have been uploaded. As a routine check up the 2D Echo was done recently i.e. on 22nd Oct.2o12 of which the reports are also uploaded. The LV RWMA - Localized inferior wall scar has been observed in 2D Echo.While going thru the 2D Echo report my family doc feels there could have been a mild heart attack.
Hope I have cleared the points as above and by uploading all the reports. I guess now you will be able to give more clarity.
Thanks in advance.
With Best Regards,
XXXXXXX
Thanks for writing back.
Well there is no change in interpretation of echocardiography report if any point is not clear to you please write, I shall be happy to respond.
Scar is old infarct of no significance as your overall contractility of heart is normal.
So, please continue with treatment and followup with the group who did the angioplasty.
My concern is your angiography report jpg, which showed a significant 90% lesion in RCA (agreed in non dominant Right Coronary Artery so stent was not needed there) which can explain some degree of RWMA seen now in echo.
Personally, I would have wanted to see that lesion at followup angiography some time now; provided 90% occlusion report of first angiography was accurate. It might have decreased that would have assured me more. Otherwise, you have been given best stent available in Indian Market it is Drug Eluting Stent (Xience) so it will stay open for years to come. Good Luck and Best Wishes. Take care of your diabetes, you will do well.
Regards.
Dr Anil Grover
Well there is no change in interpretation of echocardiography report if any point is not clear to you please write, I shall be happy to respond.
Scar is old infarct of no significance as your overall contractility of heart is normal.
So, please continue with treatment and followup with the group who did the angioplasty.
My concern is your angiography report jpg, which showed a significant 90% lesion in RCA (agreed in non dominant Right Coronary Artery so stent was not needed there) which can explain some degree of RWMA seen now in echo.
Personally, I would have wanted to see that lesion at followup angiography some time now; provided 90% occlusion report of first angiography was accurate. It might have decreased that would have assured me more. Otherwise, you have been given best stent available in Indian Market it is Drug Eluting Stent (Xience) so it will stay open for years to come. Good Luck and Best Wishes. Take care of your diabetes, you will do well.
Regards.
Dr Anil Grover
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many Thanks Dr.Gover. I am more relaxed now and have better clarity. I am taking due care of diabetes. Definately I would love to be in touch with you for an expert advice. In my opinion it is always better to have second opnion for clarity,confidence etc.
With Best Regards,
XXXXXXX
With Best Regards,
XXXXXXX
Thank you Mr XXXXXXX for your kind words. It was a pleasure interacting with you. You can always contact me through WWW.WWWW.WW address is in my first reply. If you have no more query for now please close the query with comments and stars. Thank You.
Warm Regards
Dr Anil Grover
Warm Regards
Dr Anil Grover
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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