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What Do The Following ECHO Test And Holter Monitor Report Indicate?
Question: My father recently suffered from a minor brain stroke which involved a clot in the brain and it caused his speech to become slurred. This was second occurrence for him, the previous instance being in 2009. Doctor's kept him in ICU for two days and he was moved to normal ward after that and they continued his medication. Neurologist informed that they are giving medications to dissolve the very minor clot in his brain. He was advised to undergo ECG, Ultrasound tests initially. The ultrasound reports came our alright as per the hospital specialist, but for the ECG report they informed that multiple etropics are occurring. So they suggested an echocardiogram test. Following are the interpretations from his ECHO report:
VERY POOR ACOUSTIC WINDOW
MILD CONCENTRIC LV HYPERTROPHY PRESENT
MILDLY DILATED L.A.
HYPOKINETIC APEX, MID ANTERIOR SEPTUM, MID ANTERIOR WALL
MODERATE LV SYSTOLIC DYSFUNCTION (EF = 40%)
TRACE MR, TRACE TR(NORMAL PASP)
GRADE 1 LV DIASTOLIC DYSFUNCTION
NO THROMBUS OR PERICARDIAL EFFUSION
They also connected a holter monitor to track ECG for 24 hours. and following is its summary of interpretation:-
24 HOUR HOLTER MONITORING REVEALED NORMAL SINUS RHYTHM THROUGHOUT THE RECORDING PERIOD WITH MINIMUM HEART RATE OF 52 BPM AND MAXIMUM HEART RATE OF 112 BPM. FREQUENT ISOLATED APC's, ATRIAL COUPLETS AND ATRIAL RUNS MAXIMUM UPTO 9 BEATS SEEN. FREQUENT ISOLATED VPCs, VENTRICULAR QUADRIGEMINY, TRIGEMINY & BIGEMINY, VENTRICULAR COUPLETS & ONE EPISODE OF vt UPTO 14 BEATS (Duration 5.8 seconds) SEEN. NO SIGNIFICANT SINUS PAUSES ARE SEEN, NO SYMPTOMS REPORTED BY PATIENT IN EVENT RECORD DIARY.
As queried by the doctor, my father has never had instances of palpitations, chest pain or feeling of irregular (weak/strong) heartbeat. Please advise what is the current state of the patient based on these reports and how should we proceed clinically to nurse him back to health.
VERY POOR ACOUSTIC WINDOW
MILD CONCENTRIC LV HYPERTROPHY PRESENT
MILDLY DILATED L.A.
HYPOKINETIC APEX, MID ANTERIOR SEPTUM, MID ANTERIOR WALL
MODERATE LV SYSTOLIC DYSFUNCTION (EF = 40%)
TRACE MR, TRACE TR(NORMAL PASP)
GRADE 1 LV DIASTOLIC DYSFUNCTION
NO THROMBUS OR PERICARDIAL EFFUSION
They also connected a holter monitor to track ECG for 24 hours. and following is its summary of interpretation:-
24 HOUR HOLTER MONITORING REVEALED NORMAL SINUS RHYTHM THROUGHOUT THE RECORDING PERIOD WITH MINIMUM HEART RATE OF 52 BPM AND MAXIMUM HEART RATE OF 112 BPM. FREQUENT ISOLATED APC's, ATRIAL COUPLETS AND ATRIAL RUNS MAXIMUM UPTO 9 BEATS SEEN. FREQUENT ISOLATED VPCs, VENTRICULAR QUADRIGEMINY, TRIGEMINY & BIGEMINY, VENTRICULAR COUPLETS & ONE EPISODE OF vt UPTO 14 BEATS (Duration 5.8 seconds) SEEN. NO SIGNIFICANT SINUS PAUSES ARE SEEN, NO SYMPTOMS REPORTED BY PATIENT IN EVENT RECORD DIARY.
As queried by the doctor, my father has never had instances of palpitations, chest pain or feeling of irregular (weak/strong) heartbeat. Please advise what is the current state of the patient based on these reports and how should we proceed clinically to nurse him back to health.
Brief Answer:
please see detailed discussion
Detailed Answer:
Dear Sir
1. The summary of holter report does not show any significant arrhythmia (disorder of rhythm).
2. The ECHO report says that there are certain parts of heart which are not contracting well and the pumping capacity of heart is ~40% (which should be more than 52% for an adult male). This usually represents a heart attack which in given scenario may be old.
3. For clots in brain, usual treatment involves giving drugs which prevent further formation of clot like aspirin, clopidogrel etc depending upon the profile of the patient. I am sure that your neurologist must be giving them. Normally the current clot gets dissolves on its own and no specific treatment is given beside these medications. For larger clots emergency administration of certain agents is useful but that is for initial few hours. Beside, medicines for high blood pressure and control of cholesterol levels are also given.
4. For abnormalities in ECHO, we normally match it with ECG findings. If ECG also suggests heart attack, we advise a coronary angiogram to ascertain coronary anatomy. If ECG does not suggests old or new heart attack, we re-evaluate ECHO. Again if findings are confirmed, next step is angiogram. Going for angiogram does not always mean that patient will be subjected to angioplasty (ballooning or stenting) or bypass surgery. But as it is a silent attack, knowing exact status of coronaries and any blockade is helpful. Some of the cardiologist advise stress test in such scenario before angiography. However, in view of recent stroke, it would be prudent to wait for sometime before performing any of these two. I would suggest you to seek advise of a good cardiologist after the discharge from hospital.
Hope this helps.
Feel free to discuss further.
Sincerely
Sukhvinder
please see detailed discussion
Detailed Answer:
Dear Sir
1. The summary of holter report does not show any significant arrhythmia (disorder of rhythm).
2. The ECHO report says that there are certain parts of heart which are not contracting well and the pumping capacity of heart is ~40% (which should be more than 52% for an adult male). This usually represents a heart attack which in given scenario may be old.
3. For clots in brain, usual treatment involves giving drugs which prevent further formation of clot like aspirin, clopidogrel etc depending upon the profile of the patient. I am sure that your neurologist must be giving them. Normally the current clot gets dissolves on its own and no specific treatment is given beside these medications. For larger clots emergency administration of certain agents is useful but that is for initial few hours. Beside, medicines for high blood pressure and control of cholesterol levels are also given.
4. For abnormalities in ECHO, we normally match it with ECG findings. If ECG also suggests heart attack, we advise a coronary angiogram to ascertain coronary anatomy. If ECG does not suggests old or new heart attack, we re-evaluate ECHO. Again if findings are confirmed, next step is angiogram. Going for angiogram does not always mean that patient will be subjected to angioplasty (ballooning or stenting) or bypass surgery. But as it is a silent attack, knowing exact status of coronaries and any blockade is helpful. Some of the cardiologist advise stress test in such scenario before angiography. However, in view of recent stroke, it would be prudent to wait for sometime before performing any of these two. I would suggest you to seek advise of a good cardiologist after the discharge from hospital.
Hope this helps.
Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Thank you for your reply to our concerns.
1. When you say "This usually represents a heart attack which in given scenario may be old." does it mean that this clot came in the brain because he had a heart attack or did he suffer one like weeks or days back ? Please clarify and enlighten us as we're anxious.
2. I've attached the ECG they did at Sir XXXXXXX XXXXXXX hospital as well (Ecg1 & ECG2 Files). Please do take a look & let us know your opinion if it points to anything in specific ? I must also tell you that the patient is 65 Yrs Old and ~115KGs .
3. The patient has already been discharged from the Hospital as the Nuero Surgeon was satisfied with the recovery. However, we were told to get Cardio Follow up which has'nt been done yet as you also said "However, in view of recent stroke, it would be prudent to wait for sometime". The concern here is, how long do we wait , like a week or a fortnight ? What would be your suggestion on this ?
4. The patient has been recovering slowly but steadily . He is though feeling very weak for now.
5. I've also attached the medicines list that he's taking post discharge. Includes replacements for his Ecosprin and Presollar he was having previously I believe.
Thank you again for your valuable time & hope to hear soon from you.
1. When you say "This usually represents a heart attack which in given scenario may be old." does it mean that this clot came in the brain because he had a heart attack or did he suffer one like weeks or days back ? Please clarify and enlighten us as we're anxious.
2. I've attached the ECG they did at Sir XXXXXXX XXXXXXX hospital as well (Ecg1 & ECG2 Files). Please do take a look & let us know your opinion if it points to anything in specific ? I must also tell you that the patient is 65 Yrs Old and ~115KGs .
3. The patient has already been discharged from the Hospital as the Nuero Surgeon was satisfied with the recovery. However, we were told to get Cardio Follow up which has'nt been done yet as you also said "However, in view of recent stroke, it would be prudent to wait for sometime". The concern here is, how long do we wait , like a week or a fortnight ? What would be your suggestion on this ?
4. The patient has been recovering slowly but steadily . He is though feeling very weak for now.
5. I've also attached the medicines list that he's taking post discharge. Includes replacements for his Ecosprin and Presollar he was having previously I believe.
Thank you again for your valuable time & hope to hear soon from you.
Brief Answer:
please see details below.
Detailed Answer:
Dear Sir
1. The echocardiographer has not qualified further regarding the area of decreased pumping. Hence it is not possible to say that attack is fresh, recent or old. However the ECG shows established Q waves with absence of any significant ST elevation which is suggestive that heart attack is not fresh. The ECG also shows frequent VPCs which may occur in multiple conditions and are not specific of a disease process. A clot from the heart can go to brain, both in case of fresh heart attack or old heart attacks. It is possible but is not common.
2. There is no need to wait for consulting a cardiologist. You should consult him on priority. Only the concerned test will have to wait, as the consulting cardiologist will also explain you. (please re-read para4 of last answer).
3. In place of ECOSPRIN the doctor has prescribed CERUVIN which is also an anti-platelet like ECOSPRIN. PRESOLAR is a medicine for high blood pressure which contains two medicines. EMBETA-XR has one medicine which is also meant for reducing blood pressure. He needs blood pressure monitoring for titration of these drugs. Two to three readings in a week are usually sufficient for most patients; However, if your doctor has prescribed more frequent monitoring, it must be followed.
4. Since, he had a stroke recently, it will take some time for weakness to recover.
Hope it helps.
Sincerely
Sukhvinder
please see details below.
Detailed Answer:
Dear Sir
1. The echocardiographer has not qualified further regarding the area of decreased pumping. Hence it is not possible to say that attack is fresh, recent or old. However the ECG shows established Q waves with absence of any significant ST elevation which is suggestive that heart attack is not fresh. The ECG also shows frequent VPCs which may occur in multiple conditions and are not specific of a disease process. A clot from the heart can go to brain, both in case of fresh heart attack or old heart attacks. It is possible but is not common.
2. There is no need to wait for consulting a cardiologist. You should consult him on priority. Only the concerned test will have to wait, as the consulting cardiologist will also explain you. (please re-read para4 of last answer).
3. In place of ECOSPRIN the doctor has prescribed CERUVIN which is also an anti-platelet like ECOSPRIN. PRESOLAR is a medicine for high blood pressure which contains two medicines. EMBETA-XR has one medicine which is also meant for reducing blood pressure. He needs blood pressure monitoring for titration of these drugs. Two to three readings in a week are usually sufficient for most patients; However, if your doctor has prescribed more frequent monitoring, it must be followed.
4. Since, he had a stroke recently, it will take some time for weakness to recover.
Hope it helps.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Thank you for your quick response Sir.
I wish to add 2 Important facts here,
1. Patient is a XXXXXXX Rtd. Govt. Officer who has a history of Hypertension. During his job in XXXXXXX 2009, he had his BP shoot to 220/140 one morning & During his treatment that followed, it was discovered he had a clot/blockage in his carotid artery which was treated with Presolar/Ecosprin ever since. Plus, he has been borderline Diabetic since past 2 years. We only came to know during this issue that he was not taking Ecosprin regularly since a while thanks to these TV Products and he was trying one such product.
2. We've noticed abnormalities in his BP while monitoring at home, like upper one is high & Lower one is Low . Could this be due to the Electronic BP machine ? We are going to monitor his BP using conventional machines henceforth and will update you on any deviation.
3. We have an appointment with his Nuero Surgeon this weekend so could the Cardiologist appointment wait until then or you suggest an Immediate consultation for any reasons you may know better ?
Thank you again for your prompt response.
I wish to add 2 Important facts here,
1. Patient is a XXXXXXX Rtd. Govt. Officer who has a history of Hypertension. During his job in XXXXXXX 2009, he had his BP shoot to 220/140 one morning & During his treatment that followed, it was discovered he had a clot/blockage in his carotid artery which was treated with Presolar/Ecosprin ever since. Plus, he has been borderline Diabetic since past 2 years. We only came to know during this issue that he was not taking Ecosprin regularly since a while thanks to these TV Products and he was trying one such product.
2. We've noticed abnormalities in his BP while monitoring at home, like upper one is high & Lower one is Low . Could this be due to the Electronic BP machine ? We are going to monitor his BP using conventional machines henceforth and will update you on any deviation.
3. We have an appointment with his Nuero Surgeon this weekend so could the Cardiologist appointment wait until then or you suggest an Immediate consultation for any reasons you may know better ?
Thank you again for your prompt response.
Brief Answer:
please see details
Detailed Answer:
Dear Sir
1. The higher upper BP and lesser Lower BP is a variant of the disease only. You can continue using electronic device and have it calibrated at regular intervals. Conventional BP instruments using mercury will soon be banned because of environmental hazards. The current medicines should be continued as your doctor seems to have taken care for both ecosprin and presolar.
2. Yes, Cardiologist consultation can be done after this neuro consultation at this weekend.
Sincerely
Sukhvinder
please see details
Detailed Answer:
Dear Sir
1. The higher upper BP and lesser Lower BP is a variant of the disease only. You can continue using electronic device and have it calibrated at regular intervals. Conventional BP instruments using mercury will soon be banned because of environmental hazards. The current medicines should be continued as your doctor seems to have taken care for both ecosprin and presolar.
2. Yes, Cardiologist consultation can be done after this neuro consultation at this weekend.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Prasad
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