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    What do these ECHO reports indicate?

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Posted on Thu, 6 Jul 2017 in General Health
Question: Dear Dr. Iliri,
It is XXXX, the woman you have helped many many times, with the history of pvc-induced cardiomyopathy. It has been a few months since I have spoken to you and I continue on my path of having very severe OCD with continual fears of returning heart failure, and constant measuring of all my fluids and food, and weighing myself many many times a day.

It is now 6 months since my 2nd successful ablation, and 3 months since my last echo. I am no scheduled for a follow-up echo because I have to be cleared for State Department travel. I am very very very scared, once again, so sure that this is the time that my heart will shown to be weak again. I feel the same, but I notice that I have slight variations in my weight (1-4 lbs) even though I eat very little (only about 500 calories per day) and I am so scared of water retention that I measure all fluids and try to limit activity or even standing when I've had water. My old cardiologist had told me putting my feet up and resting is the only way I wouldn't "blow up with fluid". Even when I walk around, I don't notice any swelling, but it does seem as if my urine output is lower than when I am able to be still. I cannot measure fluids or my weight when I'm not at home, of course, so I am often afraid to be out of my home.

I am most scared this time, as my last echo (l've attached last two echoes) had that weird observation of "diastolic dysfunction" and "delayed relaxation" even though when I asked my cardio about it, he said it meant "absolutely nothing". I am so scared that it's a sign that some sort of heart disease is ongoing, and I am deteriorating and will again find myself in heart failure. I have been off of all heart meds for 18 months now.

Do you think it's extremely unlikely that I would have a bad echo just three months after the last one? I think I'm more afraid now than I ever have been before, although I suppose I feel this way before every echo I have. My anxiety is so high that I fear the anxiety itself will cause my heart harm. I don't know how to forget the fear.

Thank you so much, Dr. Iliri. You have been so much help to me over the last two years. I hope you are well.

XXXX
doctor
Answered by Dr. Ilir Sharka 6 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Dear XXXX,

I am happy to hear from your again on HCM!

You are one of my favorite online patients and of course I remember all your medical history.

I am glad that you are feeling OK after your last ablation.

Regarding the findings in your last echo (diastolic dysfunction and delayed relaxation), I agree with your doctor on the fact that these findings have no clinical significance.

As you do not have any leg swelling, shortness of breath or any other symptoms, fluid retention can be excluded.

The changes of your body weight through the day are quite normal. They are related to the continuously changing balance between input (food and drinks) and output (urine, stool, sweating, and other body fluids). These changes are quite normal and occur in every healthy person.

So, there is nothing to worry about!

Coming to this point, I am quite sure that your next cardiac echo will result normal. You should not doubt on this!

Regarding physical activity, you are allowed to perform as much physical activity as you need. It is quite normal to have a higher urine output when resting compared to physical activity. It is related to the changes in the blood flow to the renal arteries. But, our body has its own balances and it regulates the blood flow to the urinary arteries as needed, in order to avoid fluid retention.

You have a normal heart now and there you should not be afraid of fluid retention.

Just relax and don´t worry about it!

You should remember that you are the boss of your mind! You are the one who commands your thought. So, when these bad thoughts and fears come into your mind, take a deep breath and say `Stop`! In that moment try to think about something different, a dear person to you or some beautiful memories. This will help push away the bad thoughts and think more positive. You can do it! I am sure about it, because you are a strong woman! Just try it!

I remain at your disposal whenever you need!

Kind regards,

Dr. Iliri



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 4 days later
Dear Dr Iliri,
Thank you so much, as always. I am trying so so hard to get past this but I can't get past the issues of recurrence and water retention.

If there were any chance I was having a recurrence, would there have been signs in my echo of 12 weeks ago? I think that is what I am most afraid of/ that the findings of "diastolic dysfunction" and delayed relaxation are the earliest signs of a return of cardiomyopathy. Is diastolic dysfunction a sign of general heart weakness?

I am supposed to schedule my echo for next week- but I haven't done it yet. I always feel scared, but this time feels the worst- I just feel like my last echo was the beginning of the return of heart disease.

Thank you, Dr Iliri, for all your help.

XXXX
doctor
Answered by Dr. Ilir Sharka 5 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Dear XXXX,

I understand how you feel, but these findings have no clinical significance.

You have no symptoms of heart failure and your last performed echo is within the normal ranges. I am sure that if something was going wrong it would show up on the echo report.

So, relax and don’t worry about it!

I am sure that your next echo will result normal again.

Regarding diastolic dysfunction, I would explain that it is necessary to provide also Tissue Doppler parameters and investigate also the ratio E/E’ in order to have more information on this disorder.

You have only the usual mitral inflow spectral parameters on your echo reports. There is no utilization of tissue Doppler techniques during your echo-cardiogram.

But I am also of the opinion that they are not necessary because your mitral inflow pattern is within the normal ranges for your age. You can see them also on your echo reports (E/A 0.6-2 ).

So, I do not think that there is any signs of diastolic dysfunction.

That is why they have not utilized tissue Doppler techniques, because they have considered them unnecessary in your case.

Hope to have clarified some of your uncertainties!

Dear, I would just recommend you to be more optimistic and try to push away those bad thoughts. They are just suppositions. The reality is that you are feeling OK and all your echo reports can confirm this.

Anxiety is not going to help! Try to manage it by thinking about beautiful things or memories. You should try to enjoy more your life!

Let me know about everything!

Wishing good health,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 39 hours later
Thank you so much, Dr. Iliri. This time I am so afraid, I have not yet made my appoinment for my echo and it is required for my work clearance. I have been badly frightened by the "diastolic dysfunction" and so scared that my echo will have worsening plus other problems. My cardiologist had said, as you do, that there were no changes but there must be a reason that was noted on my last echo. It wouldn't have come from nothing.

Dr Iliri, is there absolutely no logic to my "resting" after drinking water? I fear water retention so much, and yet I "test" myself by drinking lots of water, too much probably(over 3 liters in a day) in order to make sure that I am voiding enough. When I drink less, I feel like I never need to void and so I worry even more. I can't forget how my doctor wrote on all my appointment records, "water is your enemy, feet up and weigh, weigh, weigh!"

I admit I now despair that I will ever be the normal, happy person I once was. Even in important meetings, or while trying to do anything fun, I am only thinking of my heart and when I can next weigh myself and worrying if I have been standing too long and that it will make me retain water.

Are you quite certain that in three months, I couldn't have deteriorated into an abnormal state? I don't have visible edema or shortness of breath but I feel afraid that those symptoms will develop 24/7. I am thinking of it every minute.

Thank you so much, Dr Iliri. You are probably the person who has helped me most through this terrible few years of constant worry and terror.

Many thanks,
XXXX
doctor
Answered by Dr. Ilir Sharka 5 hours later
Brief Answer:
My advice as follows:

Detailed Answer:
Dear XXXX,

I am glad that you have found our thread helpful. Your appreciation means a lot to me!

But, you should not be afraid of anything.

Your clinical situation indicates a normal heart function. You have no signs of fluid retention, neither any other possible signs of aggravation.

So, just try to relax and do not think about it all the time!

I am sure your next ultrasound will result normal too.

Regarding the term 'diastolic dysfunction', you should know that it has no clinical significance, but it may be related to inter-observer variability.

But, as I already explained to your, your echo parameters are within the normal ranges.

So, there is no reason to think so much about it!

You should try to weigh yourself more rarely, because it has become a compulsion to you. You need to weigh yourself in order to feel better and relax, otherwise you feel anxious.

But, you should try to fight these compulsions. I know you are a strong woman and you can do it. My advice would be to do this gradually: try to forget about it and make up your mind as if you have just weighed yourself and everything is OK. You will understand that even if you do not weight yourself all the time, nothing bad happens.

This will help you go on and win over your fears.

Let me know about everything!

I am here always for you!

Regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 2 days later
Dear Dr Iliri,
Thank you so much for your continued help. I am having such a hard time and am so scared to even make my appointment.

If there were going to be a change in my echo, would I definitely some symptoms like visible edema! I am trying so hard to catch any possible relapse and so it seems my weight is not steady despite my low calorie intake and that my urine output is always too low. Last time I was sick, I was near death before I even got to the dr.

Dr Iliri, will it make a difference in my echo if I am hydrated or not? One time a dr said to me that EF was higher if you were more dehydrated. In November EF was 67, last time, 3 months ago, 62, and to me that seemed to be signficant lowering. What if next time it is just 57(another lowering of 5) or just 50? So worried.

Thank you so much.
XXXX
doctor
Answered by Dr. Ilir Sharka 7 hours later
Brief Answer:
My opinion as follows:

Detailed Answer:
Dear XXXX,

In every healthy person like you there is a hydro-electrolytic balance. I am sure that the fact that you drink a lot of water and do not urinate too much, is because you may lose some water with other body fluids (salivation, sweating, stool, vaginal discharge, respiration, etc.).

But you have no symptoms of fluid retention. So, I am sure that your body hydro-electrolytic balance is quite preserved.

Regarding those changes in your ECG, I think that they are not related to the degree of hydration. They are just relate to inter-observer variability.

Both those values are within the normal ranges.

I would recommend you try not to think too much on these issues. Anxiety is not going to help. It is just preventing you from thinking about the truth. And the truth is that you are OK now.

I am sure that your new cardiac ultrasound will result normal.

You should just have some faith and be more optimistic.

If you have any other questions, please don't hesitate to ask me again!

Wishing all the best,

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

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