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    What does this MRI report indicate?

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Posted on Fri, 4 Aug 2017 in Hypertension and Heart Disease
Question: My recent MRI for heart area noted some changes to the negative; I am 79 yo.
NOW my pulse rate has varying swings from the usual 55-65 to as high as 86 without notable exercise. My doctor said be sure my upper blood pressure reading was no lower than 120, but did not mention pulse rate.
In 1 1/2 weeks, I have an angiogram scheduled.
Should I be unduly worried about pulse rate swings, mostly taken after sitting a while?
doctor
Answered by Dr. Ilir Sharka 54 minutes later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your question and would explain that these heart rate variations between resting and exercising conditions is quite normal and physiological.

There is no reason to worry about this!

A heart rate between 55-100 bpm is considered normal under usual physiological conditions.

But, for properly judging on heart rate issues and blood pressure recommendations, it is necessary to directly review your cardiac ultrasound and also MRI reports.

Please, could you upload them here for a second professional opinion?

I remain at your disposal whenever you can upload those reports.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 2 hours later
7/11/2017
4
~me: XXXX 1DOB:0000 MRN:U0000PCP:XXXX J Wong, MD
UW Medicine eCare - Test Details
CTA CHEST ABDOMEN PELVIS ANGlO - Details
Study ~esult
Impression
IMPRESSION:
1. Smallest arterial lumen caliber in the right pelvis is 9.6 mm in the
proximal to mid common femoral artery. Smallest caliber in the left pelvis is
8.9 mm in the proximal common femoral artery. There is severe atherosclerotic
calcification burden in the abdominal aorta with extension into the
significantly tortuous iliac vasculature.
2. No thoracic or abdominal aortic aneurysm. There is mild atherosclerotic
calcification in the thoracic aorta, with small focal burden in the ascending
aorta. - Severe coronary artery calcifications.
3. There are atherosclerotic calcifications present in all abdominal aortic
branch vessels with moderate to high grade stenosis of the proximal celiac.
4. With regards to aortic leaflet length:
-Left leaflet measures 22.3 mm; aortic annulus to left coronary artery ostium
length 17 mm; aortic annulus to sinotubular junction in the left sinus: 23.9
mm.
-Right leaflet measures 18.9 mm; aortic annulus to right coronary ostium 16.3
mm; aortic annulus to sinotubular junction in the right sinus 24.1 mm.
5. Severe aortic leaflet calcifications without extension into the LVOT.
6. Tiny focus of myocardial thinning of the left ventricular apex. Prominence
of the pulmonary arteries could indicate underlying pulmonary hypertension.
7. Tiny pulmonary nodule in the right middle lobe is below size criteria to
warrant follow-up based on current guidelines.
8. When compared to 2009, there is been interval increased size of a now 1.6
em cyst in the upper pole left kidney with suggestion of thin internal
septation. Follow-up with renal ultrasound should be performed in 6-12
https://ecare.uwmedicine.org/mychartprod01/inside.asp?mode=labdetail&orderid=1 &printmode=true 1/5
7/11/2017 UW Medicine eCare - Test Details
months. Bosniak 2[_,._ ~"
- 9. Approximately 3 cm fluid-filled structure in the posterior mediastinum to
the right of the esophagus is likely benign and either a foregut duplication
cyst versus pericardial cyst or pericardial diverticulum.
Narrative
EXAMINATION:
CTA CHEST ABDOMEN PELVIS ANGlO: TRANS-ARTERIAL AORTIC VALVE REPAIR PROTOCOL
CLINICAL INDICATION:
heart, aorta from aortic valve to bifurcation of iliacs, ascending aortic
aneurysm, presyncope
Aortic stenosis, planned percutaneous transcatheter repair. On most recent
cardiology clinic. The patient states symptoms of tightheadedness and marrow
vision when standing, no XXXXXXX syncopal episodes reported. Increasing
shortness of breath.
TECHNIQUE:
CVA 15 TAVR
CTA of the abdomen and pelvis
ECGGated CTA of the heart and thoracic aorta
Multidetector row CTA of the chest, abdomen and pelvis was performed in the
arterial phase following contrast. The chest was scanned from the thoracic
inlet to the domes of the diaphragm wth ECGgating. The abdomen and pelvis was
scanned from the domes of the diaphragm to the lesser trochanters. Axial and
multiplanar reconstructions were performed. On an independent workstation,
volume rendered and/or MIP reconstructions were generated to evaluate the
cardiac structures, thoracoabdominal aorta, and the itiaofemoral vessels.
Advanced techniques were used to customize the radiation dose to the clinical
indication and patient characteristics.
CONTRAST:
Omnipaque 350 mg-mI120@5 ml 07/06/201712:35 PM INTRAVENOUS
COMPARISON:
Portions of CT abdomen pelvis dated 12/30/2009
FINDINGS:
NONVASCULAR FINDINGS
CHEST:
Lungs: No consolidation. Mild lung base atelectasis. There is a 5 x 3 mm solid
nodule in the lateral aspect of the right middle lobe (axial 79, sagittal
114). Scattered small emphysematous blebs.
https:llecare.uwmedicine.org/mychartprod01Iinside.asp?mode=labdetail&orderid=1 &printmode=true 2/5
7/11/2017 UW Medicine eCare - Test Details
Mediastinum and Esophagus: 3.1 x 1.4 cm right hilar lymph node (axial 59).
- Smaller inferior right hilar lymph node measures 1.8 x 1.3em. Interval
increased size of a oblong-shaped 2.8 x 1.4 cm fluid collection adjacent to
the lower esophagus, possibly a pericardial cyst or pericardial diverticulum,
on exam 2009 this structure was of similar shape but thinner measuring 2.4 x
0.7cm.
Pleural effusions: none
Chest wall: Unremarkable.
ABDOMEN:
Liver: Unremarkable.
Gallbladder: No calcified stones.
Pancreas: Unremarkable.
Spleen: Unremarkable.
Adrenals: Unremarkable.
Kidneys: Symmetric cortical enhancement. When compared to exam from 2009,
there is been interval enlargement of left upper pole hypodensity now
approximately 1.6 cm in size, sagittal image 56 suggest a thin internal
septation. No hydronephrosis. Prominence of the perirenal septa is likely
senescent.
Abdominal Lymph Nodes and Retroperitoneum: No enlarged lymph nodes.
Bowel: There is a mild to moderate-sized hiatal hernia
Peritoneum and Abdominal Wall: Small fat-containing umbilical hernia measuring
up to 2.1 cm craniocaudal with the orifice measuring 0.6 cm (sagittal 76).
Small left and tiny right fat-containing indirect inguinal hernias.
PELVIS:
Bladder: Unremarkable.
Prostate remains prominent at 5.9 cm mediolateral, unchanged. There is also a
similar impression upon the bladder. No pelvic adenopathy.
BONES:There are no acute or suspicious osseous findings present. There are
degenerative changes in the spine, shoulders, hips and SIjoints. Severe
degenerative disc disease is noted in the lower lumbar spine with near
complete disc space loss at L3-L4, and L4-L5 along with mild to moderate
bilateral facet hypertrophy.
VASCULARFINDINGS:
Thoracic aorta and branch vessels: The thoracic aorta is nonaneurysmal
anatomy.
Mural calcification in the ascending thoracic aorta: Mild focal ringlike mural
calcifications in the ascending aorta anteriorly
https://ecare.uwmedicine.org/mychartprod01Iinside.asp?mode=labdetail&orderid=1&printmode=true 3/5
7/11/2017 ./1 UW Medicine eCare - Test Details
There is conventional branching of the great vessels from the aortic arch.
Heart size: Significant cardiomegaly with dilatation of a1l4 chambers.
Incidental note is made of left ventricular apical myocardial thinning.
Pulmonary Arteries: The main pulmonary artery measures 34 mm in caliber, and
the proximal main pulmonary arteries are ectatic.
Coronary arteries: Right dominant. No anatomic anomalies seen. Severe coronary
artery atherosclerotic calcifications throughout.
Mitral anulus: Small valvular calcification of the anterior leaflet. The
posterior leaflet is unremarkable.
Aortic root and valvular calcifications:
Distribution: Severe, diffuse, globular valvular calcifications along the
aortic leaflets and thickening. No calcification extension into the LVOT.
Three aortic sinuses present: Yes
Visibility of three separate sinuses: Adequate ..
Aortic root measurements:
Sinuses of Val salva = 40.2 x 40.4 x 40.7 mm
Sinotubular junction - Non-effaced = 37.3 x 36 mm
Mid ascending aorta = 45 x 45 mm
Aortic valve and anulus dimensions:
Annulus at leaflet insertion (30% R-R interval) = 28.7 x 36.9 mm; 784.7 mm2;
circumference 104.4 mm
Annulus at LVOT (30% R-R interval) = 29.4 x 37.2 mm, 829.1 mm2; circumference
103.4 mm
Valve leaflet length (measured with CPR) left = 22.3 mm, right = 18.9 mm
Measured distances and lengths:
Aortic annulus to left coronary ostium = 17 mm
Aortic annulus to sinotubular junction in left sinus = 23.9 mm
Aortic annulus to right coronary ostium = 16.3 mm
Aortic annulus to sinotubular junction in right sinus = 24.1 mm
Best Image Intensifier angulation to profile LVOT and aortic valve.
10 deg LAO; 15 deg caudal
Abdominal aorta: Moderate to severe burden of calcified atheromatous plaque
throughout the nonaneurysmal abdominal aorta with extension into the branch
vessels orifices. At the proximal aspect of the celiac axis there is moderate
to severe focal stenosis with poststenotic dilatation (sagittal image 75).
https:llecare.uwmedicine.org/mychartprod01/inside.asp?mode=labdetail&orderid=1 &printmode=true 4/5
7/11/2017 UW Medicine eCare - Test Details
1
Iliofemoral arteries:~Jhere is mild to moderate calcified atheromatous plaque
in the iliac vasculature. The external iliac arteries are significantly
- tortuous.
Smallest arterial lumen calibers:
Right pelvis (I) = 9.6 mm in the right proximal to mid common femoral artery,
at to slightly below the inguinal ligament.
Right pelvis (2) = 10.8 mm in the right proximal common femoral artery, above
the inguinal ligament.
Left pelvis {'I} = 8.9 mm in the left proximal common femoral artery, at to
slightly below the inguinal ligament.
Left pelvis (2) = 10.5 mm in the left distal external iliac artery, above the
inguinal ligament.
ATTENDINGRADIOLOGISTAND PAGERNUMBER
002172 XXXXXXX XXXXXXX Phelps MD
(206)541-1595
Component Results
There is no component information for this result.
General Information

Collected:
07/06/201712:34 PM
Resulted:
07/07/20177:41 PM
Ordered By:
RosarioV Freeman, MD
Result Status:
Final result
MyChart®licensed from Epic Systems Corporation © 1999 - 2016
https:llecare.uwmedicine.org/mychartprod01/inside.asp?mode=labdetail&orderid=1 &printmode=true 5/5


I note for further evaluation that most bp readings were taken after sitting for at least 10 minutes and a wrist monitor was utilized.
doctor
Answered by Dr. Ilir Sharka 17 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again, dear XXXX!

I passed through your uploaded test results and would say that several changes compatible with age advancing are present.

What is more prominent seems to be the extensive atherosclerotic vascular process, extending from different portions of aorta to its branches (coronary arteries, celiac artery, ilio-femoral arteries, etc.)

These findings need to be clinically correlated and also monitored with several laboratory exams (potential chest angina, limbs pain, cardiac enzymes, etc.)

The presence of aortic stenosis and high burden of aortic calcification weakens the aortic baro-reflexes in blood pressure values control.

That’s why blood pressure values should be closely monitored.

In addition, cardiac findings like myocardial wall thinning, enlarged cardiac dimensions need to be followed and confirmed also by cardiac ultrasound.

The presence of concomitant extra-cardiac disorders, like pulmonary structural changes (atelectasis, emphysema, pulmonary arteries dilation [implying pulmonary hypertension], makes trans-catheter aortic valve intervention the preferred and most feasible alternative.

Also, certain finding like the pericardial and renal cysts need to be followed periodically by means of imagine studies in order to avoid any potential complications.

Hope to have been helpful to you!

In case of any further questions, feel free to ask me again.

Wishing you are having a pleasant weekend!

Regards,

Dr. Iliri

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

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Practicing since :2001

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