Experiencing Palpitations. Undergone 2D Echo, Doppler Study And TMT. Suggest

Posted on Sat, 2 Nov 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sat, 2 Nov 2013 Answered on

Tue, 26 Nov 2013 Last reviewed on

Question : My brother-in-law who is 83 years old and very active but known heart patient for the last 10 years and on medication. Since last few months he was feeling palpitation even on minor gradient. Few days back he was subjected to 2D echo, Doppler study and TMT. The observations are as under: "No regional wall motion abnormalitiess--Concentric left ventricular hypertrophy--Normal LV syssstolic function at rest--LV diastolic dysfunction--LVEF=60%--Mild pulmonary artery hypertension (RVSP=38 mm Hg)--No clot/vegetation/pericardial effusion--AORTIC VALVE:sclerotic--IVS: HYPERTROPHIED" TMT findingss--Exercise time: 7.08 minutess XXXXXXX HR attained: 102 bpm 74% of HR 137 XXXXXXX BP 130/80 WorkLoad attained: 8.3 (Fair effort Tolerance) Significant ST segment changes noted during exercise or recovery Angina/Arrhythmia/S3/murmur Final impression: Test is negative for inducible isschaehmia MODERATE EFFORT TOLERANCE NORMAL HR AND BP RESPONSE NO ST-T CHANGES NO ANGINA ARRAHYTHMIAS TMT IS NEGATIVE FOR INDUCIBLE ISCHAEMIA My brother-in-law is active in his daily routine. But he has stopped walking due to palpitation/breathlessness. Kindly advise what to do XXXXX

Answered by Dr. Indu Kumar (1 hour later)

Brief Answer: He need Holter ECG and further investigations. Detailed Answer: Hello Thanks for writing to XXXXXXX Findings of ECHO is due to history of hypertension and it is acceptable considering his age. Concentric left ventricle hypertrophy and IVS hypertrophy occurs due to hypertension and it is due to the fact that left ventricle has to pump blood against increased pressure and in long term it causes hypertrophy. Mild LV diastolic dysfunction is acceptable.Mild pulmonary arterial hypertension is due to increased resistance in the body.Other parameters like wall movement and ejection fraction is normal. Aortic valve sclerosis is age related. TMT findings is also acceptable. There is no signs of ischemia on exertion. Palpitation and breathlessness has to be taken seriously in old age as they are more prone to heart diseases. He need proper clinical examination and detailed history like chest pain, radiation etc. He need further investigations like Holter ECG(24 hour recording),Thyroid profile and angiography or CT Scan. He should consult cardiologist and follow their advice. Get well soon Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

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

Follow up: Dr. Indu Kumar (15 hours later)

Respected Dr. I have uploaded old angiogram reports and details of current medication of my brother-in-law. Current echo and doppler reports and TMT--negative reflects and his active life does not worry us. But we are unable to understand despite regular medication and followup checkups he is feeling PALPITATION AND HEAVY BREATHING whenever he encounters gradients while he walks from his house. Attending drs say that he should walk atleast 1--2 km everyday even after seeing latest echo, doppler and TMT reports. I am looking at you with a hope that I will get guidance from you in this regard. My brother-in-law stayed in a District Headquarter and he is having regular checkup with local available drs and facilities. Kindly advise me the cause for his discomfort and also about his health condition. Thanking you, XXXXX

Answered by Dr. Indu Kumar (15 hours later)

Brief Answer: Walk as much possible on plain ground Detailed Answer: Hello Thanks for writing back. There are few points to be discussed with the treating doctor. At age 83 years, the body becomes weak and may not have enough stamina to take walks along steep gradients.In that case I would suggest him to take short walks on roof top or nearby on plain ground. Since his ejection fraction is normal and TMT does not show stress induced ischemia, his heart condition is relatively better. Please remember that it is not compulsory for him to take 2 km walks, instead he may stop when he feels uncomfortable. Regarding surgery or angioplasty, the risks involved are more than the benefits and his tests like echocardiography and TMT are normal. Therefore doctors do not want to do any surgery or angioplasty. Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

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

Follow up: Dr. Indu Kumar (43 hours later)

Thank you Dr. Most of the doubts lingering in our mind have been cleared from your reply. But some still remained in our mind. Most important is some are alternatively suggesting to go for CT Angiogram (64 or 128 slice). I do not know whether it is absolutely necessary and also what is to be done after that. Another question is that Aortic valve sclerotic which is being reported in ECHO even in the last report 10 years back. Is there any medicine for that? My brother in law is regular in taking medicine and followup and also is not leading sedantry life. I, therefore, request you kindly advise me about the necessity of CT Angiogram and further action on its findings and also medicine for Aortic valve sclerotic. Kindly advise even any other action which will help us to go further. Thank you, XXXXXX

Answered by Dr. Indu Kumar (19 hours later)

Brief Answer: CT& conventional angiography is done for stenosis. Detailed Answer: Hello Thanks for writing back. CT angiography or conventional angiography is done for proper assessment of coronary artery obstruction. Conventional angiography is more accurate for assessment of stenosis in coronary arteries where as CT angiography not so accurate for stenosis grading but CT angiography is more sensitive for assessing calcium scoring in coronary arteries.These are required if you and surgeon is considering for any intervention. But his age is not in favour of any intervention.So,it can be discussed with cardiac surgeon. Aortic valve sclerosis is due to aging and hypertension. It doesn't require any treatment. But calcium also get deposited at other sites like carotid vessels and it may lead to neurological problems.So,Carotid vessels should be assessed. Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

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