What Do These Echo Readings In A BP Patient Indicate?

Posted on Mon, 14 Sep 2015

Question: I am living in Saudi Arabia and working in IT (under pressure) environment, hence I go quarterly to cardiologist for regular checkups, it has been 10 years and at times I had high BP (150/90 -160/90), doctor never prescribed me any medication during these years I underwent 4 times stress test (last one was three years before). Everything was normal, in May 2015 I was feeling more stress and I went to another cardiologist for checkup, he had asked for an ECHO test and told me that you have mild LVH (1.27cm) but this is not significant and your BP is 155/90 and we need to control it. At present he has prescribed me Olemesartan Medoxomil/Amlodipine Besilate (40/5 mg). The readings are IVSD - 12, PWd - 9, LVIDd - 39, LVIDs - 2.6, EF > 55% and all interpretation are normal. Since I travelled XXXXXXX this month I have taken an echo the readings are different and as follows Left Ant - 54, Left Ari - 30, Aorta - 23, IVSD - 9, LVIDD - 54, LVIDs - 30, LVPW - 9, EF - 65%, AO Flow - 1.6 M/s, PV Flow - 1.1 M/s, E.Velocity - 1.1 M/s, A.Velocity - 0.8 M/s and chambers, valves and impression are normal. He said everything is normal. But when I checked in the internet the LVIDD is near border to the reference point. What should I do and I am more stressed.

Answered by Dr. Lilit Baghdasaryan (35 minutes later)

Brief Answer:
Nothing serious

Detailed Answer:
Dear Sir,

I went through your echo reports and images, the point is, it seems that walls are overestimated in one image (which leads to underestimation to left ventricle) and underestimated in another (and left ventricle is overestimated in this image), so I think the real values are somewhere in between.
Actually there is nothing to worry.
The only advise I would give, to control your blood pressure and follow healthy lifestyle. If you are concerned much, you can repeat the echo in an experienced center in a year. But there is really nothing to be concerned.

Wishing you good health

In case of further questions don't hesitate to ask

Regards,

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

Follow up: Dr. Lilit Baghdasaryan (6 minutes later)

Dr. Thank you very much but i would like to know in which image this is overestimated and which image this is under estimated. What would happen if they overestimate and underestimate? More over what is the XXXXXXX size of LVEDD? And which report seems to be near to alright?

Answered by Dr. Lilit Baghdasaryan (14 minutes later)

Brief Answer:
Welcome back

Detailed Answer:
Dear Sir,

According to the recent European Echocardiography Association/American Society of echocardiography guidelines (2015) the maximum diameter of left ventricle is 58 mm among men.
The interventricular septum seems overestimated in one from Saudi Arabia, so the left ventricle underestimated, and vise versa in echo report from XXXXXXX
You should know that interobserver variability is very common even among experienced echocardiographers. I think there is nothing to be concerned about echo report.
In your case the most important thing is blood pressure control, which can lead to serious consequences over the years if left untreated.

Take care,

Note: For further queries related to coronary artery disease and prevention, click here.

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