What Does My Echocardiogram Test Report Indicate?

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I carefully reviewed your recent medical history and uploaded cardiac echo.

Regarding your concern, I would like to explain that it is necessary to further investigate some important clues:

(1) your palpitations complaint seems to be related to recurrent cardiac arrhythmia events. The subsequent feelings of dizziness, light headed, fainting are likely to be caused by episodic arrhythmia. Whether a supra-ventricular or ventricular arrhythmia is implicated, it remains to be clarified by heart rhythm monitoring.

This latter objective is achieved in two ways:

(a) by reviewing the arrhythmia-storing memory of your ICD hardware (performed by your arrhythmia doctor).

(b) performing an ambulatory 24 to 48 hours ECG monitoring (Holter)

After cardiac arrhythmia profiling is performed, it is necessary to review:

- potential ongoing cardiac ischemia (pharmacological cardiac stress test, nuclear perfusion stress test, coronary angio CT and coronarography if necessary),

- thyroid function status (check blood hormone levels and review actual thyroid therapy doses),

(2) regarding shortness of breath, it seems to be mostly explained by your overall cardiac function impairment (systolic and diastolic). This is confirmed by your cardiac ECHO report: it shows decreased systolic function (40%); but what is also very important an impaired diastolic function (confirmed by the marked left ventricle concentric hypertrophy (increased thickening of ventricular walls leading to impaired relaxation during diastole).

(3) regarding tingling, vibrations, electricity running through my left arm, chest and head and stomach cramps, they may be mainly explained by anxiety, depression and associated therapy (Tofranil may exert several side effects like weakness, sedation, lethargy, headache, nausea, etc. It is necessary to make a new review of your psychological status and underlying therapy by your therapist/psychiatrist.

Coming to this point, I would recommend as follows:

- discuss with your doctor about the possibility of stopping digoxin, which would not the preferred choice in the presence of left ventricular hypertrophy and hypertension.

- review your actual thyroid therapy doses in order to avoid potential adverse effects in the case of overdosing.

- check some lab tests:

a) complete blood count (investigate for possible anemia)
b) NT-proBNP (to confirm the implication of heart failure/cardiac dysfunction in shortness of breathing complain),
c) check AST & ALT, CPK to explore potential adverse effects of Pravastatin (myopathy expressed with fatigue, myalgia, etc.)

- discuss with your doctor the opportunity of starting any vasodilators like ACEI (Ramipril, Lisinopril, etc.) or ARB (Valsartan, Olmesartan, Irbesartan, etc.), if no contraindications exist.

From your cardiac ultrasound (ECHO) report it was not evaluated (written) the presence of no of pulmonary artery hypertension. Nevertheless, if this is present (discuss with your doctor), and NT-ProBNP results abnormally high, it would be rationale to start any low dose diuretics (Furosemide, Torasemide).

Hope to have clarified the main issues of your concern.

Anyway, in case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

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Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again!

(1) First of all as I explained you before, I am more concerned on the real nature of your palpitations than running to stop them.

It is necessary to ascertain whether we have to do with a simple extra systolic arrhythmia or a more complex arrhythmia.

Is is supra-ventricular or ventricular?

And before deciding to treat them, some main causes should be excluded first.

As you have a past history of a heart attack and coronary artery disease is thus confirmed, I recommend following a comprehensive evaluation for ruling in/out cardiac ischemia (a possible reason of arrhythmic events).

As I mentioned before, several imagine cardiac tests (dobutamine cardiac echo, nuclear perfusional cardiac stress test [CARDIOLITE], coronary angioCT) would properly clarify this issue.

If an important coronary artery disorder would be detected, then treating coronary stenoses would yield beneficial results in controlling and minimizing palpitations (arrhythmia).

I agree with your doctor as Amiodarone may exert serious side effects. Dronedarone could be an alternative (no obvious adverse effects on thyroid glands).

(2) Regarding physical exertion, I recommend to not be afraid of continuing a physically active daily profile, as it has several beneficial effects on your blood circulation, cardiac function, and psychological profile.

The only advice would be to follow a gradual training schedule without too much strain; just walking outside 2-4 km daily or trying cardio fitness.

Hope to have been helpful to you!

Best wishes,

Dr. Iliri

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