New here-questions on diagnosis

I was diagnosed with stenosis of the aortic valve in 2014. In my case, I had to have a valve replacement and have had at least one echo every year since 2014. You are correct that the interpretation of echocardiograms can be very different, depending on how skilled the sonographer was and how well the reviewing physician is at interpreting your echo. After experiencing some wildly different assessments of my echos done close to each other, it seems to me that there should be a more accurate way to assess patient's EF. From what you've said, it appears that you lead a healthy lifestyle and stay active. That's what heart patients are told to do, so you're at the head of the pack already. The biggest thing I've learned in my more frequent encounters with healthcare professionals is if you don't feel good about a doctor you're seeing for any reason, find another. And if that one isn't a good fit either, move on. There are great doctors out there, but sometimes you have to kiss a lot of frogs before you find your (prince) doctor. Gut feelings usually are right. I hope this helps!

Sorry but it's time to get a referral to a different medical facility.

Yes, diagnostic imaging has some variance in it, both in the operators and the equipment they are using (so technique), but also in interpretation by a physician. You have two estimates of your EF, and while they're not by any means bad, the vector indicates a decline....which needs attention.

As a fit person, keep an eye on your BP and pulse. If you find your pulse below 50, certainly below 40 at rest, and if your BP runs below about 100/60, this could be the metoprolol. It has two purposes across specialties: to slow the heart some, and also to make its contractions less forceful. This makes it a decent rate control medication if you have tachycardia (ventricular or supraventricular). But those properties also make it good for 'incipient' hypertension. My caution is to keep an eye on your dizziness, light-headedness, any ankle swelling, shortness of breath...they could all signify that your fit heart is being held back too much. Let your cardiologist know right away!

The angiogram comes is two main forms: done externally with imaging, sometimes with contrast dye, or it's a thin catheter tube slipped up your radial vein, at your wrist, and slid up past the tricuspid valve and into your artery ostia to see how plugged up they are. They use a dye that way, as well, and flouroscopy...meaning you are lying on a sort of x-ray table. CT angiography, the one you're going to experience, is not done with the catheter as far as I know.

Thank you all for the helpful replies. I was a bit in shock/denial yesterday which is not my norm. The ECHO was done in December when my Internist heard a murmur. That first cardiologist who only reviewed the ECHO and sent to my INternist is who said EF 50% . Then I had an appt yesterday with a different Cardiologist who said more like 45-50%. He also did an ecg which shows left axis deviation and he said said right chamber is dialated. He ordered the CT to rule out ischemic cardiomyopathy. I am asking for another cardiologist referral for a 3rd opinion. I'll be honest--I don't want to start meds yet, is that crazy? As I mentioned, I am healthy weight/thin but already take thyroid medicine, metformin, b12 injections (deficiency from 25 years on metformin). I do jog/walk daily--but am now trying to finally add some strength training with light weights. I want to try that plus Coq10 and omega 3, and maybe re-do ECHO in 6 months? I know you're not my Dr but just wondering any advice. Yes, I have strong family history of CHF but I have a healthy lifestyle. Is RF at 45-50% really suggestive of meds? He prescribed 25 mg toprol and 10 mg jardiance. Thanks

@lizzyhope
'...Is RF at 45-50% really suggestive of meds?...'
It 'could be', but it could also be the CHF. CHF implies reduced heart function, and it might be related to cardiomyopathy or to one or more valves needing a bit of work. It could also be an as-yet-undetected arrhythmia.
https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure

Just an update after another visit with the Cardiologist. I asked if I could start with just the Jardiance (and not also metoprolol) and then do another ECHO in 3 months to see if my EF improved. He very reluctantly agreed. I feel better about just starting with one additional, especially with some of the metoprolol side effects. Praying it's enough to help for now.

@lizzyhope Let's hope it works! Certainly worth a 'rule out'.

My cardiologist has ordered a CT Angiogram with contrast. My calcium score a year ago was zero, but given family history he wants to check. I'm mostly concerned about the contrast. I take metformin and have thyroid disease (Hashimotos), and he never mentioned either as an issue but what I'm reading says it can be and to definitely stop metformin 48 hours prior.
My recap is strong fam history of CHF. Tricuspid and mitral valve with moderate regurgitation. EF 45%. Left axis deviation (not sure if that means much).
He had prescribed metoprolol and jardiance. I asked for a dif. beta blocker (bystolic or coreg) and he said no. So I said I wanted to wait on the met., and just do jardiance. I'm now thinking a new ECHO might not show much change in 3 months, but I'm also thinking I don't want to do the CT Angio. My only symptom is some fatigue, and I can't run/jog as fast as I used to. Appreciate the advice & wisdom here. This all feels pretty lonely. I just moved to a new city after 20 years and this all started, plus a few other health issues, including teeth removed and implants!