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New here-questions on diagnosis
Hi All, I just came from my 1st visit with a cardiologist. My internist had heard a murmur last month and sent me for an ECHO. The cardiologist who reviewed it said 3 valves with mild-moderate regurgitation, and EF of 50%. So I made this appt today (different cardiologist) simply so I could understand more, as I have strong family history of heart disease and was told from ECG I have incomplete right bundle branch block (which apparently isn't a big deal). Well, at the appt today, he re-read the ECHO and said my heart is weak, and he thinks the EF is more like 45% (didn't realize it's so subjective). He prescribed a beta blocker and jardiance, and ordered a CT angiogram. I was a little blindsided. The previous cardiologist said I'm fine and this one looks at same ECHO and prescribes meds.
For refernce, I am 54 year old female, 5'3", 109 lbs, walk or jog 6 miles every day, have always eaten very healthy. My father died of cogestive heart failure at 59 (as did his father). He was also an alcoholic. I have never drank or smoked and virtually no symptoms though I've never had great circulation, I have thyroid disease, insulin resistance (though my weight is well managed), I take metformin and thyroid meds. Sorry for the length! Appreciate any wisdom and advice. Blessings!
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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!
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1 ReactionSorry but it's time to get a referral to a different medical facility.
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1 ReactionYes, 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.
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1 ReactionThank 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
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