Follow up Echo

I should add

by Lulu2468 - 2023-10-30 19:08:19

I have high cholesterol and a family history - my dad and sister- of heart attacks.  

Echo 45%

by Good Dog - 2023-10-30 21:28:03

I cannot say with any certainty what has caused your EF to drop below normal. I can tell you that it happened to me after being paced for over 30 years. I do not know exactly when my EF dropped below normal, because I did not have an echo for over 15 years. When I finally had one it had dropped from nomral (55%) to about 40%. I was told at that point that I had heart failure. My left ventricle was somewhat mishaped. That freaked me out, because I was, and I continue to be symptom-free (asymptomatic). I have now been paced almost 37 years and my EF seems to have stabilized at 40%, at least for now. The most likely reason for your EF to drop is the dyssynchrony between your chambers as a result from being paced for a very long time. To some extent it can be exacerbated by the placement of the lead in the right ventricle (with a dual chamber PM). The Apical location is the worst (in terms of dyssynchrony) and that is what I have. If the RV lead placement is septal, then the dyssynchrony is less and the likelihood of HF is somewhat less. Do you know what your RV lead placement is? I did not know my lead placement until I found-out that I had a problem. That is when I decided I needed to learn more. Obviously, HF is not the fate of everyone that is paced for a very long time and there isn't always an explanation why some suffer and some do not. In any case, I am only explaining my situation and I cannot know if yours is the same or not. I do want to reassure you that there is no reason at this point to be too concerned. As long as it remains above 35% and your are not symptomatic, then there is no urgency to do anything. Your EF could even stabilize where it is now. An EF of 45% is really not very low and is not that far below normal. Given that the test results are +/- 5%, your EF could actually be close to 50%. Regardless, it is certainly something that you'll want to keep an eye on. I would think that your Doc would want you to get an echo at least every year, but maybe more frequently in the short-term. It is something to discuss with him.

The good news is that your EF can stabilize. However, even if it continues to drop, there is much that can be done to alleviate the problem. The most likely is a CRT. That is a 3-lead PM that can bring your synchrony back and even return your EF to normal. There are no guarantees, but it is usually very effective. That is the avenue that I am headed down if they can get another lead in my vein. I am headed in for a venogram this week to see if that is a possibility. 

In any case, just keep thinking positively and continue to monitor your situation. Most importantly is how you feel. I noticed in a recent post that you said you are feeling good after your recent generator change. Frankly, that is all that matters. That is the whole point of being paced in the first place. 

I hope that what I wrote is helpful and not worrying. You are still young (when compared to me) and have a bright future ahead. Since you just received a new generator, it is unlikely that there will be a need to do anything or worry about the road ahead until it is time for another new generator/battery. So you have a lot of time to monitor and get a handle on your EF. Hopefully you will post again if and when you learn more...............

I wish you the very best!

Sincerely,

Dave  

Echocardiogram

by piglet22 - 2023-10-31 06:46:52

Just caught my eye as I had one yesterday.

It was 18-years since the last one.

I wasn't told what the first findings in 2005 were and thanks to them losing the keys to the echo room, there wasn't time to discuss anything yesterday, other than being told I had a heart.

Plenty of opportunity to listen to a lot of splish splash noises. Not sure if that was good or bad but something still doing something.

Dave/Good Dog explains it nicely. If it changes, it changes, it is what it is. If things get critical, they will tell you.

Just a bit of nit-picking, they don't change the battery, they change the device. The device, the generator or whatever, is sealed and sterile. It wouldn't be feasible to take the thing apart, fit a new battery/cell, resterilize it, test for leaks etc., and put the old one back.

Apart from that, you would never get the latest technology.

My Aunt always said they were changing her battery and no amount of arguing convinced her otherwise.

I think someone on the clinical side thought it was kinder to tell a 90-year old that the battery was changed like the hearing aid, rather than something alarming like we're changing your IPG.

Reply to Good Dog and piglet22

by Lulu2468 - 2023-10-31 12:08:39

Thanks so much for your kind and helpful replies.  I love this group!
I think my pacer wires are in my right atrium as the findings say " there is a linear echodensity consistent with a pacer wire.  ( in the RA & RV).  I got my 1st PM in 1998.  Generator change - Tks for correction piglet- in 2009. In 2016 I initiated getting an echo as I felt I had less stamina compared to typical non PM friends.  I thought I'm either REALLY out of shape or something is going on with my heart.  No red flags at the time and I'm glad I had one as a baseline.  A third lead has been brought up and I have heard long term pacing may cause slightly  lower function - for me 24 years- like you pointed out Good dog.  I do feel fine for me but have noticed when on hikes with friends I drop back and wave as they forge ahead.  SOB.  
I will post again after talking to my Doc.  I wish everyone in this club great health and longevity.  
Thanks again for sharing your stories and your experience and advice.  
 

"Mild" Concentric Hypertrophy

by Gemita - 2023-10-31 12:40:52

Hello Lulu,

I note you have a family history of heart disease and that you have high cholesterol but are currently taking no meds.  I also see that you have been diagnosed with mild concentric hypertrophy (increased muscle thickness of the left ventricle).  It develops in response to high blood pressure or other heart problems, that requires the left ventricle to work harder.  As the workload increases, the walls of the chamber grow thicker, lose elasticity and eventually may fail to pump with as much force as a healthy heart. Treatment would depend on the cause.  Mild, concentric left ventricular hypertrophy is often seen with intensive exercise and may increase with age.

I am glad you will be seeing your cardiologist to discuss your echo results fully with him and to learn whether treatment or further investigations are required.  In the meantime, I would feel assured that your ejection fraction of 45% remains unchanged/stable.  I am sure your cardiologist will want to look at treating your cholesterol levels, checking for other health conditions and taking a detailed family history.  

Both Dave (Good Dog) and Piglet have already given good advice.  Remember too that the type of echo we have done (transoesophageal or transthoracic), operator experience and our body size/shape may all have an affect on the results that we receive from an echocardiogram examination.  Our % ejection fraction for example, can be higher, or lower because of so many different factors.  I have had many sub-optimal echo results because of poor body position during examination, operator inexperience, type of echo examination requested.  Your doctor may therefore ask for a more detailed echo examination or other tests before making a decision on what needs to be done, if anything (like a third lead). 

Transthoracic echocardiogram is limited in what it is capable of doing/seeing. It is a surface examination, and ultrasound waves must go through skin and soft tissue before reaching the heart. Instead, Transoesophageal echo in which the probe is directly behind the left atrium in the esophagus and has far less tissue to penetrate, means images are superior in quality to those of Transthoracic echocardiograms.   However a Transoesophageal echo is of course more invasive.

Good luck Lulu.  I hope you can be reassured that "Mild" Concentric Hypertrophy is not of any real concern and that lifestyle changes alone may help you to manage your condition safely without further intervention.

Definitions

by Penguin - 2023-10-31 15:17:31

 Hi Lulu, 

 I’ve provided two very basic definitions of ‘hypertrophy’ and ‘concentric’ below so that you have an idea of what they found.  The definitions will need to be fleshed out to explain how they apply to your heart. 

Hypertrophy = an increase in LV (left ventricular) mass.  

This increase is due to an increase in chamber size or an increase in wall thickness, or both. 

Concentric / Eccentric = these two terms are used to explain the ratio between your left ventricular wall thickness and the size of your left ventricular chamber. 

Concentric describes a high LV wall thickness relative to the size of your LV chamber.  

Presumably this ratio means something to the doctors!  'Mild' sounds reassuring - but you might like to enquire about monitoring, cause and what you can do to limit any progression.

Good luck x