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Prognosis Anterior Septal Hypokinesia?
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sabrinaz123 posted:
General: 64 year old male, cardio exercise 30 min 4-5 times per week. Recent stress echo Bruce protocol 13 minutes, 13.34 mets, VO2max 46.288, score 98. Max Heart Rate (182), not recommended to exceed MHR, but felt good and tech allowed. Last stress test, non echo, 1 year ago, 13.45 minutes. three years ago 15 minutes.

Echo stress report: Suggested by Cardiologist to establish base line.
Base Line images revealed normal LV size and systolic function with no segmental wall motion abnormalities identified. Repeat images a peak stress demonstrated mild anteroseptal hypokinesis. There were no exercise induced arrhythmias however, EKG at peak stress was difficult to interpret.

2 Dimensional Doppler Echo numbers
Aortic Root 3.4, Left Atrium 3.6, LVEDD 5.1, LVESD 3.3, IVS 1.3, LVPW 1.3, E.F. approx. 60%
Interpretion; 1. Technically difficult study, 2. Normal LV size and function, 3. Mild LVH, 4. Mild AV sclerosis with normal leaflet motion. MV, TV appear normal. There is trace MR and mild TR with RVSP=30-35mmHg, 5. RA/RV appear normal in size and function, 6. No significant pericardial effusion or intracavitary echo densities seen.

Conclusions
1.T.D.S with adequate data quality, 2. Normal L.V. size and function with 60% EF, 3. No significant valve disease.

Cardiologist recommended a SPECT stress echo, however insurance company declined coverage even after peer to peer review.
So what does this all mean? I think is fair to assume that at my age and subject to an American diet, that there some level of stenosis in my coronary arteries. The location and level of occlusion is unknown and without further testing we can only approximate based on the previous echo numbers. That said, where do we go from here? Based on the echo numbers, what is my prognosis and is a stress profusion test, paid for out of pocket, worth the time and expense? Or, is a CTA or cath angiogram a better approach, although much more expensive.

Septal Hypokensia is a wall motion defect, although mild in my case. However is does imply some level of occlusion, and in my case possibly LAD associated, and therefor potentially dangerous to ignore. So essentially we are left to guess, without insurance support, about possible outcomes.

Can you all put the echo numbers in perspective for me and possibly provide some direction? Also, is it possible that by exceeding my MHR during the stress test that the numbers or indications may have been effected, or skewed?
Regards............JM
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billh99 responded:
I am not a medical professional, but rather a cardiac patient which has studied a lot of these issues.

Hopefully Dr Beckerman will be able to respond with more specific information.

I wonder what symptoms are condition that caused you to have 3 stress tests in 3 years.

Max Heart Rate (182), not recommended to exceed MHR, but felt good and tech allowed. ... Also, is it possible that by exceeding my MHR during the stress test that the numbers or indications may have been effected, or skewed?

If you (or the doctor) got the MHR from the 220-age formula it is notoriously for not being accurate. Many people have MHR at are very different from what is predicted. There are a couple of newer formulas that are somewhat more accurate on the average, but still does not give a good job of predicting what any individual will do.

The true MHR is the maximum that you can develop if not limited by angina, physical limitations, or the test is stopped early due to abnormal EKG changes.

BTW the MHR can vary somewhat with different types of exercise.

Different doctors seem to report ECHO data in different formats and some report different parameters. So I am not family with a couple of the terms, but in general the numbers seem to be in the normal range.

Septal Hypokensia is a wall motion defect, although mild in my case. However is does imply some level of occlusion, and in my case possibly LAD associated, and therefor potentially dangerous to ignore.

Here is what I have learned about CAD is that coronary blockages need to reach 70-80% before they cause symptoms such as angina or shortness of breath. But they are stable and typically don't rupture and cause a heart attack. Although they can slow increase.

It is plaques that are in the 20-50% range that can be unstable and rupture. And when they rupture blood clot can form in the artery and cause a heart attack.

Currently there no non-invasive way to detect those plaques.

Studies have show that for people with stable CAD that people that where treated with stents or bypass have the rate of future heart attacks as those that where only got optimum medical treatment. However a number of those in the medical treatment arm did later require stents or bypass when symptoms increased.

Basically stable CAD is when angina only happens during exercise and it is controllable with medicines.

But I am not sure exactly who fits in to parameters of this trial.

Let me give you my history. 4 years ago I had shortness of breath on exhortation and fatigue. I only lasted 4:30 on the stress test. An angiogram showed 70% blockage in the left main and one in a branch off the LAD. So I had a CABG (bypass).

1 1/2 years ago I had a stress/echo. This time I lasted almost 11 minutes. BTW the report indicates that I reached 110% of my "maximum" heart rate.

Also it reported "possible distal anterolateral hypokinesis". The cardiologist said that getting an agniogram was optional. I decided not to get it. My reasoning was based on the trial and that being able to last almost 11 minutes on the stress test it it did not significantly limit my performance.

Last month, for my 70th birthday, I challenged myself to ride 700 miles on my bike. About 1/3 way through I had a regular checkup with my cardiologist. And he said that I guess we can ignore that echo report.
 
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sabrinaz123 replied to billh99's response:
Thank you so much for taking the time to respond. Your insight and experience in interpreting some of the numbers and conditions is very much appreciated. Putting much of the information into perspective is vitally important in understanding what I am facing going forward.

Thanks again..........JM


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