Hello, I would like some help understanding how cardiomyopathy is diagnosed. My cardiologist suspects that I may have asymptomatic cardiomyopathy. My doctor sent me for preventative consult to a heart clinic, my EKG was normal, but my echocardiogram showed moderate global hypokinesis, ejection fraction of 40 to 45%, and mild left ventricle dilated, LVD grade 2 to 3. I also had frequent PACs and my family doctor says my heart sometimes seems to skip a beat. I was sent for a nuclear test and had to wear a holter monitor for 48 hrs, but have not seen the results of those.
I am 38 years old, I have raynauds syndrome (mild and only affects me in very cold winter, I just get itchy feet/hands) and have developed a varicose vein in one leg in the past few years. Other than that very healthy. I should also mention the reason I was sent to the cardiologist is heart disease in my family (CHF and coronary artery disease) and I also had a weird bout of sickness in March which knocked me out (dizzy, nausea, abdominal cramps, no chest pain that I can remember, and my iron levels shot up) but that has all passed.
I am just wondering how/when the cardiologist will be able to tell me what is going on with my heart and how it is treated? Is it necessary that medications will be prescribed or can it be treated with exercise and healthy eating. I am not overweight, my BMI is just slightly over 25 and I am in relatively good shape, I run, weight train, try to eat healthy. Since I talked to the cardiologist I have stepped up my exercise.
I am getting a bit anxious and I think sometimes my anxiety is getting the best of me (e.g. feeling as though I have pain in my chest/shoulder, which wasn't there before I had this consult, which I know makes no sense . Any insights would be appreciated. I see my cardiologist in a few weeks. Thanks.
"just wondering how/when the cardiologist will be able to tell me what is going on with my heart and how it is treated? Is it necessary that medications will be prescribed or can it be treated with exercise"
thank you for the reply and the great links. I have read some of these and they are great sources of information.
i don't think i asked my question clearly. With echo findings like mine, ejection fraction of 40-45, moderate global hypokenisis, left ventricle dilated, is it always the case to treat with something, whether it be meds or otherwise? Or do they sometimes just let it be and see if things get better? Can these things improve without any treatment, just lifestyle changes?
"With echo findings like mine, ejection fraction of 40-45, moderate global hypokenisis, left ventricle dilated, is it always the case to treat with something, whether it be meds or otherwise?"
L@@king at the findings
"moderate global hypokinesis, ejection fraction of 40 to 45%"
An ejection fraction (EF) of 40-45% is considered as mild heart failure.
Hypokinesis is low or reduced wall motion or contractility, which can occur in one (regional) or more areas of the heart. If/when the entire heart is affected it is referred to a "global'. This can be mild, moderate or severe. "mild left ventricle dilated"
From MedicineNet Q & A
An enlarged left ventricle is usually due to either cardiomyopathy (a weakening of the heart muscle) or valvular heart disease. Valve disease is usually treated by correcting the underlying valve problem (initially with medicines, often later with surgery). The most common cause of an enlarged left ventricle is cardiomyopathy.
Initial treatment is with medications, such as diuretics, digitalis, vasodilators (ACE inhibitors and/or ARB inhibitors), and beta blockers, such as carvedilol (Coreg) or metoprolol (Lopressor, Toprol XL). In more severe cases special pacemakers or defibrillators are used. Only in the most difficult cases are heart transplants occasionally required.
"Or do they sometimes just let it be and see if things get better? Can these things improve without any treatment, just lifestyle changes?"
As reported, and as applicable to the patient, if/when the LVEF improves substantially or even recovers, and the heart (valves, chambers) appears to function near-normal or normally, other problems (unseen, that is, at a cellular or molecular level) often exist, or possible problems may/can occur anytime down the road, putting one at an increased risk. More about Left Ventricular Ejection Fraction (LVEF)
**To get a decent estimate of LVEF, a MUGA scan is reported as being the most accurate of the non-invasive methods.
Pertinent excerpt from an article on About.com by cardiologist Richard N. Fogoros, M.D.
When is the MUGA scan more useful than other heart tests? The advantages of the MUGA scan over other techniques (such as the echocardiogram) for measuring the LVEF are twofold. First, the MUGA ejection fraction is highly accurate, probably more accurate than that obtained by any other technique. Second, The MUGA ejection fraction is highly reproducible. That is, if the LVEF measurement is repeated several times, nearly the same answer is always obtained. (With other tests, variations in the measured LVEF are much greater.
Take good care,
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Thanks again for the reply and info. This is helpful information. I think I did have a MUGA scan done or something similar where radioactive dye was injected, a few weeks ago. I am just waiting for those results.
I can relate. Did you mean PVC's? I ask because I work in a hospital and experienced something similar. I wasn't feeling well but then talked myself right into more symptoms leading me to believe heart attack. Fortunately that wasn't the case but my EKG (hooked up for 24 plus hours) registered constant PVC's. I had an echo, 2 stress (one of which they couldn't get a picture at full exertion because my lungs were in the way), and a test that basically checks the valves (or the plumbing as my pcp suggested). Nothing. I realize you do have issues and your ejection fraction prompted me to go back and take a look at mine which was 65%. My relation to your issue is the recurrent anxiety I'm experiencing worrying over a heart issue. I too feel left arm, neck and back pains...I know I'm dwelling on this and making things worse for myself.
I hope you get your answers and continue with your doctor visits. It'll be to your advantage that you're in shape and not overweight. Good Luck
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