Heart Health: Insights from Recent Cardiac Tests

Examination Report

Due to chest pain a few months ago, I underwent a Doppler echocardiogram and a stress electrocardiogram at the hospital this month.
The doctor mentioned that there is arrhythmia and mild mitral regurgitation.
They suggested that I consider paying out of pocket for a cardiac CT scan, which could cost several thousand dollars.
I am still contemplating this.
The doctor prescribed Concor 1.25 mg for 30 days, indicating that I should take it only if necessary.
I would like to ask: 1.
If the heart issue is serious, shouldn't the doctor arrange for further tests, such as a 24-hour Holter monitor, which should not require out-of-pocket expenses? 2.
The medication prescribed is indicated for moderate to severe heart failure, and since it is to be taken only as needed, how serious is my condition? Thank you, doctor! Below are the echocardiogram results: [M-mode] [Mitral flow] Measurements Units and Normal Values Measurement Values Units and Normal Values IVSd 1.03 cm (0.70 - 1.10) MV E point 87.90 cm/s LVIDd 4.33 cm (3.80 - 5.60) MV A point 73.10 cm/s LVPWd 0.80 cm (0.70 - 1.10) MV E/A 1.20 IVSs 1.13 cm MVA(P1/2t) cm² LVIDs 2.63 cm (2.20 - 4) [Tricuspid Flow] LVPWs 1.06 cm Measurement Values Units and Normal Values LVOT diameter 1.70 cm Max vel (TR) 235.00 Ao root diameter 2.40 cm (2.00 - 3.70) Max PG (TR) 22.09 mmHg ACS 1.70 cm (0.50 - 1.60) RA pressure 3.00 mmHg LA dimension 3.40 cm (1.90 - 4) RVSP (TR) 25.00 mmHg EF (Teich) 70.00 % (>55) TR S/D <1.4 EF (Simpson’s) % (>55) [PA flow] EF (3D) % (>55) Measurement Values Units and Normal Values [Ao flow] PA Vmax cm/s Measurement Values Units and Normal Values PA Max PG mmHg LVOT max 92.00 cm/s PAAT > 100 ms AV max 145.00 cm/s [Tissue Doppler] AV max PG 8.00 mmHg Measurement Values Units and Normal Values AV mean PG mmHg E’ (Lateral) 14.80 >=10 cm/s AVA 1.44 cm² E’/A’ (Lateral) 1.50 <=12 cm/s AVAI cm²/m² E’ (Septal) 12.40 >= 7 cm/s Cardiac Output L/min (4 - 8) E/E’ (average) 6.46 <=14 QP/QS [Other] Measurement Values Units and Normal Values Measurement Values Units and Normal Values LA Volume Index (Simpson’s) ml/m² (<=34) TAPSE (M-mode) >= 1.7 cm RV S wave (TDI) > 9.5 cm/s LV Mass 127.00 F < 162 g; M < 224 g RIMP (TDI) <=0.54 RV FAC >35% LV Mass Index LVEDV (Simpson’s) ml LV MPI (Doppler) (0.39 ±0.13) LVESV (Simpson’s) ml LV dP/dt mmHg/s (>=1200) MAPSE (M-mode) >= 10 mm DT 140 - 240 ms MASV (TDI) F (8.2 ±1.3 cm/s); M (8.6 ±1.4 cm/s) pul vein S/D >=1 RV MPI (PW Doppler) >0.43 LVEI <= 1.7 RV dP/dt mmHg/s (<400) RA Volume Index F < 33 ml/m²; M < 39 ml/m² IVC diameter <= 2.1 cm LV IVCT RA Length F < 3.1 cm/m²; M < 3.0 cm/m² LV IVRT LV IVCT (TDI) RA Width F < 2.5 cm/m²; M < 2.5 cm/m² LV IVRT (TDI) 70 ± 12 ms LV MPI (TDI) (0.39 ±0.05) RA area < 18 cm² RV IVCT (TDI) RA Volume (Api4) RV IVRT (TDI) RV E/E’ >=6 [Conclusion] (1) normal LV contractility (2) No evidence of regional wall motion abnormalities (3) No chamber dilatation (4) sclerotic AV; none AR (5) mild TR (6) No evidence of thrombus, vegetation formation (7) No evidence of pericardial effusion [Impression] Below are the results of the stress ECG: [Procedure] Reason For Test: Chest pain; Chest tightness; Dizziness.
Protocol: Bruce Duration: 00:07:43 Exercise Tolerance: Good Stage: III Chest Pain: N Reason For Termination: Very SOB & Leg so Fatigue.
Medication: □Beta-block □Calcium antagonist □Coronary dilator BP RESTING: 96 / 63 mmHg BP MAXIMUM: 115 / 61 mmHg MAX.
MET: 10.00 HR RESTING: 77 bpm HR MAXIMUM: 153 bpm THR: 90 % Resting EKG: RBBB.
Arrhythmias: Couplet (6) & Bigeminy (19) & Single (133) VPCs & APCs (10).
[Record] STAGE SBP DBP HEART HR*SBP STAGE SBP DBP HEART HR*SBP (KMPH-GRADE) RATE (KMPH-GRADE) RATE REST 96 63 78 7488 0 Recovery 99 55 153 15147 I(2.7-10%) 96 63 116 11136 1 min REC 101 51 142 14342 II(4.0-12%) 105 65 137 14385 2 min REC 104 53 111 11544 III(5.4-14%) 99 55 153 15147 3 min REC 115 61 107 12305 IV(6.7-16%) 4 min REC 98 59 98 9604 V(8-18%) 0 5 min REC 98 60 92 9016 VI(8.8-20%) 0 6 min REC 94 64 93 8742 [ST Changes] LEAD ST mm REMARK LEAD ST mm REMARK I 0.40 V1 -0.15 II 0.35 V2 0.75 III -0.05 V3 0.05 aVR -0.40 V4 0.30 aVL 0.25 V5 0.15 aVF 0.10 V6 0.10 [Comment] No significant ST-T segment.
[Result] Negative.

Miss Ye, 50~59 year old female. Ask Date: 2024/05/11

Dr. He Dongjin reply Cardiology

Hello, the information you provided is normal.
As for why a cardiac CT needs to be self-paid, I'm not sure.
It would be best to discuss his thoughts with the physician.
Changhua Hospital cares about you.

Reply Date: 2024/05/11

More Info

Understanding heart health is crucial, especially after experiencing symptoms such as chest pain. Based on your recent cardiac tests, including a Doppler echocardiogram and an exercise electrocardiogram (ECG), there are several important insights to consider regarding your heart health and the recommendations provided by your physician.

1. Assessment of Heart Function: Your echocardiogram results indicate normal left ventricular (LV) contractility and no evidence of regional wall motion abnormalities. This is a positive sign, as it suggests that your heart is functioning well in terms of pumping blood. The left ventricular ejection fraction (LVEF) is within normal limits, which means that your heart is effectively ejecting blood with each contraction. However, the presence of mild tricuspid regurgitation (TR) and a sclerotic aortic valve (AV) should be monitored, as they can indicate underlying issues that may require further evaluation.

2. Exercise ECG Findings: The exercise ECG showed some arrhythmias, including couplets and bigeminy, which can be concerning but are not uncommon during physical exertion. The fact that you experienced significant shortness of breath (SOB) and leg fatigue during the test suggests that your heart may be under stress during exertion. However, the overall interpretation of the exercise test was negative for significant ischemia, which is reassuring.

3. Need for Further Testing: Regarding your question about whether further testing, such as a 24-hour Holter monitor, would be necessary if your heart condition were serious: Typically, if a physician suspects significant heart disease or arrhythmias, they would indeed recommend additional monitoring to capture any irregularities that may not be evident during a standard test. A Holter monitor can provide valuable information about your heart's rhythm over an extended period, especially if you experience intermittent symptoms.

4. Medication Considerations: Your physician prescribed Concor (a beta-blocker) at a low dose, indicating that they may want to manage your heart rate and reduce any potential strain on your heart. While beta-blockers are often used in cases of heart failure, they can also be prescribed for patients with arrhythmias or those who experience symptoms like palpitations. The instruction to take the medication only as needed suggests that your physician is taking a cautious approach, likely due to the mild nature of your current symptoms.

5. Understanding Severity: The combination of your echocardiogram and exercise ECG results suggests that while there are some mild abnormalities, there is no immediate indication of severe heart disease. However, the presence of arrhythmias and the recommendation for further testing (like a CT scan) indicates that your physician is being thorough in ensuring that no significant coronary artery disease (CAD) is present. It's essential to weigh the risks and benefits of any additional tests, including the cost, against the potential for gaining critical information about your heart health.

6. Lifestyle Considerations: In addition to medical management, lifestyle changes can significantly impact heart health. Regular exercise, a balanced diet low in saturated fats and high in fruits and vegetables, maintaining a healthy weight, and managing stress are all vital components of heart health. Avoiding smoking and limiting alcohol intake can also contribute positively to your cardiovascular well-being.

In conclusion, while your current tests show that your heart is functioning adequately, the presence of mild abnormalities and symptoms warrants ongoing monitoring and possibly further testing. It is essential to maintain open communication with your healthcare provider, discuss any concerns you have about your symptoms or treatment plan, and consider lifestyle modifications that can support your heart health. Always feel empowered to seek a second opinion if you feel uncertain about the recommendations provided.

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