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Dr. Saleem
Dr. Saleem, Other
Category: Cardiology
Satisfied Customers: 2303
Experience:  I am resident cardiologist and have 03 years experience of working in all the domains of cardiology
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I need a cardiologist who can look at my echocardiogram and

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I need a cardiologist who can look at my echocardiogram and answer some questions
Customer: replied 2 months ago.
History of pericarditis.
Primary rhythm: sinus.
Height: 165.10 cm BSA: 1.94 m²
Weight: 81.65 kg BMI: 30.0 kg/m²Heart rate 70 bpm
Blood pressure 105/56 mmHgColor Doppler was utilized to interrogate the cardiac valves assessed and spectral
Doppler was utilized to determine the flow velocities and pressure gradients
reported in this exam. Myocardial strain analysis was performed in this exam to
aid in the assessment of cardiac function.MEASUREMENTS:
Value Indexed Normal
Max aortic dimension 2.9 cm 1.50 cm/m²
Left atri
um diameter 3.7 cm (M-Mode)
Left atrial volume 54 ml (biplane A-L) 28 ml/m² LAVi <= 34
LV ID (diastole) 4.4 cm (2D)
LV ID (systole) 3.2 cm (2D)
IVS, leaflet tips 0.7 cm (2D)
Posterior wall thickness 0.5 cm (2D)
Left ventricular mass 75 g (2D) 39 g/m²
Global peak long strain -21.8 %
LV stroke volume 58 ml (2D biplane)
LV end diastolic volume 99 ml (2D biplane) 51.3 ml/m² 29<=EDVi<62
LV end systolic volume 41 ml (2D biplane) 21.3 ml/m²
Ejection Fraction 59 % (2D biplane) EF > 54FINDINGS:LEFT VENTRICLE
The left ventricle is normal in size.
Left ventricular systolic function is normal. Global LV myocardial strain is
normal.
Normal left ventricular diastolic function.
Mitral annular lateral E/e': 5.8. Mitral annular septal E/e': 6.7.
Diastolic Function:
Respiratory Variation Expiration Inspiration % Difference
MV Peak E 87.0 cm/s 79.0 cm/s 9.2 %
TV Peak E
42.0 cm/s 56.0 cm/s -33.3 %Wall Motion:
All scored segments are normal.RIGHT VENTRICLE
The right ventricle is normal in size.
Right ventricular systolic function is normal. RV systolic tissue Doppler velocity
is 15.0 cm/s. Tricuspid annular displacement is 2.7 cm.
Estimated right ventricular systolic pressure is likely underestimated due to a
weak or incomplete tricuspid regurgitation signal and is, at least, 20 mmHg
consistent with normal pulmonary artery pressures. Estimated right atrial pressure
is 5 mmHg.LEFT ATRIUM
The left atrial cavity is normal in size.Pulmonary Veins:
The pulmonary venous pattern showed normal systolic flow.RIGHT ATRIUM
The right atrial cavity is normal in size.
Inferior Vena Cava:
The inferior vena cava appears normal. The vessel decreases greater than 50
percent with inspiration.MITRAL VALVE
The mitral valve leaflets are structurally normal. There is trivial mitral valve
regurgitation. The pressur
e half time is 51 msec. The peak mitral E/A ratio is
1.23. The average mitral E/e' ratio is 6.2. The mitral flow deceleration time is
176 msec.TRICUSPID VALVE
The tricuspid valve leaflets are structurally normal. There is trivial tricuspid
valve regurgitation.AORTIC VALVE
The aortic valve cusps are structurally normal. There is no aortic valve stenosis.
There is no aortic valve regurgitation. Tricuspid aortic valve. There is no
thickening. There is no calcification.PULMONIC VALVE
The pulmonic valve cusps are structurally normal. There is mild (1+) pulmonic
valve regurgitation. The peak gradient is 4 mmHg.AORTA
The visualized aorta is normal in size.
Measurements - Sinus 2.6 cm. Sinotubular junction 2.7 cm. Mid ascending aorta 2.9
cm.PULMONARY ARTERIES
The pulmonary arteries are unseen or not interrogated. The main pulmonary artery
diameter is 1.5 cm (diastolic).INTERATRIAL SEPTUM
The interatrial septum is normal.INTERVENTRICULAR
SEPTUM
There is a diastolic bounce of the interventricular septum.PERICARDIUM
There is trivial pericardial effusion.CONCLUSIONS:
- Exam indication: Pericardial conditions
- The left ventricle is normal in size. Left ventricular systolic function is
normal. EF = 59 ± 5% (2D biplane) Normal left ventricular diastolic function.
- The right ventricle is normal in size. Right ventricular systolic function is
normal.
- There are no significant valvular abnormalities.
- Trivial pericardial effusion.
- There is mild septal bounce, no significant respiratory variation through the
mitral and tricuspid inflow. The IVC is normal in size and collapses with
inspiration.
- Exam was compared with the prior CC echocardiographic exam performed on 2/13/17
STRESS.

Hello and welcome to JA. Dr Saleem here. Will be answering you shortly

Well all of your findings are pretty much normal . No remarkable abnormality seen there. Just a trivial effusion around the heart ,shouldnt be of much concern. All in all , looks good for your age.

Let me know if you have any further queries.

Customer: replied 2 months ago.
I am concerned most about the septal bounce, which is the 3rd time now that it has come back. My ultra sensitive CRP was at 15-so I just finished a month of 2 Aleve per day. I am most concerned that I might have cardiomyopathy or pulmonary hypertension,or perhaps the beginnings of constrictive pericarditis. It has been going on now for almost 3 years. I can't do much physically, or I get shortness of breath. Beofre this started, I walked briskly a mile and a ahlf each night. Now I can onlyt walk slowly through my house or yard.

Well your chambers are pretty much ok ,so does your inferior vena cava. Inferior vena cava should dilate as a result of back pressure had there been significant pericardial fluid around your heart causing constriction.

Your cardiologist must be monitoring it as he thinks the fluid isnt sufficient enough to merit any drainage .

Constrictive pericarditis over 3 yrs would lead to gross swelling in limbs due to back pressure . There isnt significant progression in your fluid volume so thats why no intervention done. Thats what i understand from these findings.

A more thorough opinion however needs cardiovascular exam that i am unable to do . Hope it addresses your concerns.

Customer: replied 2 months ago.
Ok. I just don't understand WHY would this septal bounce keep coming back? What else would cause this? Simply flare ups of pericarditis? I understand there are 20%of cases where constriction can be present without thickening of the pericardium. Do you think this might bema possibility, or do you think this might simply be an effect of flares/higher inflammation of pericarditis? I have also had pro ntbmp elevated several times with this-the last time was the highest at 277.

Sorry for the delay, i am currently at work actually.

Yes the septal bounce obviously shows ventricular interdependence.

Ventricular interdependence occurs in conditions where an increase in volume of one ventricle causes a decreased volume in the opposite ventricle. This phenomenon is caused by reduced ventricular compliance due to a fixed pericardial volume.

The mild pericardial effusion in your echo is the explanation for that.

However its not significant enough to be causing any circulatory compromise.

The cause of pericardial effusion needs thorough work up as there is a long list of possible causes .The recurring effusion is due to some underlying cause that we need to find out. Following are possible causes of effusion, do you have any of these? ;

  • Autoimmune disorders, such as rheumatoid arthritis or lupus
  • Cancer (metastasis), particularly lung cancer, breast cancer, melanoma, leukemia, non-Hodgkin's lymphoma or Hodgkin's disease
  • Cancer of the pericardium or heart
  • Radiation therapy for cancer if the heart was within the field of radiation
  • History of chemotherapy treatment for cancer, such as doxorubicin (Doxil) and cyclophosphamide
  • Waste products in the blood due to kidney failure (uremia)
  • Underactive thyroid (hypothyroidism)
  • Viral, bacterial, fungal or parasitic infections
  • Trauma or puncture wound near the heart
  • Certain prescription drugs, including hydralazine, a medication for high blood pressure; isoniazid, a tuberculosis drug; and phenytoin (Dilantin, Phenytek, others), a medication for epileptic seizures
  • History of heart attack

All of these causes are needed to be ruled out. I do not know about your medical history so i mentioned all of them, may be you could mention a bit on that

Customer: replied 2 months ago.
I have had rheumatoid arthritis for 38 years, since age 24. it is well controlled--my SED rate and regular CRP are normal, However, my ultra sensitive CRP was at 15 a month ago, hence they put me back on additional NSAIDS for a month, I am about to get a new USCRP to check if it came down. I also recently read that autoimmune diseases it is normal to have a trivial effusion as well as a US CRP of 10 sometimes. When I first got the pericarditis, I had a moderate sized pericardial effusion as well as pleural effusion in both lungs. I also had a slightly elevated troponin. All of that resolved--so did the septal bounce, but it has come back and gone away 3 times now. This has me most concerned that they are possibly missing something else. They did all the workups for M proteins, and I do not have any blood cancers etc. So maybe it is just simple pericarditis flares causing this?

Its simple RA causing flares with recurrent accumulation of fluid around the heart. It has to be treated symptomatically each time. NSAIDs can help . The management will depend on the severity of effusion and while its trivial only medical management is sufficient.

Thats unfortunate but its an autoimmune condition and keeps coming back . NSAIDs and corticosteroids are the preferred options for this.

You need to treat the cause to help reduce the effusion. This should help with the septal bounce and your symptoms too.

Customer: replied 2 months ago.
In other words, before I got the pericarditis nearly 3years ago, I may have always had a trivial effusion and maybe even septal bounce? But I never had any sort of issue doing exercise, shortness of breath, chest pain or anything. However, I spent 18 months on the sofa, barely able to walk across the room, so perhaps some of it is deconditioning? Maybe I can stop worrying so much about it-and use NSAIDS to add extra help for flares of the pericarditis. They are now sometimes doing a pericardectomy for long term Pericarditis, but I hate to get such a serious surgery without constriction being confirmed.

Yes as your ejection fraction is pretty good, no systolic or diastolic dysfunction as per your echo so no signs of heart failure to suggest that your symptoms are because of this trivial effusion.

I would like you to have a chest CT or atleast x ray to rule out any fluid there. I would not recommend pericardectomy at this point in time as the findings are not severe enough.

Hope it was useful.

Feel free to ask any more queries.

Please reward a 5 stars rating if you are satisfied.

Wishing you a healthy life.

Dr. Saleem and other Cardiology Specialists are ready to help you
Customer: replied 2 months ago.
I have been going to Cleveland Clinic, Dr Klein, pericardial disease unit. he has given me 3 or 4 cardiac MRI's with Gadnolinium enhancement-none of which show much inflammation. This was another concern for me-and originally the rheumatology dept thought perhaps I had drug induced lupus from a arthritis medication. So its been very confusing and not at all clear what's going on.You have cleared up a lot for me, and I am feeling much better about it. Dr Klein is not very forthcoming with info, but of course, he is busy as well.

You can always post a query with my name. Available to help you any time.

Kind regards.

Dr Saleem.

Customer: replied 2 months ago.
ps: I'm sorry, I just thought of one last question:You say heart is good, and are you saying trivial effusion is not necessarily the cause of my SOB on exertion sometimes? Or are you saying the trivial effusion is not enough to be causing any symptoms? I am feeling better now after the month on NSAIDS. So do you think this has calmed the inflammation down, and that's why I am not having as much SOB etc? or do you think there could be something wrong with my lungs?(I did have alung function test a year or so ago, mild asthma was the only finding)

Its possible that the effusion settled with NSAIDs down to trivial volume now and may be thats the reason for the improvements in your symptoms.

Otherwise a trivial pericardial effusion in absence of significant cardiac abnormalities on echo should not be causing any such symptoms .