concerning echocardiogram results FINAL UPDATE 3/12/2024

[teleguy57]

Well, my recent echocardiogram came up with some concerning results. I got some helpful insights from folks here when approaching my TKA in 2020, so searched here and found several threads including posts from @bocaarider, @classtimesailer, and @cyclisticliff with great contributions from medical professionals such as @gasman and @slinkywizard. I'm smart enough to know not to ask for diagnostics from the interwebs, but I am interested in any counsel people have about how to think about what I may be facing.

I won't go into all the details, but several months shy of 69. Issues include aortic root and ascending aorta echo measurements which seem to approach or be at the dimensions leading to surgical actions per the Nov 2022 updated ACC/AHA guidelines, aortic valve issues and atrial enlargements (both L&R). My personal physician referred me to a cardiology group; I'm scheduled for a consult late Feb (their first opening since my MD said he didn't feel it was super urgent given his assessment of my high function). I will admit to being overwhelmed by the significance of what I'm seeing online, and having a great deal of trepidation about permanent lifestyle changes for someone who enjoys picking up and putting down heavy things and likes the discipline of structured intervals/intensity.

My big question is how to think about qualifying the professionals with whom I will be consulting -- and who I would choose for whatever potential procedures may be in my future. Already thinking after local consult here in WI I may look to Mayo and Cleveland Clinics as well. Also wondering about waiting 5 weeks for a first consult...

I'm probably thinking too far ahead, but thinking an e-bike may be one part of my future -- wish there was an equivalent in the nordic skiing world.

Any experiences or insights appreciated!

[rzthomas]

Having been through my own cardiac journey, I would encourage you to check out the Cardiac Athletes FB group. Some folks have certainly been through the same diagnosis you have and it's helpful to talk with them about how they've adapted to their own new normal.

Good luck.

[callmeishmael]

My only suggestion would be to look for a sports-literate cardiologist. Many will be used to dealing with a sedentary patient group and their default position may simply be 'don't' when it comes to hard exercise, simply because they have rarely been faced with a patient with your lifestyle.

Good luck.

[bigbill]

I had a hard time doing a stress test because I couldn't get my HR high enough on a treadmill. I needed 141 and the best I could get was 119. I ended up getting the meds to dilate my blood vessels. It made me question the validity of the test but the cardiologist said I was okay, no blockages. I see him again next month.

My ECG showed thickening of the valves but still in the range of normal.

[MatchDave]

Regarding your big question about determining who you want to work with...

A few years back a good friend was diagnosed with aortic disease potentially leading to aortic surgery. Hasn't needed surgery yet, but he expects it will come, and he plans to go to a team/hospital that does a lot of the surgery he may need. We were in San Diego, and he was looking at a team at UCLA, but thought he'd likely go to Cleveland Clinic. I'm not a physician, but he is, and he talked often about "if you need something big and have the option, go someplace where they do lots of that big thing."

Abstract and take-home highlights in the guidelines article you linked talk about better outcomes with an experienced aortic care team that does a lot of cases. Same thing my friend says and that you're thinking.

Scary stuff - glad it sounds like you have some time to work with for evaluation and planning. Best of luck!

[flying]

Originally Posted by callmeishmael

My only suggestion would be to look for a sports-literate cardiologist. Many will be used to dealing with a sedentary patient group and their default position may simply be 'don't' when it comes to hard exercise, simply because they have rarely been faced with a patient with your lifestyle.

Good luck.

^^^+1^^^^

A few months back I had a Sports exercise stress echocardiogram test done by a sports cardiologist

It was different to say the least & they have you go till you can't on an Exercycle if your a cyclist. Of course in a stepped increase

But then the tough part is laying right down immediately to get the echo measurements done while holding your breath for x amount of seconds many times as they make their measurements

Boy sounded easy enough when they described it to me beforehand but they assured me correctly this was going to be tough after that level of exertion

But yes if your concerned it would be great to find such a test & have it done & see.

I was 65 at the time of test

[metalheart]

After two heart attacks my experience is that it is important to have a cardiologist who understands the interaction of your condition and your cycling capabilities. In Wisconsin you are close enough to both the Mayo and Cleveland Clinics that you should be able to find someone who has good qualifications and understands the demands of cycling, not just riding a bike. I found that when I told my docs I was a cyclist it translated for them to "riding a bike" which is not cycling. When I found a cardiologist who was also a cyclist it made a difference in medications and assessments of occasional symptoms.

[teleguy57]

Thanks to everyone who has posted here and those who have PM'd me. Still very new news so continuing to gather info and figuring out the right questions to ask/think about as this all move forward over the next several weeks.

This is a a great place with great people -- thanks again, and keep the insights and counsel coming.

[hammerdocnomo]

Important you know the signs and symptoms of Aortic Dissection and the importance of immediate care.

Typically the symptoms of it are sudden, severe chest or upper back pain described as a tearing or ripping sensation that radiates up into the neck or down the back. In your case you will need immediate emergency care without hesitation. Good luck.

[OtayBW]

I went in for a physical a ~month ago. Dr. does an EKG and tells me that I had a heart attack recently. WHAAAT the? She orders up a conventional stress test at their companion clinic which was performed in <10 minutes and during which I never got above a heart rate that gave me an easy 'conversational' stress level. Second Dr. says that I did not have a heart attack.

The problem is that I have had issues in the past that occur above max HR/anaerobic and they didn't get anywhere near that despite my debriefing them of that situation. I believe I need to switch providers....

[teleguy57]

Originally Posted by hammerdocnomo

Important you know the signs and symptoms of Aortic Dissection and the importance of immediate care.

Great advice; thank you.

[flying]

Originally Posted by OtayBW

I went in for a physical a ~month ago. Dr. does an EKG and tells me that I had a heart attack recently. WHAAAT the? She orders up a conventional stress test at their companion clinic which was performed in <10 minutes and during which I never got above a heart rate that gave me an easy 'conversational' stress level. Second Dr. says that I did not have a heart attack.

The problem is that I have had issues in the past that occur above max HR/anaerobic and they didn't get anywhere near that despite my debriefing them of that situation. I believe I need to switch providers....

This is a real problem these days & I know their busy but......Like you we all need to be vigilant

[callmeishmael]

Originally Posted by OtayBW

I went in for a physical a ~month ago. Dr. does an EKG and tells me that I had a heart attack recently. WHAAAT the? She orders up a conventional stress test at their companion clinic which was performed in <10 minutes and during which I never got above a heart rate that gave me an easy 'conversational' stress level. Second Dr. says that I did not have a heart attack.

The problem is that I have had issues in the past that occur above max HR/anaerobic and they didn't get anywhere near that despite my debriefing them of that situation. I believe I need to switch providers....

Interesting; in the UK, I believe standard practice is that you must hit 90% of your theoretical max HR, or declare yourself too exhausted to continue, for a test to be valid (of course, assuming no adverse changes are visible prior to reaching that point).

I would also urge that any cardiac tests, even standard ECGs where possible, are performed by a cardiologist. I have a (benign) heart conduction abnormality that shows as a non-typical ECG pattern. It was first interpreted by my primary care GP as evidence of a historic heart attack, something dismissed by a cardiologist in <5 minutes. While all's well that ends well, the ~7 days waiting for an appointment were not fun.

To keep this to the OP's question, it's another example of the importance of ensuring you see an absolute expert if you have the opportunity.

[markie]

Originally Posted by OtayBW

I went in for a physical a ~month ago. Dr. does an EKG and tells me that I had a heart attack recently. WHAAAT the? She orders up a conventional stress test at their companion clinic which was performed in <10 minutes and during which I never got above a heart rate that gave me an easy 'conversational' stress level. Second Dr. says that I did not have a heart attack.

The problem is that I have had issues in the past that occur above max HR/anaerobic and they didn't get anywhere near that despite my debriefing them of that situation. I believe I need to switch providers....

I too get some heart pain when going all out. I did a dress test a while back and they cut that early before I really got maxed out. But last year I did a stress echo and they let me go till I was about to pass out. They didn’t see anything which I guess is good and some peace of mind. I made sure that it was clear with my doctor and the stress echo team that there was only any point in it if I could max out. Luckily everyone was on board. That was in Umass in Worcester.

[NHAero]

I had a stress test and IIRC they told me they shoot for 95% of peak heart rate. I asked the tech how they determine peak and she told me the computer does it - yeah, well the computer does 220-age, duh, so mine was determined to be a peak of 152. I was on the 2nd level of the treadmill and having conversation with the cardiologist and my HR was 148 bpm. Because of my nerve/muscle loss in the lower left leg he was nervous about steepening the treadmill and he decided my HR was high enough to learn what was needed from the test. I was kinda disappointed because I was just getting warmed up!