Update 1-19-22 Echocardiogram results Update with monitor results 8/31

[Scarlett]

Update 1/29/22 Everything moves so slowly in the medical world.

Dh had a consult on the phone for the results of the echo and monitor.  It was the cardiologist's PA.  She was very nice. Dh acted ridiculous and it was very embarrassing....glad I was there to hear the conversation though.  She was very nice...and since this appointment happened back in September it is easier for me to post her notes about the visit.  I will add that her notes exactly describe what happened.

>>His recent episode could be secondary to supraventricular tachycardia vs vasovagal syncope. Given the episode of PSVT noted on his monitor as well as recent racing of his heart with heart rates in the 200s at rest, I recommended referral to EP for evaluation. I also recommended initiating low dose metoprolol succinate at bedtime. The patient became very hostile and informed me that he is frustrated that he is even going through any of this testing for one episode of syncope that occurred in front of his friends and his wife. He states that he has been "poked and prodded" for ten years after a previous motorcycle accident and he has no interest in "any of this." I did place the order for the metoprolol succinate as well as the referral to EP.  Otherwise, he may follow up with Cardiologist as needed>>

So we joke that the PA fired him.  Which he deserved to be fired.  But anyway, he has been taking the metoprolol since then and he got over himself after a conversation with his mother and sisters.  He saw the EP (which is my EP also and I love him) in December. The EP has ordered a Loop recorder to be put in dh.  We had an appointment for that procedure but insurance had a hiccup so waiting for a new approval. The EP asked 100 questions....a lot directly to me since I have witnessed all 4- (or is it 5) episodes of fainting in the last 5 years. He keyed in on dh's esophageal issues as well as the neck fusion dh had in 2019.  At any rate, EP said he could do a lot of guessing but he really wants to see what is happening for himself and that is  impossible to catch with a 30 day monitor.

Interestingly enough, EP is guessing that this is a  vasovagal response.  And the triggers are probably physical (esophagus and neck pinching nerves....and one time in a plane where he was scrunched in)  Dh's youngest son and dh's youngest brother both faint from the sight of their own blood.  EP says that is an A plus symptom, where as dh's symptoms are more A minus.  LOL  At any rate, it makes the most sense of anything I have heard so far and actually it is what I have been suggesting for years--especially about the esophagus issue, but the gastro assured me there was nothing there that was causing fainting. 

So if you read this far, thanks!  I feel like we are getting close to some answers.   Oh and there might be something else going on with his heart that needs addressed (nothing serious) but EP doesn't think those things are causing the fainting. 

_______________________________________________________________________________________

Update 8/31  Does anyone know if these monitor results have to do with the Echo results?  I mean....are they related?  Does one set of issues cause the other?

Monitor results---

The patient was monitored for 26 days, 18 hours, 7 min.

 

The predominant rhythm was sinus with intact AV conduction. Rates ranged from 50 to 178 bpm with an average of 80 bpm.

 

Isolated PACs were present

 

PSVT was present

 

Isolated PVCs were present.

 

Symptoms correlated with PSVT onset and sinus tachycardia.>>>

 

 

We will go for a follow up but does anyone know if this is concerning?

Conclusions:

 

1. The left ventricular ejection fraction is preserved at 63%
2. Normal diastolic function
3. Mild tricuspid regurgitation.
4. Mildly enlarged left atrium.

Edited January 19, 2022 by Scarlett

[Acorn]

I believe that the 63% is within normal range. I’m not familiar with others, hope all is well.

[Indigo Blue]

I hope all is well, too, Scarlett.

[TCB]

17 minutes ago, Scarlett said:

We will go for a follow up but does anyone know if this is concerning?

Conclusions:

 

1. The left ventricular ejection fraction is preserved at 63%
2. Normal diastolic function
3. Mild tricuspid regurgitation.
4. Mildly enlarged left atrium.

An ejection fraction of 63% is good news.

[Pawz4me]

I think the mild tricuspid regurgitation means a leaky valve. Similar to mitral valve prolapse, but the tricuspid valve. If it's mild it may not be a big deal. I have mild mitral valve prolapse and (knock on wood) it never bothers me.

[Nicholas_mom]

Geez!  I am totally in your corner.  I had one done and I received results of the echocardium before I was supposed to have my follow-up appt!!!  I was freaking out at all the langauge and looking everything up on the Web, scarry results.  For me, most were within range and only 1 thing pop up that made the doctor ask me if I snore.  Otherwise, she just turned the page.

I had the "Mild tricuspid regurgitation."  I dont know about the others.  It was normal results for me, too with strange words!

I forgot to add- I had to wait 3 weeks for my doctor to tell me my results!!!!

Edited August 13, 2021 by Nicholas_mom

[hippymamato3]

All that seems pretty good and mild! They will likely keep an eye on the regurgitation, but I don't expect they'd need to do anything further now.

 

[Scarlett]

1 hour ago, Nicholas_mom said:

Geez!  I am totally in your corner.  I had one done and I received results of the echocardium before I was supposed to have my follow-up appt!!!  I was freaking out at all the langauge and looking everything up on the Web, scarry results.  For me, most were within range and only 1 thing pop up that made the doctor ask me if I snore.  Otherwise, she just turned the page.

I had the "Mild tricuspid regurgitation."  I dont know about the others.  It was normal results for me, too with strange words!

I forgot to add- I had to wait 3 weeks for my doctor to tell me my results!!!!

Yes his follow up is about 3 weeks away.  I think I will call and try to move it up. 

[Scarlett]

36 minutes ago, hippymamato3 said:

All that seems pretty good and mild! They will likely keep an eye on the regurgitation, but I don't expect they'd need to do anything further now.

 

Number 4 n the list can cause fainting.,,..but I doubt his is severe enough for that. 

[Junie]

2 hours ago, Pawz4me said:

I think the mild tricuspid regurgitation means a leaky valve. Similar to mitral valve prolapse, but the tricuspid valve. If it's mild it may not be a big deal. I have mild mitral valve prolapse and (knock on wood) it never bothers me.

I have MVP too and I also thought that tricuspid regurgitation was similar.

IME, the word mild repeated on the test results is a very good thing.

My kids and I have had multiple echos.  Dd11's first echo was when she was 12 hours old.  I will say that I love the pediatric echos because the cardiologist usually performs the test and gives immediate feedback.

Also, IME, when I had some truly concerning lab results (bloodwork, not an echo), the doctor called me at home and told me that I needed to take immediate action.

 

[Scarlett]

This is the result of dh's heart monitor that he wore for 30 days.  I have consulted Google and I think it sounds like he will need an ablation....does anyone have any insight?  His follow up is Sept 9, but I am nervous about this.

 

 

>>>>>The patient was monitored for 26 days, 18 hours, 7 min.

 

The predominant rhythm was sinus with intact AV conduction. Rates ranged from 50 to 178 bpm with an average of 80 bpm.

 

Isolated PACs were present

 

PSVT was present

 

Isolated PVCs were present.

 

Symptoms correlated with PSVT onset and sinus tachycardia.>>>>

[KSera]

55 minutes ago, Scarlett said:

This is the result of dh's heart monitor that he wore for 30 days.  I have consulted Google and I think it sounds like he will need an ablation....does anyone have any insight?  His follow up is Sept 9, but I am nervous about this.

 

 

>>>>>The patient was monitored for 26 days, 18 hours, 7 min.

 

The predominant rhythm was sinus with intact AV conduction. Rates ranged from 50 to 178 bpm with an average of 80 bpm.

 

Isolated PACs were present

 

PSVT was present

 

Isolated PVCs were present.

 

Symptoms correlated with PSVT onset and sinus tachycardia.>>>>

I would say it depends on how frequent it is and what his symptoms are. Is he able to stop the tachycardia with a Valsalva maneuver? Has he been taught to do that? I went through a couple years of really bad PVCs, with thousands a day sometimes, but my cardiologist didn’t want to do anything about it with them at that point (and then they went away when I got pregnant again). I don’t have any personal experience with PVST though, so I don’t know what the threshold is for going ahead with an ablation for that. FWIW, when I was having so many PVCs, the thought of an ablation didn’t even bother me, because I was so uncomfortable from the symptoms. If his is really bothersome, he might feel the same way.

[Scarlett]

20 minutes ago, KSera said:

I would say it depends on how frequent it is and what his symptoms are. Is he able to stop the tachycardia with a Valsalva maneuver? Has he been taught to do that? I went through a couple years of really bad PVCs, with thousands a day sometimes, but my cardiologist didn’t want to do anything about it with them at that point (and then they went away when I got pregnant again). I don’t have any personal experience with PVST though, so I don’t know what the threshold is for going ahead with an ablation for that. FWIW, when I was having so many PVCs, the thought of an ablation didn’t even bother me, because I was so uncomfortable from the symptoms. If his is really bothersome, he might feel the same way.

His main symptom is fainting.  He doesn't do that often...4 times in 5 years...with a few other times he avoided fainting.  I suspect his fatigue and general feeling of unwell is related to this heart issue and it has come on slowly enough he doesn't realize how affected he is. The rapid heart rate bothers him a lot but also sporadically.  If that makes sense.  Seemingly no pattern to when or where or how long.

[eagleynne]

My mother has Wolff-Parkinson-White syndrome which causes paroxysmal supraventicular tachycardia (PSVT). It can cause lightheadedness, fainting, shortness of breath, and some other stuff. It is generally managed with a beta-blocker like metoprolol, but in severe cases there is an ablation surgery they can do. Aside from her metoprolol the things she was warned to pay attention to were her overall stress levels, stimulant intake (no caffeine), and her thyroid levels (high t3 can cause episodes of refractory SVT).

[sassenach]

3 hours ago, Scarlett said:

This is the result of dh's heart monitor that he wore for 30 days.  I have consulted Google and I think it sounds like he will need an ablation....does anyone have any insight?  His follow up is Sept 9, but I am nervous about this.

 

 

>>>>>The patient was monitored for 26 days, 18 hours, 7 min.

 

The predominant rhythm was sinus with intact AV conduction. Rates ranged from 50 to 178 bpm with an average of 80 bpm.

 

Isolated PACs were present

 

PSVT was present

 

Isolated PVCs were present.

 

Symptoms correlated with PSVT onset and sinus tachycardia.>>>>

Echo- nothing that I would be concerned about.

monitor- PSVT can be treated with meds or ablation. There are pros and cons to both, which the dr will go over with him. I had an ablation and am glad I did but I was in my 20's and not ready to commit to a med. My arrhythmia was also incredibly frequent. If I had the same issue now, I would probably go on a beta-blocker. 

[Scarlett]

1 minute ago, sassenach said:

Echo- nothing that I would be concerned about.

monitor- PSVT can be treated with meds or ablation. There are pros and cons to both, which the dr will go over with him. I had an ablation and am glad I did but I was in my 20's and not ready to commit to a med. My arrhythmia was also incredibly frequent. If I had the same issue now, I would probably go on a beta-blocker. 

Dh is already on blood thinners so I hate for him to add another med or even if the two can be taken together.  I would definitely lean toward ablation if it were me.  

So no trouble since you had the ablation?

[Scarlett]

59 minutes ago, eagleynne said:

My mother has Wolff-Parkinson-White syndrome which causes paroxysmal supraventicular tachycardia (PSVT). It can cause lightheadedness, fainting, shortness of breath, and some other stuff. It is generally managed with a beta-blocker like metoprolol, but in severe cases there is an ablation surgery they can do. Aside from her metoprolol the things she was warned to pay attention to were her overall stress levels, stimulant intake (no caffeine), and her thyroid levels (high t3 can cause episodes of refractory SVT).

From what I read that is the rare version of what this might be.....but also if I understand it correctly they basically diagnose the type and repair at the same time. It is kind of confusing.

Thanks for taking the time to post.  The more I learn before the doctor visit the better. I will at least know what questions to ask.

[Katy]

Having had multiple kids in my home that needed frequent follow ups with a cardiologist, I'd say it's a good idea to not do this.  Get off Google.  Rhythms and issues and the way they are best dealt with are so individual that you're probably NOT going to find the diagnosis here, you'll just find a bunch of scary information.  What triggered heart failure and surgery in one child did not in another. It really has a lot to do with the whole picture, not isolated incidents. Go in with your ears open. Take notes. Chances are high the cardiologist will give you a diagram of the heart and write down exactly what is going on so you can reference it later, when you have a clearer mind.  Only when you know exactly what is happening is it time to google. Chances are there is nothing so urgent that it needs surgery now or they would have had you in for a follow up immediately.

[Scarlett]

13 minutes ago, Katy said:

Having had multiple kids in my home that needed frequent follow ups with a cardiologist, I'd say it's a good idea to not do this.  Get off Google.  Rhythms and issues and the way they are best dealt with are so individual that you're probably NOT going to find the diagnosis here, you'll just find a bunch of scary information.  What triggered heart failure and surgery in one child did not in another. It really has a lot to do with the whole picture, not isolated incidents. Go in with your ears open. Take notes. Chances are high the cardiologist will give you a diagram of the heart and write down exactly what is going on so you can reference it later, when you have a clearer mind.  Only when you know exactly what is happening is it time to google. Chances are there is nothing so urgent that it needs surgery now or they would have had you in for a follow up immediately.

Well, too late for me not to do it.  I have gathered a lot of info.  And I am not worried about it being a critical issue because we have had no phone call from the cardiologist.  I have to gather info ahead of time especially on medical terms that are not familiar to me.  

[sassenach]

3 hours ago, Scarlett said:

Dh is already on blood thinners so I hate for him to add another med or even if the two can be taken together.  I would definitely lean toward ablation if it were me.  

So no trouble since you had the ablation?

They would likely add a beta blocker, which is not a big deal in the grand scheme of things. Yes, the ablation fixed my issue, mostly. Wine or sweets can occasionally set it off. The ablation was unpleasant but not the end of the world. They had to punch through to my left atria and that’s the main reason I wouldn’t do it again. Just an extra risk that I didn’t really enjoy taking on. 

[sgo95]

My DD had SVT but never passed out. She knew tricks to get over the episodes but in her senior year of high school the episodes started coming very frequently. We opted for the ablation and it's stopped the SVT. It was a quick surgery and easy recovery for her.

[Scarlett]

Update 1/29/22 Everything moves so slowly in the medical world.

Dh had a consult on the phone for the results of the echo and monitor.  It was the cardiologist's PA.  She was very nice. Dh acted ridiculous and it was very embarrassing....glad I was there to hear the conversation though.  She was very nice...and since this appointment happened back in September it is easier for me to post her notes about the visit.  I will add that her notes exactly describe what happened.

>>His recent episode could be secondary to supraventricular tachycardia vs vasovagal syncope. Given the episode of PSVT noted on his monitor as well as recent racing of his heart with heart rates in the 200s at rest, I recommended referral to EP for evaluation. I also recommended initiating low dose metoprolol succinate at bedtime. The patient became very hostile and informed me that he is frustrated that he is even going through any of this testing for one episode of syncope that occurred in front of his friends and his wife. He states that he has been "poked and prodded" for ten years after a previous motorcycle accident and he has no interest in "any of this." I did place the order for the metoprolol succinate as well as the referral to EP.  Otherwise, he may follow up with Cardiologist as needed>>

So we joke that the PA fired him.  Which he deserved to be fired.  But anyway, he has been taking the metoprolol since then and he got over himself after a conversation with his mother and sisters.  He saw the EP (which is my EP also and I love him) in December. The EP has ordered a Loop recorder to be put in dh.  We had an appointment for that procedure but insurance had a hiccup so waiting for a new approval. The EP asked 100 questions....a lot directly to me since I have witnessed all 4- (or is it 5) episodes of fainting in the last 5 years. He keyed in on dh's esophageal issues as well as the neck fusion dh had in 2019.  At any rate, EP said he could do a lot of guessing but he really wants to see what is happening for himself and that is  impossible to catch with a 30 day monitor.

Interestingly enough, EP is guessing that this is a  vasovagal response.  And the triggers are probably physical (esophagus and neck pinching nerves....and one time in a plane where he was scrunched in)  Dh's youngest son and dh's youngest brother both faint from the sight of their own blood.  EP says that is an A plus symptom, where as dh's symptoms are more A minus.  LOL  At any rate, it makes the most sense of anything I have heard so far and actually it is what I have been suggesting for years--especially about the esophagus issue, but the gastro assured me there was nothing there that was causing fainting. 

So if you read this far, thanks!  I feel like we are getting close to some answers.   Oh and there might be something else going on with his heart that needs addressed (nothing serious) but EP doesn't think those things are causing the fainting. 

[Scarlett]

After he finished with his little rant to the PA she said, 'Well, Mr. Scarlett, you are a 54 year old man, and if you don't want to see a doctor or have a test then you certainly don't have to.'

SMH.  I don't know what got into him.

[prairiewindmomma]

1 hour ago, Scarlett said:

After he finished with his little rant to the PA she said, 'Well, Mr. Scarlett, you are a 54 year old man, and if you don't want to see a doctor or have a test then you certainly don't have to.'

SMH.  I don't know what got into him.

He's probably scared it might actually be something serious. Sometimes denial is more comfortable than confronting your own mortality.  I've seen a similar dynamic in my own family members.

[Catwoman]

21 hours ago, prairiewindmomma said:

He's probably scared it might actually be something serious. Sometimes denial is more comfortable than confronting your own mortality.  I've seen a similar dynamic in my own family members.

I would wonder about this, as well, because Scarlett's dh always sounds like such a nice guy, and it's hard to imagine him intentionally behaving this way without an underlying reason. He might just be frustrated that he feels like he is being forced to keep investigating incidents that he believes were minor, but he might also be secretly scared that it might be something more serious. (I would be!)

[Scarlett]

44 minutes ago, Catwoman said:

I would wonder about this, as well, because Scarlett's dh always sounds like such a nice guy, and it's hard to imagine him intentionally behaving this way without an underlying reason. He might just be frustrated that he feels like he is being forced to keep investigating incidents that he believes were minor, but he might also be secretly scared that it might be something more serious. (I would be!)

Mr. Scarlett is a wonderful man but he can be a jerk in certain situations.  LOL.  I really do think he was just sick of the appointments and having test after test. 

That feeling was exacerbated by the gastro doctor who had just finished a scope, where they stretched him and said, 'it wasn't narrow enough to be causing his symptom of feeling like he couldn't swallow.'  It made him furious...because he literally will throw up sometimes because something shuts off in his esophagus.  So I had pushed the gastro nurse and told her well, 'he certainly CAN'T swallow so something is up' and that is when she said they could do another test.....and apparently all of these years no one has really listened to dh when he describes it....and so I started doing my own research for him and there is a rare condition he could have causing this.  So that was already in his mind and he was just sick of doctors.

So after that conversation where he was fired by the PA I just calmly told him he was very unkind to her.  And that I agreed....if he didn't want to do any more tests or see any more doctors then I wasn't going to try and force him.  That calmed him down.  And then by the time they called for the consult he was willing again.

So once we get finished with the EP I might revisit the issue with the esophagus....which is one of the vagal response triggers that make him pass out--probably...

[TravelingChris]

Bu the way, Scarlett, what is an EP?  I know what an NP or CRNP is. as well as a PA, but not heard of an EP/

[Scarlett]

38 minutes ago, TravelingChris said:

Bu the way, Scarlett, what is an EP?  I know what an NP or CRNP is. as well as a PA, but not heard of an EP/

Electrophysiologist.