AboutDavid Richardson Expertise Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.
Experience Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.
Organizations Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..
Publications Circulation, American Heart Journal, Hypertension.
Education/Credentials M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.
Awards and Honors Gold Heartt Award from American Heart Association in 1995.
Expert: David Richardson Date: 7/19/2008 Subject: Echocardiogram: biatrial dilation and normal ventricles
Question I had an echo on Jun 8 the with these results and the following:
"Echo cardiogram also shows tricuspid regurgitation and nonspecific mitral valve thickening.
I was hospitalized with chest pain behind my breast under my breastone that radiated to my right shoulder and neck. I felt pretty sick to my stomach and light headed. I was monitored for 28 hours (my lowest BP was 87/56 and a persantine nuclear stress test run on the second day came back normal. My internist felt it was most likely GERD causing esophageal spasms as only the myoglobulin was elevated, not the tropinins, nor the dimer.
I have had a number of tests run with a variety of test results. I find it all very confusing. I don't know if to be concerned or shrug my shoulders. What prompted the testing was an episode of near syncope when I was at the doctor's office. The med student in the room just happened to catch an atrial (flutter of fibrillation?). And I felt like I was falling off the edge of the world. Sudden vertigo. ( I have had this a number of times since 2004). I was immediately attached to an ekg (which was normal) and then put in a holter monitor for the next 24 hours.
The results are as follows.
1. Sinus rhythm, rates 51 to 101.
2. Occasional ventricular (59) and atrial (31) ectopy.
3. No pauses (this is good??)
4.Around 4:02am there seems to be an episode of ectopic atrial tachycardia at a slow rate around 128bpm.,, two runs of 9 beats each
5. Non specific ST-T abnormalities. (atrial related??)
6. One episode of 3 consecutve PACs
Ejection faction estimated at 65%. Perfusion indicates no reversible ischemic lesion.
I get kind of short of breath, dizzy and chest pain (on occasion). Is this something to be concerned about? (I also am being treated for GERD).
Should I see a cardiologist or is this pretty normal sounding (the test results in light of the GERD?)
I am in a quandary as to whether there is anything to really follow through with here. I am a 56 yr old female with moderately elevated cholesterol, but good HDL. Heart disease does run in the generation up from me on my father's side...most have died of cardiac complications.
What is your take? Do I need to see a cardiologist or watching and waiting for something more the most reasonable choice?
It is really difficult to discern the middle of the road approach without further input.
Your response is SO appreciated."
Answer Dear Linda,
The echo shows no significant problems.
Near syncope is a problem, which the Holter didn't clarify. Ask for an event monitor, a little box you carry with you all the time that records your EKG a few minutes before and after you push a button on the box to indicate near syncope. But vertigo is something else. If you really feel that you are spinning round and round or the world is spinning around you, go to an ear specialist, preferably one who specializes in vertigo. She or he can teach you maneuvers to dislodge the tiny grit in your semicircular canals of the inner ear. That tiny grit causes vertigo.
I believe a 56-year-old woman with a recent episode of chest pain and a family history of cardiac death (especially if below age 55) and an elevated cholesterol should be taking aspirin 81 mg daily, a statin like lovostatin or pravastatin, and probably a beta blocker like metoprolol or atenolol. This combination of meds has proven effective in preventing heart attack and sudden cardiac death. A cardiologist can best guide you.
Please write back if this note doesn't answer all your questions.
