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Heart & Cardiology/mild left an right atrial enlargement

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QUESTION: Hello Dr. Richardson,

You have provided me with sound advice in the past which I thank you for.

I am an athletic 42 year old male that runs 25 to 35 miles per week.  I have undergone numerous echos in the past, have very good cholesterol profile but have sometimes elevated BP.  I underwent an echo on 11/8 which was normal with exception of trace mitral, tricuspid regurgitation and mild pulmonary hypertension (41mm). It also noted that my left atrium was top normal size. The latter alarmed my because I have never had that noted before although I sometimes have mild thickness of my LV which they attribute to my exercise.  I do get PAC's often (sometimes strings of them - not reated by meds).  I went to  a cardiologist that I typically see as needed or once a year and he suggested I get another echo.

The next echo, 10 days later noted no pulmonary hypertesion (31mm) my LV is normal at .8 cm, but my right and left atrial were "mildly enlarged (left - 4.2cm). It also noted "mild" regurgitation in mitral and tricuspid valves. I am perplexed and a bit worried.  My cardiologist does not think the atrial enlargement is due to exercise but the PACs I get.  He said keep exercising and come back as needed.  I feel I am in better cardiovascular shape now that when I was 32 and did a marathon. I have revamped my exercise to more cardio based since entering my 40's and feel good.  I try to run everyday for both mental focus and health (I also do Yoga).  My questions are as follows:

1.  Will exercise make this worse?

2.  Am I exercising too much and "aging my heart" faster than normal?

3.  Do you think the enlargement is dangerous and can it be caused by PACs or exercise or both?

4.  Can the enlargement discrepancies be a matter of interpretation?

5.  Should I consider BP meds?  At home my BP is normal and after the ususal white coat syndrome my last measurement was 122/78.  

Any advice would be appreciated.  Thanks, Rob

ANSWER: ello Rob,

1. No
2. No
3. Not dangerous.  Can be caused by exercise, PACs and aging.
4. Probably not.
5. If your BP in the doctor's office is over 140/90, I'd consider BP meds.

Please write back if this doesn’t answer all your questions.

David Richardson

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for your response.  Some final questions:
1.  Is there a diagnostic difference between mild and trace regurgitation or is this semantics?
2.  Can exercise increase regurgitation or am I doing anything to make it worse?
3.  Does cutting out coffee, wine reduce PACs and can the enlargement continue over time to become more problematic?
4. Is what I have considered "athletic heart" and how does this differ from what I read about when highly trained athletes die from rhythm disturbances?

Thanks again!  Rob

Answer
1. Semantics.
2. No, exercise won't make mild regurgitation worse.
3. Coffe and wine won't affect PACs.  Enlargement might occur, but return to normal is more likely.
4. Athletic heart means thickening of left ventricle, not atrial enlargement.  Athletes who die young usually have a congenital hear disease called hypertrophic cardiomyopathy.  You don't have any sign of that.

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David 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.

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