Heart & Cardiology/echo results


QUESTION: Dr. Pearl,
Thank you for taking my questions. I am 44 years old and had an echo in 2002 and 2011 and a stress test in 2011 after experiencing some PVCs.  Both in 2002 and 2011, the cardiologists (two separate cardios) examined me and the results of the tests and told me that things looked good.  However, my father, who is 74, just required aortic valve replacement surgery last week for what was found to be a bicuspid aortic valve (that was thought to be tricuspid until TEE).  Now I am naturally re-examining my test results with even greater interest and worry.  

In 2002, my EF was 55 with "trace to mild" regurg in mitral, tricuspid, and aortic.  In 2011, the new place didn't use the same nomenclature of being between two, and my regurg showed as trace in mitral and tricuspid and mild in aortic.  EF remained 55 (LVOT:  1.0 m/sec) with LV wall thickness normal and RV normal in size/dimension.  Antegrade flow velocities across mitral and aortic also normal with no evidence of percardial effusion. Aortic judged to be trileaflet with adequate cusp separation, but I'm not sure how much I trust that without a TEE since my dad is bicuspid.

Furthermore, on my Bruce test, I lasted 14 minutes, 20 seconds with a peak heart rate of 182 and peak systolic of 166 with no arrhythmias or pain.  They injected Myoview at some point that revealed no evidence of reversible ischemia or infarct.  

Then, in a part that confuses me more, the "gated spect scan" reveals LV EF of 65%, which isn't the 55 that shows on my echo.  The report notes "No EKG changes during exercise," "adequate heart rate and blood pressure response," and "excellent effort tolerance."  

So here are my questions (thank you for being patient with all of this--I'm quite worried):
1.  Is this EF worrisome?  I know 55 is normal, but aren't I young to be so close to abnormal (50), and does this mean I'm likely to fall to 50 in the next 10-20 years and require heart surgery?
2.  Which EF is the real EF?
3.  Assuming I keep my BP down and exercise, how good are my odds of keeping this AR at mild or at least not progressing to point of heart surgery?
4.  Should I avoid weightlifting?  I don't do bench press anymore, but I do push ups and curls with 35 pound weights--should I lighten up or cease entirely or can I go heavier?
5.  When I run on the treadmill at the gym, can I go hard or do I need to keep it at a jog?  I like to max out and then gauge my recovery heart rate (which drops 30 in the first minute and 55 after two minutes), but am I hurting myself in running that hard?
6.  How often should I get follow-up echos and are there other tests you'd recommend?  

Thank you so much for generously lending your expertise to provide information, advice, and solace to those of us who have zero medical background.  Bless you.  I've included a few more numbers below in case you need them to get a clearer picture.  THANK YOU!!

RVID:  1.8          LVIDs:  3.7          LVEF (est): 55
IVS (D):  .8          Left atrium (ES): 4.1          EPSS:  .9
LVPW(D):  .8          Aortic Root (ED):  3.2          LVOT:  2.2
LVIDd:  5.5          Aortic Cusp Separation:  ___     MV E/A ratio:  1.2

ANSWER: 1 - No
2 - Not important. Future trends will be more important
3 - Good but who can predict what will happen 30 -40 years from now
4 - Train don't strain
5 - Train don't strain
6 - Every few years. ask your doctor about a 64 slice CT to assess coronary Ca++. If your score is above zero then your cholesterol is not good enough

Good luck!!!

Dr. P

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

QUESTION: Thank you.  When you say "train don't strain," does that mean I should not lift to failure?  that is, if I'm lifting a light 25-lb dumbell and doing reps, can I go until I can't go anymore or do I need to stop well before that?  And when I run a competitive 5K, does that mean I can't give my all (since that would require me pushing it) but rather should jog it comfortably?  Exercise is a big part of my life so I guess I'm just wanting a little clarification because this will really change how I live going forward.

thank you again

When I was training my trainer told me that you should be able to do 3 sets of 10 reps. If you can't do it, the weight is too heavy, if it is done easily, it is too light.

Common sense and moderation is the general rule but that does not mean you cannot be competitive.

Good luck!!!

Dr. P

Heart & Cardiology

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Frank J. Pearl, M.D.


Voluntary Professor of Medicine, University of Miami Miller School of Medicine, Miami, FL. Board certified in cardiovascular disease

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