Heart & Cardiology/Left atrial dilatation

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Question
Dear Dr. Mustafa,
Here I come back to you. I went to the cardiologist (electro physiologist) because of PVCS and AVNRT. Advice is not to go for EFO and ablation at the moment, he is expecting me back after three months, in the meantime I will got holter and ergometrie. Im again on Metoprolol retard (100 mg a day). Before my visit I got an echo. Im a bit worried about the outcome, could you please have a look to the next echo results:
Echo November 2014:
-   LVF ok
-   RVF ok
-   Valves ok
-   LA volume increased
Echo August 2015:
-   LV: normal syst. and diast. LVF normal dimensions and normal walls
-   RV: normal RVF RVSP: 32+CVD
-   AOV: opening ok no AI
-   MV: slightly MI
-   TV : slightly TI normal VCI
-   LA: severe dilatation,  vol index 41 cc

1. Wat does severe LA dilatation means for me? My cardiologist told me that my heart is healthy and didnt spook on LA dilatation at all.
2. When is this dangerous? Can LA dilatation becomes more and more with rupture as a result?
3. I found on internet that LAVI is a predictor of mortality? What does this mean for me?
4. What is the maximum normal value for LAVI? Is 41 cc an abnormal value?

Thanks so much for clarfication,
Said

Below the answers you gave me on my previous questions:

Expert: Mustafa Ahmed MD
> Subject: AVRT and runs of PVC's
> Date Asked: 2015-08-02 16:39:24
> Date Answered: 2015-08-07 04:22:10
>
> Question:
> QUESTION: Dear Dr. Mustafa,
> Today i was in the hospital after my heart was racing up, I'm known with AVRT and PVC's.
> New observation today is that i have also runs of PVC's (2 and 3 in a raw).
> I have PVC's since 2006 and on Metoprolol (100 mg) since that time.
> I'm 45 years old, no smoking and drinking, weight 66 kg and no diabetus and high blood pressure.
> According to the ospital my blood levels are normal.
> Echo done at the beginning of this year was normal, although dimensions were at the high side of the normal limit.
> From today I'm on Veramapil (120 mg a day).
> I would like to ask you he next questions:
> - Is veramapil save?
> - Does it work to reduce runs of PVC's and prevention of AVRT episodes?
> - Is a run of 3 PVC's dangerous? I have no symptoms, only i feel flutter when it happens.
> - Does a run of 3 PVC's means that something is wrong with my heart muscle?
>
> Thanks a lot for your answers s I'm realy worried.
>
> Thank you in advance,
> Said Lamou
>
> ANSWER: Hi, http://myheart.net/articles/pvc-heart-beats-are-they-dangerous/
>
> 1) Verapmil is a widely used medication. It is generally safe as long as there are no clear contraindications to its use. It can be used for heart rate control, hypertension, or in the treatment of angina pain. It should probably be avoided if your heart rate is very slow. These should be discussed with the prescribing Dr.
>
> 2) It may reduce the occurrence of runs of tachycardia, and importantly in the setting of tachycardia it may control the heart rate from going to high.
>
> 3) 3 PVC's is generally not dangerous in isolation if you have been assessed by a heart specialist and determined to not be at risk otherwise
>
> 4) You had a normal echocardiogram that showed no clear evidence of underlying heart disease so there is no clear evidence of heart muscle damage.
>
> Hope that was helpful,
>
> ---------- FOLLOW-UP ----------
>
> QUESTION: Thanks a lot Dr. Mustafa.
> - Is echocardiogram reliable enough to conclude that heart muscle structure is ok?
> - Is there any blood test available to exclude any heart muscle disease?
> - Is stress a cause of runs of PVC's?
> Thanks so much again
> Said
>
> ANSWER: Hi,
>
> 1 )The echocardiogram is a reliable test to rule out underlying structural heart disease and assess the heart muscle function in this setting.
> 2) There is no specific blood test in this setting and none recommended
> 3) Some say stress may be associated but there is no evidence for that,
>
> Hope that was helpful,
>
> ---------- FOLLOW-UP ----------
>
> QUESTION: Thank you so much Dr. Mustafa.
> Yesterday i was at the hospital again and was monitored for 2 hours.
> They see frequent PVC's, but also couplets and triplets of PVC's.
> They told me that they are not dangerous as there is no evidence that something is wrong with my heart.
> I have to use Metoprololtartraat (50 mg twice a day). No Verapamil anymore.
> I feel now that Metoprolol helps better than Verapamil.
> I'm still very worried as I always thincking that triplets of PVC's could turn into Vtach. I'm now using Oxazepam to reduce anxiety. I appreciate your answers on the next questions:
> - Can triplet of PVC's become Vtach?
> - When is Vtach dangerous?
> - Does Vtach starts and ends like AVRT?
> - Do you have an explanation why i have triplets of PVC's while echo and ECG are normal?
> - Do you thinck that MRI scan of my heart is recommended in my case?
>
> Thank you some much as i'm really worried.
> Regards,
> Said
>
> Answer:
> Hi,
>
> A triplet of PVC's isn't necessarily associated with Vtach, it would be different if you had 20 beats.
>
> Vtach can be dangerous, but You don't even have Non sustained vt, which would be 16-20 beats or more. The fact you have a structurally normal heart is reassuring
>
> Vtach is different to AVNRT, it depends on the type of vt which is a long conversation, there is reentry VT and focal vt and others
>
> in terms of mri scanning, if you are looking for a focus of scar or other structural abnormality it is reasonable, although you don't have a strong indication for this
>
> My advice to you is wear a 24 hour monitor, and go and see an electrophysiologist for reassurance and evaluation
>
> Hope that was helpful,
>
> Please do not respond to this message.
>
> Thanks,
> Allexperts.com
>

Answer
Hi, http://myheart.net/articles/



1. What does severe LA dilatation means for me? My cardiologist told me that my heart is healthy and didnt spook on LA dilatation at all.

Severe LA dilation means your left atrium is a lot larger than normal, likely due to underlying cardiac disease. Im not exactly sure why your atrium is so large but you can ask them to remeasure it to ensure it is truly large. It is not a primary problem rather a result of an other problems, sometimes mitral valve disease, sometimes arrhythmias. the good news is the pumping function of your hear is normal. I would ask your dr why he thinks the atrium is large, its hard for me to comment without looking at the images myself.


2. When is this dangerous? Can LA dilatation becomes more and more with rupture as a result?

LA rupture is not a concern and does not happen.


3. I found on internet that LAVI is a predictor of mortality? What does this mean for me?

LAVI has been associated with worse outcomes, but this is due to the underlying conditions that cause this. For you it means confirming the underlying dilation by remeasuring and seeing what the cause is, if it is simply diastolic dysfunction then treating normal risk factors such as hypertension is the key.


4. What is the maximum normal value for LAVI? Is 41 cc an abnormal value?

22-25 is the normal value, >40 is severely abnormal.


All in all don't worry about the LA size, it is not really a primary issue, rather ensure underlying conditions are treated and other causes ruled out as you have been doing.


Hope that was helpful,  

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

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http://blog.myheart.net

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Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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