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Respiratory Therapist/Breathing Problem Following CABG x3


QUESTION: Dear Stephanie,
A big thank-you for taking the time to answer my questions so expertly, professionally and with great detail. I am pleased that my test results are good and I can at least now rule out a respiratory problem as such.
I got more test results today from a recent echocardiogram but it's all a bit alien to me. It basically showed the following: Left Ventricle Systolic Function low/normal - ejection fraction 50-55%.
Basal Inferoseptal Segment Hypokinetic.
Left Ventricle Size and Wall Thickness is normal.
Right Ventricle Normal Size and Function.

What this all means I have no idea as I have yet to have a follow-up appointment. Until then I will keep cycling away, I managed 33 miles the other day so I am pleased with my progress.

Once again thank-you sincerely (from the UK)
My Very Best Wishes

ANSWER: Hi again James,

Normal left ventricular ejection fraction is 55-70% so, as your results indicate, yours is on the low normal side. Hypokinetic basically means decreased motion / contraction. Translated this means that the wall motion/contraction in that part of the heart (basal inferoseptal segment) is less than normal. This is most commonly due to ischemia, or to previous heart attack in that part of the heart. In these cases less blood and therefore less nutrients and oxygen are delivered and the muscle function becomes compromised. So your doctor will look at your echo in the context of your other results, your physical assessment, and your medical history. If you had other echos he or she will compare results to see if any changes have occurred on this echo in relation to the previous results, and if so, to determine the nature of these changes i.e. whether the change is something new, or something old that has gotten better or worse. Your L ventricle wall thickness is normal and your right ventricle is normal in size and function which are both very good things. Be sure to ask your doctor about these things on your follow-up visit so you can have a full understanding of these results and the relevance to your health now and in the future.

It is really important to ask questions and get meaningful and satisfactory answers from your doctor since he/she has all of the necessary information to give you a personalized viewpoint. It would probably be a good idea to keep a notebook with your ongoing results and explanations so you can more easily see your whole health picture, to ask better questions, and so you
can take a fully interactive role in improving and maintaining your health. Also, write down any new concerns or symptoms etc. that you have so you can address them with the doctor.

I hope this helps a bit to explain your echo results, at least from the standpoint of what I know about your situation.

Glad to hear your bike riding is going so well. I am sure that this great activity plays an important role your overall health. I think you have inspired me to start bike riding again since I live in a nice area for it and the mornings have been usually cool here lately.

Best wishes,

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

QUESTION: Thank-you so much Stephanie for taking the time to look closely at my echo results and to explain them to me.
Could I please trouble you to ask if it is a possibility that my deep breathing problem 'might' be due to the Hypokinetic in the basal inferoseptal segment or would this be unlikely. Also does the muscle function becoming compromised mean the heart itself. Can this left ventricular ejection fraction percentage be improved with exercise etc.  I'm sorry to be a bother.

Before the op last September, I had a 24 hour monitor fitted in June and an echo done in July, then the stress test in September resulted in me being detained in hospital for 3 weeks (I had another echo during my stay) before being transferred to another hospital for the op. I often thought it odd that nothing was picked up on the 24hr tape two months before having a triple bypass but maybe this is common enough. Anyway, the cardiologist in the hospital where I spent 3 weeks said I didn't have a heart attack but the team at the other hospital where I had my op said that I did, so it's all a bit confusing.

I'm hoping to do a big charity cycle next year, I had thought about asking the doctor to do a stress test to make sure all is ok, however I made the point of cycling during the two 24hr tapes I have worn this year so maybe that's as good as. When I get the results of my recent tape in June perhaps I can send them to you.

I'm glad I have inspired you to take to the bike again, I rode 23 miles this morning and all being well I hope to do approx 30 miles on Saturday morning which will take me just over 100 miles for the week (over 4 days).
Carpe Diem!! :-)

Thank-you so much again Stephanie, it's so much appreciated.

Hi James,

No bother at all; I will tell you what I think but have given you a couple of links below to Cardiologists that are better able to answer your specific cardiac questions.

Different people seem to experience cardiac events in many different ways, some have different types of pain and some do not have any pain, even with a heart attack, so I suppose it is possible that your chest discomfort on deep breathing could be at least in part attributed to the hypokinetic factor but I do not know how likely or unlikely this might be; this is a good question for your doctor or one of the cardiologists in the links given.

As for the muscle compromise this would be in the particular segment indicated by your echo, the basal inferoseptal segment, not the entire heart. Your ejection fraction is still fairly adequate; but, whether or not you can improve upon this with exercise I cannot really say. It might depend on the ability to restore normal function to the hypokinetic segment if this is affecting the EF, and I do not know that likelihood. These are also good questions for your doctor though, so be sure to ask. Also, I do not know if your recent echo results represent improvement, are not as good, or have stayed the same with respect to your previous results. You have been getting aerobic exercise with your biking, which I am sure you discussed with your doctor, so it would be interesting if this has had any effect. That is why it is important to discuss this with your doctor(s) because they have access to all the supporting information needed to make the appropriate interpretations, and recommendations regarding exercise, diet, outlook, further testing if necessary, etc. I know I keep saying this but it is that important. I wish that physicians would offer some written explanation to patients with their results, or call and discuss them in a timely fashion instead of just providing results that may produce anxiety in some patients. I always encourage patients to call the doctor and ask for results and explanations relatively soon since no one needs the extra stress and you might have to wait a while for them to contact you.

And, it is not unusual for a 24h holter monitor not pick up periodic abberancies. Some things come and go and so if you don't have irregularities while wearing the monitor these will not show. Frequently, I have patients that say nothing happened while the monitor was on although the particular problem seems to happen often otherwise. I know you said you had some PVCs, bigeminy and trigeminy, on a previous holter  and that you did not feel these during biking so it will be interesting to see what your recent holter results show during biking and non-biking events and how these compare to previous results. There are holter monitors that record for longer than 24 hours and event monitors that can be used for extended periods of time as well.

Here is a summary of a few questions for your doctor (and you could send some questions to the Cardiologists referenced in the links meanwhile)

Did I have a heart attack? (You indicated one group said no and one said yes. I tend to think the hospital where your surgery was done might have a better idea of this, and they said yes.) But since you are uncertain it is important to clarify this.
What is the significance of the hypokinetic segment?
Is the hypokinetic segment related to a heart attack, ischemia,
or some other factor?
Is the hypokinetic segment related to the EF in this case and
and can this be improved by exercise / other?
Can the hypokinetic segment be related to the deep breathing discomfort?
What is the overall significance of my results with regard to my health (don't forget about your holter results also)?

Hopefully the doctor will explain this and more anyway but asking questions let them know you are interested and help can keep things straight for you.

Links to Cardiologists:


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Stephanie Tyrrell


Respiratory Therapy is a very diverse field encompassing many specialty areas. I have experience in many of these areas and I am willing to answer any question I feel competent to answer within the scope of my experience in the following areas: neonatal ICU and transport, pulmonary rehabilitation, sleep studies, BiPAP/CPAP therapy, Holter monitoring, EKG, ventilator management, chronic and acute respiratory diseases,(i.e. COPD, asthma, restrictive disease, ARDS (acute respiratory distress syndrome), pneumonia, etc) and therapeutics, arterial blood gases, and others. Please see my profile under Experience for a full listing of areas of experience.


I have worked in respiratory therapy for over 25 years in all facets of patient care including level 4 neonatal ICU and neonatal transport, Director of Cardiopulmonary, community health fairs and networking, staff therapist, pulmonary rehabilitation, sleep studies and BiPAP/CPAP therapy, Holter monitoring, EKG, cardiac clinics, pre and post cardiac surgery education and patient care, emergency and long-term ventilator management, chronic diseases such as COPD, asthma, cystic fibrosis; acute respiratory distress syndrome, emergency room, home and nursing home respiratory care. I also provided temporary staff to area hospitals through an allied health business I owned and managed, while also working as a staff therapist for the business.

Certified Respiratory Therapist, Registered Respiratory Therapist, Licensed RT, NRP ((Neonatal Resuscitation Program) certified, BS Biology/Botany, MS Environmental Sciences - Toxicology

Past/Present Clients
Thousands of in-patient and out-patient clients in the hospitals I was/am employed by as well as a number of local hospitals that utilized the services of my allied health business. I currently work as a respiratory therapist at a general hospital and a rehabilitation hospital.

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