Dr. Isaac Gana
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I want to show my echocardiogram, to know if I have diastolic dysfunction or not. I can see that the velocity is high, but the report says normal. I am not an expert, but I have read that, if E/A ratio is higher than 1.5, then it is a problem. Please help, I am worried.
Hello,
Welcome to icliniq.com.
In order to diagnose a person to have diastolic dysfunction, there are factors that have to be met. Like ejection fraction more than 45%, the presence of diastolic stiffness, and heart failure symptoms, with changes in some laboratory test indexes. E/A ratio greater than 1.5, is not a criterion for diastolic dysfunction, it is not a gold standard. E/A ratio up to 2.33 is considered normal for people below 23 years.
Patient's Query
Hi doctor,
Thank you for the reply. The problem is that I am not sure about my ratio, have you looked into the images? Would you tell me the ratio in both of the attached echocardiograms? I am so stressed about this.
Hello,
Welcome back to icliniq.com.
I have carefully seen both the images (attachment removed to protect patient identity). Your E/A ratio is around 1.0. No need to be scared if you do not exhibit any symptoms.
Patient's Query
Hi doctor,
Thank you for replying. Can you tell me in which image is the ratio 1.0? And how is it calculated?
Hi,
Welcome back to icliniq.com.
E/A ratio is E velocity/A velocity in cm/s. Although your diagrams are not quite clear, in the second image, the E velocity is almost like double the A velocity. You can send a better picture if you like.
Patient's Query
Hi doctor,
Thank you for replying. But if it is double, then E/A ratio will be 2, not 1 right?
Hi,
Welcome back to icliniq.com.
Because E velocity is 0.50, so A velocity will be 1.
Patient's Query
Hello doctor,
I am so sorry again, but I am little confused here what you mean is E/A 0.50/2? Then it will be 0.25. I just want to let you know that my heartbeat was very high during the echocardiogram because I was so worried.
Hello,
Welcome back to icliniq.com.
I meant E velocity is 0.50, and A velocity is 0.25. So, E velocity/ A velocity will be 2.0, which is normal up to 2.33.
Patient's Query
Hi doctor,
Thank you. I just measured them on one wave (the waves above the middle line), it appears that E velocity is 0.38 and A velocity is 0.28, so the E/A ratio will be 1.46. So, I think the E wave will be under 0.50. I marked them on the attached image, and please correct me if there anything wrong with it. I marked one wave with an arrow which A greater than E, please look at it and let me know what you think.
Hi,
Welcome back to icliniq.com.
The wave you marked with an arrow in the picture (attachment removed to protect patient identity) is not A wave, it is E wave. If you calculated with the waves you lettered, then yes it should be around that value you measured. I would love to know what complaints you had before going for an echocardiogram, did you go for the test on a doctor's recommendation?
Patient's Query
Hello doctor,
Thank you for replying. No, I just feel tired, I cannot run more than two minutes without feeling that I will die. I also have a trivial mitral incompetence, which I found from 10 years back. So, I repeated the test again to check it, and I discovered that I have trivial tricuspid in the new echocardiogram. And the EF was 74%, FS was 43%, the normal range was 25 to 40%, do you think it is high? My IVSD is 0.99 cm, and IVSS is 1.35 cm, I read that maximum is 1.1 cm, do you believe that there are other abnormalities in the ECG? Should I repeat the ECG soon?
Hello,
Welcome back to icliniq.com.
Your EF (ejection fraction) and FS (fractional shortening) are normal because ECG never gives the exact reading, it is only an approximate value. There is no significant change on the ECG. Trivial mitral incompetence and trivial tricuspid do not mean much clinically. They occur in healthy persons too. Were you born with a heart defect? What other symptoms do you have? What do you mean by feeling like dying after running? Do you feel dizzy or shortness of breath? Which tests have you gone for apart from ECG?
Patient's Query
Thank you doctor,
I got an ECG before, and the doctor said it was normal. I am an overweight person. I do not move much, and I am in front of my computer most of the time. I am also overthinking and worrying too much for nothing, Do you think there are other abnormalities in the ECG?
Hello,
Welcome back to icliniq.com.
There are no abnormalities in your ECG test. Being overweight does not necessarily say that you have a heart problem. It is better you start exercising and dieting to reduce your BMI (body mass index) to 25. You are suffering from anxiety, try reading information about your health from the internet less, it would not do any good. You have to start exercising and engaging in fun activities, as it will help a lot. Stay healthy.
Patient's Query
Hi doctor,
Thank you. In the first echo, the report says, the pulmonary valve is normal with normal RVOT and no pathological PG across it. I do not understand what this sentence means. Does this mean I have a trivial pulmonary regurgitation?
Hello,
Welcome back to icliniq.com.
I hope you are doing great. PG means pressure gradient, and it changes abnormally in the case of pulmonary stenosis. So, you do not have trivial pulmonary regurgitation. Trivial regurgitation is common in 9 out of 10 echocardiograms we perform on patients. Even mild regurgitation is present in healthy patients. It means no harm clinically. How are you feeling now? Have you started exercising?
Patient's Query
Thank you doctor,
In the second echo, the report said negative for MR, negative for AR, trivial TR, but they left it blank in the pulmonary section. So, can you look at the attached pictures and let me know if there is any evidence of pulmonary regurgitation. Also, my IVSD is 0.99 cm, and IVSS is 1.35 cm, some references say the normal range for IVSS is below 1.1 cm, and some says it does not have a specific range.
Hello,
Welcome back to icliniq.com.
I have gone through our echocardiogram thoroughly again (attachment removed to protect patient identity). I cannot find an evidence of pulmonary regurgitation. I do not know why the technician that performed your test left the area of the pulmonary parameter blank, but in my clinic, if at all there was a significant change that indicated abnormality it would not have been left blank. When you have issues such as pulmonary regurgitation, you would certainly have had symptoms suggestive of right-sided heart failure, for example, palpitations, dyspnea when you do physical activity, increased jugular venous pressure, and many others. The variables we use for IVSD is 0.90 +/- 0.01, while IVSS is 1.50 +/- 0.08. So, I see no abnormality in your results. I still want to advise you to stop reading information from the internet, if you have complaints about your health. If you have complaints, you should seek advice. No test result is accurate, in all healthy people, we always have variations in test results. Hope this has helped you.
Patient's Query
Thank you doctor,
You said pressure gradient changes abnormally in a case of pulmonary stenosis. So, according to my report, do I have mild or trivial pulmonary stenosis? Also, you said IVSD is 0.90 +/- 0.01, but mine is 0.99, is this still normal?
Hello,
Welcome back to icliniq.com.
I hope you are doing better today. No, pathological pressure gradient means there is no trivial or mild pulmonary stenosis. As you can see, the technician recorded trivial in the case of tricuspid and mitral. If they find mild they will record it as mild, likewise trivial. Your IVSD is normal. We consider till 1.1 cm to be normal.
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Cardiology
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