Patient's Query
Hello doctor,
I want to discuss my echocardiogram results to determine if I have diastolic dysfunction. I noticed that the velocity is high, but the report indicates it is normal. Although I am not an expert, I have read that if the E/A ratio is higher than 1.5, it could indicate a problem.
Please help; I am worried.
Hello,
Welcome to icliniq.com.
In order to diagnose a person with diastolic dysfunction, several factors must be met. These include an ejection fraction greater than 45 percent, the presence of diastolic stiffness, and heart failure symptoms, along with changes in certain laboratory test indices. An E/A ratio greater than 1.5 is not a criterion for diastolic dysfunction and is not considered a gold standard. An E/A ratio of up to 2.33 is considered normal for individuals under 23 years of age.
I hope this helps you.
Patient's Query
Hello doctor,
Thank you for the reply.
The problem is that I am unsure about my ratio. Have you looked at the images? Could you tell me the ratio from both of the attached echocardiograms? I am very stressed about this.
Hello,
Welcome back to icliniq.com.
I have carefully reviewed both images (attachment removed to protect patient identity). Your E/A ratio is approximately 1.0. There is no need to be scared if you are not exhibiting any symptoms.
Patient's Query
Hello doctor,
Thank you for the reply.
Can you tell me which image shows the ratio of 1.0? How is it calculated?
Hello,
Welcome back to icliniq.com.
The E/A ratio is calculated by dividing the E velocity by the A velocity in cm/s. Although your diagrams are not very clear, in the second image, the E velocity appears to be nearly double that of the A velocity. You can send a clearer picture if you would like.
Patient's Query
Hello doctor,
Thank you for the reply.
But if it is double, then the E/A ratio will be 2, not 1, right?
Hello,
Welcome back to icliniq.com.
Since the E velocity is 0.50, the A velocity will be 1.
Patient's Query
Hello doctor,
Thank you for the reply.
I apologize for the confusion, but do you mean that the E/A ratio is 0.50/2? If so, that would equal 0.25. I also want to let you know that my heartbeat was very high during the echocardiogram because I was very worried.
Hello,
Welcome back to icliniq.com.
I meant that the E velocity is 0.50 and the A velocity is 0.25. Therefore, the E velocity divided by the A velocity will be 2.0, which is considered normal up to 2.33.
Patient's Query
Hello doctor,
Thank you for the reply.
I just measured them on one wave (the waves above the middle line). It appears that the E velocity is 0.38 and the A velocity is 0.28, so the E/A ratio will be 1.46. Therefore, I think the E wave will be under 0.50. I have marked them on the attached image, so please correct me if there is anything wrong with it. I also marked one wave with an arrow where A is greater than E; please take a look and let me know what you think.
Hello,
Welcome back to icliniq.com.
The wave you marked with an arrow in the picture (attachment removed to protect patient identity) is not the A wave; it is the E wave. If you calculated using the waves you labeled, then yes, it should be around the value you measured. I would like to know what symptoms you had before going for the echocardiogram. Did you undergo the test on a doctor's recommendation?
Patient's Query
Hello doctor,
Thank you for the reply.
No, I just feel tired. I can not run for more than two minutes without feeling like I might pass out. I also have trivial mitral incompetence, which I discovered about ten years ago. I repeated the test to check on it and found that I now have trivial tricuspid regurgitation in the new echocardiogram. My ejection fraction (EF) was 74 percent, and my fractional shortening (FS) was 43 percent, with the normal range being 25 to 40 percent. Do you think that is high? My interventricular septal dimension (IVSD) is 0.99 cm, and my interventricular septal systolic dimension (IVSS) is 1.35 cm; I read that the maximum is 1.1 cm. Do you believe there are other abnormalities in the ECG? Should I repeat the ECG soon?
Hello,
Welcome back to icliniq.com.
Your ejection fraction (EF) and fractional shortening (FS) are normal because an ECG never provides an exact reading; it only gives an approximate value. There are no significant changes on the ECG. Trivial mitral incompetence and trivial tricuspid regurgitation are not clinically significant and can also occur in healthy individuals. Were you born with a heart defect? What other symptoms do you have? What do you mean by feeling like you are going to pass out after running? Do you experience dizziness or shortness of breath? What other tests have you undergone apart from the ECG?
Patient's Query
Hello doctor,
Thank you for the reply.
I had an ECG done before, and the doctor said it was normal. I am overweight and do not move much; I spend most of my time in front of my computer. I also tend to overthink and worry too much about trivial things. Do you think there might be other abnormalities in the ECG?
Hello,
Welcome back to icliniq.com.
Your ECG test shows no abnormalities. Being overweight does not necessarily indicate that you have a heart problem. It would be beneficial for you to start exercising and dieting to reduce your BMI (body mass index) to 25. Since you are experiencing anxiety, it may help to limit your online health research, as excessive reading might not be beneficial. Engaging in regular exercise and fun activities can significantly improve your well-being.
Stay healthy!
Patient's Query
Hello doctor,
Thank you for the reply.
In the first echocardiogram, the report states that the pulmonary valve is normal, with a normal right ventricular outflow tract (RVOT) and no pathological PG across it. I do not understand what this sentence means. Does this indicate that I have trivial pulmonary regurgitation?
Hello,
Welcome back to icliniq.com.
I hope you are doing well. PG stands for pressure gradient, which can change abnormally in the case of pulmonary stenosis. Therefore, you do not have trivial pulmonary regurgitation. Trivial regurgitation is common in 9 out of 10 echocardiograms performed on patients. Even mild regurgitation can be present in healthy individuals and typically has no clinical significance. How are you feeling now? Have you started exercising?
Patient's Query
Hello doctor,
Thank you for the reply.
In the second echocardiogram, the report indicated negative for mitral regurgitation (MR), negative for aortic regurgitation (AR), and trivial tricuspid regurgitation (TR), but the pulmonary section was left blank. Could you please look at the attached pictures and let me know if there is any evidence of pulmonary regurgitation? Additionally, my interventricular septal diameter (IVSD) is 0.99 cm, and my interventricular septal thickness (IVSS) is 1.35 cm. Some references state that the normal range for IVSS is below 1.1 cm, while others suggest there is no specific range.
Hello,
Welcome back to icliniq.com.
I have thoroughly reviewed your echocardiogram again (attachment removed to protect patient identity). I cannot find any evidence of pulmonary regurgitation. I am not sure why the technician who performed your test left the pulmonary parameters blank, but in my clinic, if there were a significant change indicating an abnormality, it would not have been omitted. If you had issues such as pulmonary regurgitation, you would likely have symptoms suggestive of right-sided heart failure, such as palpitations, dyspnea during physical activity, and increased jugular venous pressure, among others.
The reference ranges we use for interventricular septal diameter (IVSD) are 0.90 ± 0.01 cm, while for interventricular septal thickness (IVSS), they are 1.50 ± 0.08 cm. Therefore, I see no abnormalities in your results. I advise you to refrain from reading information about your health on the internet. If you have health complaints, you should seek professional advice. No test result is entirely accurate; variations are common among healthy individuals.
I hope this information helps you.
Patient's Query
Hello doctor,
Thank you for the reply.
You mentioned that the pressure gradient changes abnormally in cases of pulmonary stenosis. Based on my report, do I have mild or trivial pulmonary stenosis? Additionally, you stated that the normal range for IVSD is 0.90 ± 0.01 cm, while mine is 0.99 cm. Is this still considered normal?
Hello,
Welcome back to icliniq.com.
I hope you are feeling better today. No, a pathological pressure gradient indicates that there is neither trivial nor mild pulmonary stenosis. As you can see, the technician recorded "trivial" for the tricuspid and mitral valves. If they had found mild stenosis, it would have been recorded as such. Your interventricular septal diameter (IVSD) is normal; we consider values up to 1.1 cm to be within the normal range.
I hope this helps you.
Thank you.
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Answered byDr. Isaac Gana
Medically reviewed byDr. K. Shobana
Same symptoms don't mean you have the same problem. Consult a doctor now!
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