Dr. Prashant Valecha
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 had an echocardiogram that showed normal except for right ventricular dilation at 48 mm with normal systolic function. I have controlled hypertension. Then, does it indicate pulmonary hypertension? Kindly help.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern. The probability of measurement error could be there. However, the examiner could not measure pulmonary arterial systolic pressure and so could not comment on pulmonary hypertension. In your report (attachments removed to protect the patient's identity), there is a normal right ventricle size and function, but they mentioned right ventricular dilation. Rest all of the other things are normal and not indicating pulmonary hypertension. If you do not have other symptoms like breathing difficulty or saturation is normal, you can get a review echocardiogram after a few months. If you have a breathing or saturation drop problem, then a CT (computed tomography) pulmonary angiogram is to be done to rule out pulmonary embolism. You can upload your echocardiogram also if you have any recent ones. I hope this helps. Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply. I have attached my electrocardiogram report. And I have no symptoms other than palpitation.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. Your electrocardiogram (ECG) is normal and does not suggest embolism. Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply. I had an echocardiogram done five years back when palpitations first started, and the cardiologist said everything was normal, but I did not see the results myself. I have requested them, just waiting for them to send it.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. I think there is an error in measurement or reporting. You can ask them why there is a discrepancy in the description and conclusion. Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply. My BMI (body mass index) is higher than it should be, could this cause isolated right ventricular dilatation without a pathological reason? Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. Ask them if they can review just the RV dimension because the report is confusing. A slight possibility can be there in association with obesity. Did they give pictures of the doppler and chambers? I can say by visual analysis whether RV is dilated or not. I hope this helps. Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply. I have asked for a copy of the imaging. They measured my right ventricle basal dimension as 48 mm, several more than normal. What should I do?
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. Yes, that is why I feel that the measurement went wrong because of poor visibility of the endocardial border. If you get images, upload them here. Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply.
I will attach it as soon as possible, doctor. Is it possible that right ventricular dilatation could be caused by sleep apnea without pulmonary hypertension, other than the increased pulse volume recording during sleep? If so, is right ventricular dilatation reversible?
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Obstructive sleep apnea (OSA) may cause right ventricular dilation, and it is reversible at early stages. Therefore, if you have OSA, a sleep study can diagnose it.
Continuous positive airway pressure (CPAP) therapy can improve OSA and right ventricular dilation.
So I suggest you for a sleep study to diagnose obstructive sleep apnea.
I hope this helps.
Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply.
Sure doctor, I will do that.
Hello,
Welcome back to icliniq.com.
Okay.
Thank you and take care.
Patient's Query
Hello doctor,
I am sharing my echo reports that are five years old.
Hello,
Welcome back to icliniq.com.
I have reviewed the reports (attachment removed to protect the patient's identity). It is mentioned as RV borderline dilated, with RVDD being 4.3 cm. with normal RV function. There are no details about RV systolic pressure or PASP. Therefore, there is no pulmonary hypertension, according to the reports. However, sleep apnea must be diagnosed and treated.
Patient's Query
Hello doctor,
Due to the typical nature of 2D echo to underestimate or overestimate LVEF and RV function, should I be worried that my LVEF was 60 to 65% five years ago and now it is 55 to 60%, or is that arbitrary?
Hello,
Welcome back to icliniq.com.
I suggest you reduce your weight, if possible.
Patient's Query
Hello doctor,
Yes, I am actively working on it.
Hello,
Welcome back to icliniq.com.
Level above 55 is normal.
Patient's Query
Hello doctor,
Is it normal to have a 5 % drop or fluctuation?
Hello,
Welcome back to icliniq.com.
Normal LVEF is above 55 %, and it is given by the examiner view by adding all segment contractions of LV (17 segments). So it will be normal, please do not worry.
Patient's Query
Hello doctor,
Can I increase LVEF and decrease RV dilation through diet and exercise?
Hello,
Welcome back to icliniq.com.
What is the opinion of your doctor who has advised echo? There is no need to increase LVEF. However, it can increase in hypertensive patients if LV walls get thickened. Therefore, any reading above 55 with no LV wall motion abnormality and normal LV wall and cavity dimension is normal. Diet will not affect RV dimensions. However, exercise may indirectly help in losing weight or BMI. Do you have snoring issues, sleepless nights, or daytime sleeping while sitting?
Patient's Query
Hello doctor,
Yes, I have sleepless nights, snore loudly, and wake up with a dry nose or mouth. I also have a lot of palpitations. I am not tired every day, but I usually do take a nap during the day when I am not working.
Hello,
Welcome back to iclinq.com.
These signs suggest sleep apnea. You may need CPAP therapy, and the symptoms will improve. Probably this is the only reason for RV size. As you are going for a pulmonologist's opinion and sleep study, let us hope for good.
Patient's Query
Hello doctor,
I understand it as no other structural issues are defined in either study. I have learned to sleep on my side because I would wake up due to snoring if I slept on my side.
Hello,
Welcome back to icliniq.com.
I suggest you to continue your work towards weight loss, consult a nutritionist for a diet plan, and get CPAP if needed. They will help reverse and cure the condition.
Thank you.
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Cardiology
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