The patient is a 17-year-old male with 6'1" in height and 185 pounds weight. The primary doctor ordered an ECG and an echocardiogram because of a couple of episodes of near syncope recently. The episodes occur after sudden standing, and we were told it might be due to dehydration and orthostatic hypotension. There is no loss of consciousness and not under any medications. Blood pressure and pulse are listed below. The details of the echo cardiogram are below.
The ECG was normal.The echocardiogram reported the following:
1) Borderline asymmetric left ventricular hypertrophy (1.2 cm).
2) Borderline enlarged LVOT (LVOT 2.2 cm; LVOT velocity 1.97 m/sec).
3) Increased mitral valve E to A ratio, consistent with the patient’s age.
4) Trace-mild pulmonic valve regurgitation.
5) There is an abnormal mosaic pattern over the pulmonic valve areas during the color flow Doppler examination.
6) Normal left ventricular, right ventricular, left atrial and aortic root diameters.
7) The ECG is normal.
8) BP when sitting is typically 110/61, with a heart rate between 58 and 64.
9) BP, when lying down, is 87/43, with a heart rate between 42 and 45.
My questions are,
1) What does the echocardiogram mean? What is this likely to be? Is it of short term or long term concern?
2) What is the least aggressive treatment option?
3) What is the most aggressive treatment option?
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1) Hypertrophic cardiomyopathy (HCM) is a condition in which there is asymmetrical septal hypertrophy. LVOT (left ventricular outflow velocity) velocity is 1.97m/s, so there is no LVOT obstruction. For the long term, we need to do a follow-up echo to see for any increase in the thickness of septum. For a short time, you may need a few more tests for risk stratification like Holter test, tilt table test, and genetic testing for HCM (if available).
2) Treatment options for orthostatic hypotension are increased salt intake, avoiding prolonged standing, few drugs like Fludrocortisone. Aggressive treatment options will depend upon tests reports that are suggested in the first paragraph.
4) The mosaic pattern over the pulmonary valve needs to be correlated with the anatomy of the pulmonary valve and velocity across the pulmonary valve, which is not provided in details.
Thank you doctor,
I have some follow-up questions. Would it be fine to do the following for now?
1) Treat the near syncope with increased water and salt intake (both have been low in the past) and take more aggressive action if the near syncope continues even after increased fluid and salt intake?
2) It seems the report says that the HCM is borderline. Is that true? If so, would it be okay not to be aggressive right now, but to repeat the echocardiogram in six months to see if there are any changes?
3) Is the mosaic pattern related to the trace-mild pulmonic valve regurgitation? For more information regarding the mosaic pattern, I have copied the complete echocardiogram report. Kindly advice.
Welcome back to icliniq.com.
You start treatment for near syncope. But as the report shows changes like HCM, it needs to evaluated further as early as possible. The mosaic pattern across the pulmonary valve is likely to be related to mild PR.
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