Posts Tagged ‘Echocardiogram’

Trouble coming!

September 1, 2010

I love the idea of EchoJournal; if you find something unusual on an echocardiogram you can upload the visuals, and then everyone else can “look over your shoulder”, so to speak. They can learn from you, and you can learn from them. If I were an Echo Tech I think I’d be checking this site out every few days!

For example, take a look at these two links. (HERE and HERE) They are both Echocardiograms of someone’s Left Atrium, and they have a serious problem: It’s huge! In fact the doctor who submitted it notes that this Left Atrium is 6.5 centimeters by 9 centimeters. For a male, the average size of a Left Atrium is about 40 millimeters in diameter.

Holy cow! I hope that person got the underlying problem fixed and that Atrium back down to a smaller size. Having an Atrium blow out is not like having a tire blow, you don’t just pull off the road and change it!

Just in case…

August 26, 2010

I was very pleased – to say the least! – about my exam at the Emory Adult Congenital Heart Center yesterday. An Echocardiogram showed that my Left Ventricle is 6 Millimeters smaller than the original Echo done there in 2002. It was 82 Millimeters across in 2002; it is now 76. And in my case, a shrinking heart is a 100% Official Certified GOOD THING!

If there is trouble in the future, if my PulseOx numbers were to start dropping and I was feeling worn out all the time, there are a few options that we could try to help get me back on an even keel. A couple of them are invasive but do not involve heart surgery… surgery can be a risky (and quite possibly fatal) proposition for me.

First things first, remember that 1) I am not a doctor; I’m just trying to explain it to you as it was explained to me. 2) This applies only to my heart and my health situation. Every heart defect is different, and what works for me may not be such a good thing for you… and vice versa.

The general plan for me would be to increase the blood oxygenation… but when you do that, the heart is naturally going to work harder. The trick is to find a happy balance between a decently high PulseOx and the amount of work that the heart can do. Right now my PulseOx is in the low 80% range and I have that happy balance.

The first option I would have (and all this is way in the future, if at all!) is based on my unusual anatomy. Like many reading, I have the Glenn Shunt. But mine was done in 1967, and is a completely different operation. Let’s review the difference:

The Bi-directional Glenn Shunt, the operation usually performed today: The Superior Vena Cava is cut where it joins the heart and is sewn into the Pulmonary Artery. They usually try to sew it as close to the T formed by the Pulmonary Artery to deliver an equal amount of blood to both lungs.

The Classic Glenn Shunt, performed on me in 1967: The Superior Vena Cava stays where it is. Instead of being cut, it is sewn closed. The right branch of the Pulmonary Artery is cut and sewn into the side of the Superior Vena Cava, which means that all of the blood from the Superior Vena Cava is sent into the right lung.

Now in my case, the Vena Cava wasn’t sewn completely closed. I don’t know if that was an error or if a small opening was left to relieve pressure that got too high, but a small amount of blood gets through the chokepoint and into the Right Atrium. If I were to start having problems they could use a Catheter to plug that small hole. That would cause my PulseOx to climb but shouldn’t increase the heart’s workload too much, and would probably be my best option.

The second thing they could do would be to create a fistula in my right arm. Basically, they would “short-circuit” the circulatory system by connecting an artery directly to a vein. My blood would head down my right arm as usual, but would “turn around” and head back toward the heart before it normally would. (Don’t worry,there are lots of of arterial branches and veins…. my arm wouldn’t rot and fall off!) That would increase the PulseOx numbers… but would also increase the heart’s work load. It is probably my second best option.

The third option would be a combination of medications that could reduce the natural resistance inside my body. Part of the heart’s work comes from how far the blood travels – if you could take all of the blood vessels out of an average human child and place them end to end, you’d have about 60,000 miles of blood vessels! Part of the heart’s work is because of resistance – your blood also has to turn corners and flow through organs (“Scuse me! Comin’ through!”). The medication would “grease” my blood vessels and make the blood flow through them easier. This would cause my PulseOx to rise… but not as much as any other option. My heart would also work harder. With more effort but not as many benefits, this is my third and least attractive option.

But getting a good report now gives me something better than all three of these possibilities: time. Nothing has to be done now, nor for the foreseeable future. And if I do reach the point where something needs to be done, delaying it now means that another option  could be developed that might be even better than the three ideas currently on the table.

All part of the master plan to keep pushing that final day back!

UPDATE: See Heather’s comment below for a good laugh! 🙂  Thanks, Heather!

Importance of Fetal Echocardiograms

April 5, 2010

There is a new report out concerning Fetal Echocardiography. Printed in two parts, it appears in the February 2010 and March 2010 issues of the newsletter Congenital Cardiology Today.

The first part of the report is mainly a synopsis of how a Fetal Echocardiogram should be done and who should do it. While a non-fetal echocardiographer will know how to obtain a four-chamber view of the fetal heart, the slightest hint of a problem should trigger a Fetal Echocardiogram. Detecting a heart problem, should one exist, depends on the time of the Fetal Echo (18-22 weeks is the best time) and the experience of the echocardiographer. And when a child has a heart problem diagnosed prenatally, their chance of survival increases 50%.

In the second part of the report (Fetal Echocardiography II: Congenital Heart Defects and Management; March 2010 issue of Congenital Cardiology Today, p. 3) the author contends “The prevalence of congenital heart malformations is higher than previously thought and is about 3-4 per 100 live births.” That’s quite the contention, and the author cites a 2008 study titled Prevalence of undiagnosed congenital cardiac defects in older children as proof. The authors of the 2008 study only used a pool of 143 children, which is pretty small. The smaller the study pool, the easier it is to obtain inaccurate results. Another study used a pool of 19,502 subjects and obtained results closer to the generally accepted ration: 8.8 children out of every 1000 are born with a Congenital Heart Defect. Both article abstracts are online; click the links and decide for yourself which study is more likely to be correct.

Despite my misgivings about the number of children born with a CHD, the report emphasizes the fact that when a standard sonogram raises doubts about the heart of the fetus, a Fetal Echocardiogram is highly recommended.

Another look at Pulse Oximetery

December 2, 2009

There is a growing movement in the Congenital Heart Defect (CHD) family pushing for the inclusion of testing newborns with a Pulse Oximeter before being released from the hospital. Such a test would provide a fast, inexpensive way to determine if a CHD is present; if the situation warrants, further tests can be conducted.

Back in July I wrote a blog post about an article that appeared in the medical journals Circulation and Pediatrics that stated that Pulse Oximetery should not be supported as a routine test for newborns.

Many readers have misinterpreted that post, the Circulation/Pediatrics articles do not say that the PulseOx test should be discarded, but that more research is needed. (Very few readers click the links in each post, I do not know why. That’s where a lot of extra information about the subject can be found. And sometimes I just might surprise you!)

Seriously, let’s visit the subject of the PulseOx again for a few moments. It’s a pretty good idea – a quick reading of the child’s blood oxygenation level can be determined by a Pulse Oximeter (sometimes called a PulseOx). The test is quick (ten seconds at the most), painless, and inexpensive. Any blood oxygenation level reading below 90%  usually triggers a follow-up test: usually an Echocardiogram or an ECG.

While the medical journal article cites its own reason why there needs to be more research into the use of PulseOx, I can see one major flaw they did not mention: A PulseOx test can only detect a Cyanotic Heart Defect. And only about 25% of all heart defects cause Cyanosis.

So what we need, in my opinion, is overlapping tests: PulseOx combined with an Echocardiogram AND an ECG. And perhaps add a Fetal Echocardiogram for mothers who are in high risk groups.

But when you do all that, the CHD test for newborns is no longer fast, and certainly not inexpensive.

And the bad news is that even with overlapping tests, a few CHDs will still slip through. On May 4 of this year I blogged about Nick Heine, the police officer who died of an undiagnosed Congenital Heart Defect while answering a call. Nick had a problem in his heart’s electrical conduction system, and certainly he had undergone a complete physical exam before becoming a police officer. He probably had to have physicals all during his career, but that heart defect never showed itself until the instant it killed him.

So this is where research comes in. Keep looking at the results of the PulseOx; the more we know, the better we can make the test. Research will also make other medical procedures – of all types – better, faster, and less expensive. So perhaps one day there will be one single test, cheap, fast, and reliable, to determine if a child has a Heart Defect.

And until then, we work with what we have – PulseOx.


October 19, 2009

Trouble! Oh we got trouble! Right here in River City! – The Music Man

I don’t know if this was filmed in River City, but someone certainly does have Trouble (with a capital T!). Here’s a scan from EchoJournal, the online database of unusual ultrasound findings: This is a “apical TTE” – a TTE is a TransThoracic Echocardiogram, a test in which a small ultrasound scanner is pressed against your chest. “Apical” means the scanner head is located near the apex of the heart – the “point” located right at the bottom.

Right Ventricle pressures are usually relatively low. After all, the Right Ventricle sends blood to the lungs and back, so there is no need for a high pressure flow. But as this TTE shows, the pressure in this Right Ventricle is pretty high. The pressure is so high that the Ventricular Septum (the wall between the two lower chambers of the heart) actually bends into the Left Ventricle with each beat.

The readout screen also shows that the heart is beating 221 Beats Per Minute, so that Septum is bending a lot.

Trouble with a capital T, that rhymes with P, and that stands for pressure!

A Left Ventricle in Trouble

September 11, 2009

In the past, one of the only ways to study a medical oddity was by examination. Patients with unusual medical presentations would be examined by multiple doctors during a routine examination (which is still a common occurrence, as most Congenital Heart Defect (CHD) patients know) and then by autopsy after they died. Most likely the affected organ – and sometimes the entire body – would be preserved and wind up in a medical museum, where future doctors could examine and study the effects of that illness.

Hands on experience is still valuable, but thankfully there aren’t that many huge collections of body parts as there once were. Medical Journals are online (PubMed is probably the best; since it is administered by the National Institutes of Health, all of its information is available to the public) and there are also resources like EchoJournal.

EchoJournal is an online collection of Echocardiogram recordings. EchoJournal presents both a mixture of normal heart functions for training, and a good selection of abnormal occurances, for someone who may not be familiar with what a particular problem actually looks like on an Echocardiogram screen. For example, here is an Echo of a healthy Left Ventricle – everything loooks fine here! (That’s what the submitter, drdavemd, believes; I don’t know what I am looking at!)

But on the other hand, this heart is in real trouble – the Left Ventricle is barely functional.

Note: There are two different types of Echocardiogram. Most people are familiar with a Trans-Thoracic Echocardiogram (TTE), which require the probe to be pressed against a person’s body. It is rarely referred to as a TTE, but usually as the generic “Echo”. The Trans-Esophageal Echocardiogram (TEE) involves placing the probe on a thin tube and passing it through the esophagus.

Told ya so!

April 21, 2009

Do you remember this post? To refresh your memory, at some future date a doctor tells his patient that his heart is wearing out and it was time to take corrective action. Technology has made transplants a thing of the past – the plan for the young man’s treatment include gene matching, heart muscle regeneration, and even an artificial heart!

Near the beginning of that post I mentioned that the doctor used his handheld echocardiogram on our patient. Sounds a bit far fetched, doesn’t it? I bet you didn’t believe me!

For you doubters… here it is!