This is my ECHO report. It was followed by a letter from cardiology to the GP saying that the findings are consistent with HFpEF and that treatment should start with diuretics. However, the GP (trainee) who rang to give me the results said that I was at high risk of heart failure and should go back if I get any symptoms like shortness of breath etc. So I don’t know if I actually have heart failure or not. This has all come as a massive shock and I’ve gone from feeling perfectly well to feeling as if I have a death sentence hanging over me. The reason I had the ECHO was that in the last few months I had a terrible cough - much the worst I’ve ever had in my life - and that led the GP to feel my ankles and pronounce them mildly swollen (though I’ve never detected that) and to order a BNP test. The reading came out at 195, which triggered the referral for an ECHO. I never saw the results of the last ECHO I had over three years ago, shortly after my AF diagnosis, but the cardiologist just said in passing that it was normal. Apart from the shock of the heart failure, what I don’t understand is that my AF has been well controlled by amiodarone since diagnosis so why on earth would I get heart failure? And why would I now have a dilated right atrium? The most I ever feel is like a glimmer of a palpitation starting but stopping very quickly, and my heart rate is low. I am so worried because if I have this after three years of well controlled AF, my future seems very bleak. Apologies for the long post but I know many of you are much more conversant with the workings of the heart than I am. Oh and another question is, am I right in thinking that with a dilated right atrium I couldn’t now have an ablation?
Can anyone help interpret my ECHO ple... - Atrial Fibrillati...
Can anyone help interpret my ECHO please?
Sorry but the photo is unreadable. The one number that would be interstimg is the ejection fraction which could tell us how bad your HF is.
BobD: The one number that would be interesting is the ejection fraction which could tell us how bad your HF is.
Visigoth's was diagnosed with Heart Failure with a PRESERVED ejection fraction ( HFpEF).
That means the ejection fraction can be normal and not suggestive of how bad the heart failure is, as opposed to Heart Failure with a reduced ejection fraction (HFrEF) which is what we usually think of when hear Heart Failure.
HFpFE can be just as serious in many cases, but treatments can be different.
Jim
An explanation from the publication "Heart Failure Matters". BobD is correct in saying the ejection fraction is indicative of the degree of heart failure, whether it be HFrEF or HFpEF.
Symptoms and signs of heart failure due to a reduced EF is termed HFrEF or heart failure with reduced EF. However, when a patient has similar symptoms and signs as in HFrEF, but they have a normal EF, the term HFpEF (heart failure with preserved ejection fraction) is used to describe the condition.
When the symptoms and signs of heart failure occur with a preserved EF, the term HFpEF or heart failure with preserved EF, is used. A normal EF is usually around 70%. An EF under 40% is considered reduced (HFrEF), and over 40% is considered a preserved EF (HFpEF). Many patients will have an EF between 40-49% which is considered mildly reduced. More recently, this mild reduction in EF has been termed HFmrEF or heart failure with a mid-range EF.
Thank you for posting this - it’s very helpful to have more understanding of HFpEF and what the numbers mean.
Mav:the ejection fraction is indicative of the degree of heart failure, whether it be HFrEF or HFpEF.
Respectfully I think you rest misread the source that you posted.
But in fairness, diagnosing the different kinds of heart failure are a bit clearer here:
www1.racgp.org.au/ajgp/2019...
Specifically this part:
Unlike impaired ejection fraction, which reliably defines heart failure with reduced ejection fraction (HFrEF), the diagnosis of HFpEF can be challenging as there is no single abnormal echocardiographic parameter that defines its presence
In other words, ejection fraction with HFpEF it's not diagnostic of the degree of heart failure because by definition the ejection fraction is normal.
Jim
Report out of focus, but heart failure is a common diagnosis, especially as we get older and certainly not a "death sentence" with today's treatments. In your case, your ejection fraction is normal (preserved), so treatments may differ some from what we usually think of as Heart Failure when the ejection fraction is reduced.
Jim
Could pulmonary hypertension secondary to Amiodarone be the underlying problem here? This might explain why the report indicates RA enlargement.
What you say sounds reasonable, but I don't know how likely that would be. A bit beyond my pay grade, but something, the OP might address with her doctor.
Jim
Thank you for replying. Pulmonary hypertension is something I hadn’t thought of - it definitely needs investigating. I’ve made an appointment with the GP and will ask to be referred to someone appropriate.
As Bob says the screenshot is blurred.
A tip to all, when adding a picture, use the button for adding pictures at the bottom of this text box, it’s the one after the smiley. This will add a clear picture that can be opened up instead of a blurred one that won’t open up.
I would just echo - HF is not a death sentence. I’ve always thought it was a very unfortunate phrase to use which quite understandably frightens many. What it means is your heart is ‘failing’ to pump oxygenated blood effectively to your body, could be caused by enlarged RA which could be caused by various.
I think it’s good your monitoring has been so effective but maybe your trainee GP could have been backed up with a more experienced, reassuring supervisor.
If you have questions then ask to see a more senior GP - preferably one with specialist knowledge of cardiac issues.
Take care.
My mum has heart failure and is 96!!!
That cheered me up! Thank you
I can read the report and it doesn’t sound that bad, ‘only’ dilated atrium, no ventricle problems, one slightly leaky valve but valves all look good otherwise. The conclusion is that you are at risk of heart failure and should be reassessed. I don’t see why you couldn’t have an ablation because we often have reports of an enlarged atrium shrinking after successful ablation. The thing that sometimes rules out ablation is hypertrophy where your ventricle walls thicken so luckily your medics have been forewarned. Best wishes ❤️🩹
Atrial enlargement is common in people with AF and is often an incidental finding in people with no diagnosed heart condition. Unfortunately it is more common with age. It’s good to have these things monitored to see whether or not they progress. I don’t think this would prevent you from having an ablation
Thank you - that’s encouraging and it helps to know that atrial enlargement can be quite common.
Consider asking your doctor if your recent symptoms and right atrial enlargement are related to Amiodarone.
You may want to post a clearer report on the BHF forum on HU
Thank you for your advice and I’ve now made an appointment with the GP to ask that question (or to be referred to someone who might know the answer!) I will see if I can post a clearer report on the BHF forum when I’ve worked out why this one is so unclear.
Hi
If on a severe Left Atrium dilation I cannot have a cardioversion, ablation or anti arrhymnic meds I think the answer is NO.
I got two reports on the last ECHO. 1 x report in laymans terms. The 2nd was pages of measurements, abnormalities and straight talking assessments.
The ECG is straight forward AF and gives BP and Heart Rate.
A 24-hr heart monitor would give an indication how your meds are operating for you.
I thought that your am.... was a risky drug and should be taken for a short term.
Sorry can't read your copy of ECHO. Mine wasn't set out like that.
Get a copy of the last via your clinic. Heart Failure is not specifically bad - it's just a term thrown around by medical.
cheri JOY. 75. (NZ)
Thank you for replying. I will see if I can get a copy of my last echo and I’ve also made an appointment to investigate any possible link to amiodarone.
I cant read the echo but would tell you that I was declared in minor heart failure almost a year ago and now controlled with drugs. I too take diuretic tablet once a day for fluid overload. My symptoms were cough, breathlessness and dizzyness and since diagnosis I have kept fairly well. Good luck!
I can imagine how you feel. HF with "preserved ejection fraction" is, I gather, hard to diagnose with accuracy, however. In the circumstances, if I were you, I would either ask for a further appointment or perhaps think about paying for a private consultation so you have time to talk things over more slowly and decide whether, say, a stress MRI might be a good next test.
Steve
Thank you for replying and for your advice. I’ve now made an appointment with the GP and will hope to get referred, but if that’s going to take too long I’ll have to consider going privately. And as you say that would have the benefit of being a much longer appointment to go through things.
Heart failure is determined by clinical signs. The echo confims it . When EF is preserved they call it diastolic dysfunction. Usually they give you furosemide to treat it. If your cough improves under diuretic then the diagnostic is confirmed. What you described was stage 1 or 2 of heart failure according to NY classification. So not too much to worry now. Small swollen ankles and may be some crackles in the lungs which might explain the coughing. You have a long long way to go. Personally i am inclined with furosemide treatment and we would go from there. Remember one thing echo is very dependent on the technician. Under inexperienced hands it gives erroneous results. Clinical signs in HF are paramount not the echo.
vs
I just had an echo yesterday myself. I don’t know when you had yours done but you need to sit with your doctor and have him go over it with you. Have you heard from him? To me no news is good news and right now unless he calls and tells me to come in, I do not have an appointment until September with him. I have heart failure. It is not a death sentence FYI, and believe it or not it can improve.
this is why you need to speak to the doctor and have him interpret it. He knows your whole history we don’t. I got a pacemaker a year ago February. It’s very unique first of its kind I had crazy things going on. To show you how bad it was, my GP recently said to me I never thought you would still be here. Not only am I here, but I don’t feel like I have a heart condition. You need to get out of your head of the diagnosis if you dwell on it constantly just as you said , suddenly you feel like you have a death sentence hanging over your head. I have a feeling many of us here have been there. My doctor now gets annoyed if I say something like that. He reminds me how many parts of the body there are in there , and yet everybody blames the heart
my heart failure was in the 40s before the pacemaker. I just had my first annual my ejection rate and in the room with me has gone from 40s to the 70s. There is so much right about my heart now it’s amazing. My doctor is thrilled and said people without a heart issue would be happy to have what I have going on, especially with numbers.
You just see a few things on your report, but there’s a lot more to fill in in between the lines that the doctors know and we do not it appears you’re still sitting at home so think of this if you were that bad do you think that’s where you would be?
I had an issue with my battery and my doctor had me in within hours. He had the engineer and my technician on the phoneand in the room with us to go over everything. This was something even my EP had not been aware of about my new p.m.. I have an app apparently I saw some thing I should not have seen lol and like you with your report, it can freak us out because it’s not the whole story
Here I am not only feeling better than I did before the pacemaker, but I might actually be feeling better than I was before. I knew I had a fib.
a fib is not a death sentence neither is heart failure. I don’t like that you see five years mentioned quite a bit. That’s not how long we get after they say you have heart failure. Once again there’s a lot in between.
Take a deep breath, reach out to your doctor. Sometimes they need to be shaken a little bit because they see so much of this. It can be very black-and-white to them sometimes. When they see how upset we get, it brings them back down to remembering, we are all human. certain types of doctors are not warm and fuzzy as a rule especially surgeons they can’t be and if you look at what they do for work, you can understand. There is so much into our stuff these days they are not doctors. they are IT specialists, etc. they concentrate on what they are doing to keep us alive, and to be prepared for anything
My doctor has softened up quite a bit with me. The last time I had bad news, he was standing there, holding my hand when I was waking up. He began by telling me don’t worry I’ve got you. You’re not going anywhere. I must’ve said something. I was sure I was dead and it was close but he had me and I’m still here.
I could cry when I think of how wonderful my medical staff is. I feel like I am swaddled in safety with them.
please be good to yourself and be kind to yourself. Listen to your doctor not everything on the Internet, please. Don’t wait for answers from us. If it’s that important we can be a sounding board we can share so you know you’re not alone, but when it comes to your personal medical, you need your doctor not us
Dawn, You are amazing. Should be an online counselor. I feel better, and it’s not even my post! God bless you👍
to all my friends here. I just write what I have been through myself because sharing might help someone else. I know how frightening all of this is right now. Things are going great for me. I have to say I don’t remember when I have felt this good, it’s been that long. I want all of you to know it’s a possibility to Phil the same way a year ago this past Christmas I did not think I would be here much longer and my GP recently mentioned the same thing. It wasn’t my imagination it just how bad I was. I want to help take some of the fear away. The one thing I probably mentioned previously is about getting out of your head about it. Think about when you have an upset stomach. If you lay there and all you think about is how lousy and upset your stomach is and how you feel you are going to be sick you probably will be sick and vomit. If all you think about is your a fib, then you are not gonna have much of a life. If every time you feel a twinge in your body, you react and get afraid then you probably will cause yourself to activate a fib because of the stress. Everyone a fib or not has their heart rate go up and down all day long so checking your oximeter as I had been doing is just gonna make you crazy. people that question going on trips ask your doctor unless he has a serious reason that you should not go then go. Someone mentioned a 12 hour flight. Why is that different from 12 hours in your house? 12 hours are 12 hours sitting in your seat, reading a magazine watching a movie, and the next thing you know you’ll be landing. No doubt wherever you’re going has a doctor and the majority of a fib does not really need a doctor when you have a blip of it as I call it. We know it will stop eventually sometimes I have it 10 minutes , sometimes three days if you have a pacemaker, you are going to be uncomfortable, but remember it’s not harming you if you had the ablation as well. Your pacemaker is running the show and your a fib is just an annoyance. I made up my mind that a fib or in my case, I have a typical flutter along with heart failure is not going to run my life. Yes I get tired so I take a nap. It’s not keeping me from doing what I want to do. If I feel that badly, then I call my doctor. pretty much my EP gave me a kick in the butt and I decided to kick myself as well lol to snap out of it. It is what it is and learn to live with it. We are no different than someone who has lost an arm or a leg remember, life goes on.
Thank you for taking the time to write such an encouraging reply and for giving me good advice. I have now made an appointment with a senior GP whom I trust, and will take it from there. You have helped me to feel much more positive that things can actually improve. Yours is a very uplifting story!
What a wonderful reply.
The problem with studies on the internet is that they will be often be, essentially, out of date and recent treatment for HF has improved dramatically; also, the population under study will be generally older and often have many other ailments. As well as that, HF is an umbrella term covering a wide range of heart issues.
Are
Pleaae reach out anytime you need support. We all have. our ups and downs with this thing I have had mine. this site got me through some of them just the kindness of people on here. When you find out you’re not alone it makes it easier because this is a lifelong situation we have.
My EP has had my back from day one. I will tell you a funny thing. I was very against getting a pacemaker. I was scared to death. I didn’t think I was that sick. Have you ever felt like you were outside your own body looking at yourself? That is how I felt, and I kept saying that can’t be me. Well, I had a cardioversion go terribly wrong as I mentioned my doctor and I set up a time I was going to sit with him to discuss what’s next which I already knew. He was thinking pacemaker and ablation.
I made a list and it was slightly argumentative. I want it straight facts. having worked law enforcement, I can be hard to deal with. I don’t want anything sugarcoated. Well, I sat down with my doctor he is very low-key In Humble FYI he began to speak, and he started giving me all the answers to my questions. The funny part was I had not asked them yet. Right then, and there I knew he was for me and I had no further doubt I was in the right hands doing the right thing. The word heart failure can be frightening. It was to me because it was unexpected. I thought a fib was just a few blips where I would feel lousy and then feel OK and it would be an off and on thing. Obviously, I learned that was not to be. It’s not a case of the hiccups for sure.
my EP got me in for my pace and ablate very fast. He said you have been through enough and you can’t take anymore. So February 13 last year it was done and two weeks later the ablation. Honestly, other than the fact that it felt odd in my chest it was not a bad thing. I even got my doctor laughing when he came in to check on me because I asked him if I had Internet on it. Yes, I was able to laugh, especially because I already felt better and I was barely awake from the surgery. I think I may have told you my pacemaker is unique. After we had a meeting that day, including the engineer, I felt even better. I have no doubt that my EP is someday going to be a name people will know. If he is not, it will be of his choosing, but I would love to see the method he used on me that he created just for me he named for him. This is so well done I even have a third lead in the event something happened. It is already in there ready to be used, if you get curious, try to look up HIS pace bundling. just out of the box when he used it on me and created something to save my life. Not only that, but as you know, he’s made me healthier than I was. He has told me there is nothing I can cannot do set others can do. Of course I won’t be joining cirque de Soleil anytime soon lol. that’s OK with me. I have fear of heights and they like to swing around up high lol
please let me know how you do what your doctor says and have the faith OK. I am going to be 72 just so you know, but in my head I feel 35 again lol I always said I was but when a fib hit I aged quickly, but now I’m back 😛😜 you make me feel good telling me that I was helpful to you because I know how you feel so does almost everybody on here. You have a great support group here don’t be shy. We have all asked questions. Just remember, don’t mess with your meds if it’s got anything to do with pain, etc., call your doctor not us
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