LVSD and Abnormal septal motion

[Liam-James]

Hi guys I’ve previously posted I’m currently in the early stages of being told I have heart failure so far since my echocardiogram in January I’ve been told I have LVSD EF 40-50% and abnormal septal motion. I’m taking Ivabradine and Ramipril and I’m currently awaiting a date for a cardiac MRI and a 5 day holter monitor which will hopefully tell me a lot more about what’s going on.

But what’s worrying me is my letter stated abnormal septal motion and I really don’t understand this or know what exactly it means. My cardiologist who I’ve spoken too hasn’t even mentioned this or told me what it means he hasn’t really seemed overly concerned about my situation. I’m trying my very best not to google things but just putting it in a search opens up such a can of worms to what the causes could be and that just scares me even more.

I’ve told my cardiologist for some time I have noticed a sort of bouncing and pulsating in my chest and just below my sternum at the top of my stomach. If I sit back relaxed in a chair or lay flat I can physically see and feel my belly pulsating and bouncing in rhythm with my heartbeat the more I concentrate or think about it the more I can feel and notice it. I’m trying my best not to pay attention but I’m worried it’s my heart pumping very abnormally and the longer this goes on the more damage it’s causing.

I just wondered hasanyone got any experience or advice on this, I contacted the local PALS for my hospital and they have said they’re going to speak to my cardiologist about the concerns I’m having and call me back but that might not be quick.

Thanks for reading.

[JulianM]

Hi Liam-James - I have been learning about heart and aortic conditions over the last 2.5 years since I volunteered for a study and an echocardiogram picked up several things, including a 'highly mobile interatrial septum' which is, I think, what you are asking about. But I'm not a doctor, and ultimately you need to talk to yours and work on the relationship, which is clearly going to be important for you.

When I was diagnosed, I sat down with the cardiologist who showed me on screen - the echo produced impressive videos - exactly what it was doing.

The septum is the relatively thin wall between the two atriums - the chambers that take the blood from the veins and feed it into the ventricles which do the serious work of pumping. If it gets stretched, it can bulge one way or the other or both.

Mine goes both ways, every time my heart beats. If the stretch is large enough, the term 'interatrial septal aneurysm' is used; mine probably just qualifies. It goes about 15mm each way.

This is a condition that only became detectable with very sophisticated imaging; an American doctor called Olivares-Reyes wrote one of the early studies of it and came up with a classification based on which way the bulge goes: mine is an OR type 5. I admire what he did because it's fairly rare and he must have looked at an awful lot of scans to write his research.

But does it matter?

Short answer is, in itself, this is almost certainly harmless. It would not explain any of the symptoms you're having.

If there is another condition, called a patent foramen ovale (PFO), alongside an ISA, then there is some evidence of an increased risk of stroke. This might be a reason to consider blood thinners if the risk is rated high enough. But with no PFO there's no added risk. I expect they will have checked for it carefully; certainly my echo operator did: ask your doctor.

There is some overlap between people who have ISAs and people who have problems with their mitral and/or aortic valves. This is another thing that will have been checked by echo: these are probably genetically driven and not a case of one causing the other. If your valves are OK, they won't get worse because of mobility in the septum.

Finally, there's some suggestion that a one-sided bulge can be a pointer to abnormal blood pressure on the pulmonary side, but that's a bonus which might help identify a problem.

Very finally - sorry this is so long - I want to say that I hate the term 'heart failure'. I think it is better to think of it as scarring or wear-and-tear damage which we all pick up through our lives. At 59, when I was first assessed, I had a level of 'heart failure' which was not zero, but wasn't stopping me doing sports, either. Clearly, it's a much bigger challenge for some of us and it's good that yours is being assessed, but it's always a matter of degree. A large number of people live very good lives with a significant level of it. Very best of luck!

[Vivi2711]

Hope that you had googled & found that the bouncing is due to when the volume of one ventricle increases, the volume of the other ventricle decreases and there are many causative factors from minor to major but everything can be setright & needn't worry. Ivabradine is prescribed in your case to lower the heart beat & it is capable of keeping the heart beat around 60 bpm. I am of the view that the cardiologist is gaining time to stabilse your heart so that thereafter there could be the right interventional treatment be started.

In case of abnormal symptoms kindly don't hesitate to call 911.

All the best & ALMIGHTY'S CHOICEST BLESSINGS BE SHOWERED UPON YOU