I am 75, with 2 years of paroxysmal AF, and looking again at my first Echocardiogram I had in May 2022, I notice there was a finding of an "interatrial septal aneurysm". This finding was mentioned almost in passing, without further emphasis or mention in the Report's Conclusions.
However, while such a condition seems to be associated with arrythmias and increased stroke risk, it has never been discussed with me by a Cardiologist (seen by an Arrhythmia Nurse) re stroke risk, nor my GP, nor anyone in Haematology concerning my choice about anticoagulation or not.
I am currently not anticoagulated, by choice, because of previous unexplained chronic bilateral subdural haematomas.
I am concerned as to whether this medical condition is one that would require further investigations or at least ongoing monitoring?
So is there anyone out there who has personal experience or knowledge of this condition, and is able to share what understanding they have gleaned regarding its potential to cause future harm?
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ozziebob
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I have one of these, and because I'm one of those people who needs to know everything about any condition I'm diagnosed with, I've looked at everything I can find.
ISAs take a range of different forms, which were classified by a doctor called Olivares-Reyes, so your report may have an 'OR' number attached to it. And possibly a size in millimetres.
Mine is OR 5, which means that my inter-atrial septum is 'highly mobile' - it swings both ways with every beat of my heart. I have seen it doing this on an echocardiogram and it's a bit weird but is rated as completely insignificant in terms of health risk. (Normally, the septum is like a stretched sheet of tissue between the chambers, which stays still.)
When I was diagnosed, the echocardiographer spent some time carefully looking for any evidence of a PFO - Patent Foramen Ovale - which is an incompletely closed valve in the interatrial septum that can be left over from your embryonic circulation.
If you have both a PFO and an ISA, especially if your ISA is more one-sided than mine is, then there is some evidence for an increased risk of stroke, which might be a reason to prescribe blood thinners. One sided ISAs might create a region in your atrium where the blood is slower-moving than it should be and therefore at slightly more risk of clotting. However, in the absence of a PFO, this risk is not considered significant.
ISAs are one of those odd features of the body which only become visible with advanced scanning techniques; we'll possibly find out more about them as genomic medicine advances and they get linked to other issues. ISAs are sometimes seen alongside congenital heart valve problems, for example. I strongly suspect that mine is part of a connective tissue disorder: I also have an ascending aortic aneurysm and some arterial tortuosity, plus a couple of minor skeletal signs ... of all of these, only the aorta has any clinical meaning, so far as I and my doctors are aware. But they could also be one of those things that develop a bit with age. In the absence of evidence they're a real danger, we may never really find out ...
Apologies for such length - I know I do go on too much! - hope it's helpful.
Julian,Thank you very much for your considered and detailed reply. The more detail the better for me.
You sound much younger than me, but your Bio doesn't give your age?
But I am quickly humbled by the range of medical/heart issues you are dealing with. Respect.
Recent research into ASAs (ISA?) seems thin on the ground, so personal experience is all.
As for my Echocardiogram Report, I can see no measurements or OR numbers. It just seems to be an incidental finding not requiring further comment. But the massive ASAs I've seen in images on Google certainly aren't reassuring, but are probably totally irrelevant to my case. I just wish I had more insight, if this is possible.
A couple of things on the Echocardiogram Report however did catch my attention, and if you have any comments, they are welcome.
The first is "Study quality: This was a technically difficult study with suboptimal parasternal views. Fair remaining views". I wonder if this fact potentially interfered with better consideration of the ASA?
The second is "Left Ventricle: The left ventricular cavity size is normal. Sigmoid shaped septum with maximum wall thickness of 1.4 cm. The remaining wall thickness is normal. The LV systolic function by ejection fraction is normal (EF 60-65 % by visual estimate). No RWMAs seen. Doppler parameters indicate normal diastolic function." The only mention of my septum really? You may know more about my septum from this description?
But it is still a bit worrying for an amateur like me, as I said in my Post.
Yesterday I sent an eConsult to my Surgery informing my GP that I wanted a re-referral to Cardiology about the ASA. Today I got a text saying my GP would review my request in 12 days. Obviously she's on holidays until then. It is what it is and I don't need to agitate my self by demanding better. After all, this condition may well be congenital, and I have survived 75 years so far.
Hi Bob - that other reference to a septum would, logically, refer to the wall between the two ventricles. It's called the interventricular septum and has nothing to do with the wall between the two atria, the interatrial septum, which is what is reported as being stretched.
I have had repeated transthoracic echos, it's relatively simple and cheap to do. You don't say exactly when the first one was done: the technology has improved in recent years, though it was impressive when I was diagnosed 4 years ago at age 59 (so that hopefully answers your other question).
Definitely not an urgent issue, but knowing the size and shape might lead to a better discussion of any case for prescribing blood thinners. And getting another look at whether or not you have a PFO might be sensible, though hardly urgent.
But in your situation, having had an unexplained internal bleed, I'd be just as wary of blood thinners as you are. One thing I've learned in the last 4 years is that this area of medicine can be extremely compartmentalised, but the vascular system ... not so much.
Thanks again for the clarification and the reassurance re the urgency (or not) of my follow up. I forgot to quote the Report where the ASA was mentioned, as I intended. Here goes ...
"ASD/VSD: No evidence of interatrial communication by color flow doppler analysis. Interatrial septal aneurysm." That's it. Nothing to see here. Move on.
And your words about anticoagulation were welcome as well. If you read one of my Replies in my AF Post (I gave you the link), you will see the description of my bleed by the Neurologist, and my shock at the "collections" of blood "pooled" across my brain. Also included is my "fear" of "going to the toilet" ever again !!!!!
I will keep your "PFO" information in mind when I next talk to someone medical.
My Echocardiogram was on May 10th 2022, by a friendly Italian Cardiac Sonographer, so hopefully the device used at Barts was adequate to the task.
I've had an MRI at Barts; it's one of the leading centres in London, so as good as it gets, worldwide. And the reference to 'lack of communication' would mean they looked for a PFO and didn't find it. I'd take that as strong reassurance on stroke risk.
Yes, it is. Though it's not exactly a hole, more like a functioning basic valve (a flap that allows blood flow in one direction). In an embryo/unborn child, it enables blood flow to bypass the lungs, because the lungs don't oxygenate the blood until birth.
I liked what you wrote. My condition was discussed at an mdt meeting with norwich and Barts and iam glad to hear that they are one of the leading centres. Thay have said that it is best for me to stay on medication. So what you have written gives me some confidence.
Just an addenda. I made the same Post on the AF Forum and thought you might like to see those Replies. Here's a link ... healthunlocked.com/afassoci...
I have a PFO and ASA amongst other probs. Cardiologist doesn't bother about the PFO. Said 25% of population have a PFO and it is often only found in an autopsy. He didn't mention the ASA (mine referred to as atrial septal aneurysm). I don't have any arrhythmias though. (I forget whether mine shunts from left to right or vice versa.)
Thank you for your helpful information. I'm thinking the ASA finding on my Echocardiogram Report might not be as alarming as I first feared. The lack of "follow up" may be current medical practice, but some indication of the size of this aneurysm, or OR number, would surely be more reassuring that it has been examined in more detail.
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