Echo normal. What next? : Further to my... - British Heart Fou...

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Echo normal. What next?

Steambunny profile image
42 Replies

Further to my earlier post (to which I had so much support - thank you) I had the echocardiogram today. The radiographer said there is no immediate evidence of anything structurally wrong (which is obviously good news) I am aware though that an echo doesn’t look at the arteries. He suggested when I see the cardiologist for follow up that I should ask (insist) on having a CT angiogram. Do you think this is what will be offered next?

42 Replies
Dessert profile image

Great news regarding your echogram ! I agree with the Radiographer . Insist on a CT or MRI . Be very careful about having the contrast if you are asthmatic . You could also contact your Cardiologist’s secretary and find out when your next appointment is.

Thatwasunexpected profile image

Hi Steambunny,

Had missed your previous post but glad to hear that the echo was normal - that's a really positive step!

In your last post you mentioned "p waves in the anterior leads". I assume you meant "inverted p waves" because it's normal to have "normal" ones in those leads, it's not normal to have inverted ones.

Keep in mind, not a doctor, but....

Inverted P waves are caused by the electrical conduction going the opposite way to normal in your atria. Normally, every heartbeat starts with an electrical signal at the top right of your heart, which travels progressively down and left. The P wave is that signal passing through the top chambers.

In some situations the impulse might start in a different place and then travel through the atria from "bottom to top" instead of top to bottom. That makes the P wave look upside-down (inverted) on an ECG.

That can also cause heart murmurs and symptoms because it slightly alters the flow of blood through your heart. But, with symptoms and a murmer found, it was absolutely right for the cardiologist to order an echo to rule out valve problems as a first step. Always get the potentially more serious stuff out the way first!

A cardiac MRI gives better detail than an echo about how exactly your heart muscle is moving so may well be on the "to do" list, or he might be happy with the information from the echo once it's been reviewed in detail. Either way, today was a useful step in ruling out some of the nastier "structural" causes of what you've experienced :)

Steambunny profile image
Steambunny in reply to Thatwasunexpected

Thanks for replying. The referral from the GP said “elevated P waves” and “inverted T waves” On my letter from the cardiologist it says “p waves in the anterior chest leads and repolarization changes in the inferior leads” 🤷🏽‍♀️ Does this make any sense?

I notice you’ve done a fair bit of running after your HA? This is amazing and reassuring that whatever the problem there’s hope that I can continue to run. Thank you 😊

Thatwasunexpected profile image
Thatwasunexpected in reply to Steambunny

Ok, elevated P waves can be a sign of atrial enlargement, especially the right atrium, but isn't diagnostic. A normal echo should have ruled that out.Inverted T waves can be anything from a "normal variant" (it's completely normal in children and some people retain them into adulthood) to "you're dying in the next 20 minutes" (but pretty sure we can rule that one out given you're still here 😁)

As for the running, yes it's perfectly possible to run with some (even most) heart problems. The days of a rocking chair & tartan blanket by the fireside are long gone!

The important part is to identify the issue, if any, and be aware of any limitations that might be prudent. For example, someone with regular arrhythmias wouldn't be wise doing the repeated max effort sprints I've been doing but could well be fine chugging through a 10k or even marathon at steady state - and would probably beat me in both!

Chappychap profile image

It's important to remember that as far as your cardiologist is concerned you probably look pretty low risk

One of the main techniques our doctors use, at least initially, is the QRisk tables. But reading your post it's clear that your risk scores are likely to be very modest.

The two risk factors that you've mentioned, the cardiac related death of one close family member, and slightly elevated cholesterol scores, are actually two of the least impactful risk factors there are. That comes as a shock to many people, in particular they think a family history of heart disease is a virtual death sentence, but that's absolutely not what the evidence shows. If you were an obese 70 year old man who smoked, had kidney problems, and high blood pressure; then the warning bells would be ringing loud and clear. But you're pretty much the opposite scenario.

Let's look at the numbers.

The average 55 year old woman has a 3.2% chance of a stroke or heart attack in the next ten years. Compare that with the 70 year old man I previously mentioned, who has a terrifying risk of nearly 50%!

By adding in a family history and a slightly elevated cholesterol level the woman's risk rises to about 4.9%. Yes, that's higher, but it's still very low in any absolute sense. And here's the key thing, now factor in the moderate blood pressure and BMI that would be typical for a marathon runner, and your risk factor comes right back down to 3.6%. In other words the positives due to your fitness have almost completely balanced out the risks of your family history and cholesterol.

Of course any risk still needs investigating, but I guess what I'm saying is please don't be unduly anxious as the diagnostic process unfolds. It often takes many weeks or even months to arrive at a conclusion, but in the meantime congratulate yourself on the amazing advantages you've given yourself from your exercise regime.

Good luck!

Milkfairy profile image
MilkfairyHeart Star in reply to Chappychap

Please don't forget non obstructive coronary artery disease. Microvascular and vasospastic angina which seem to effect women more than nen.

I have no ' conventional' risks factors, my coronary arteries are unblocked, however am at still at greater risk of a heart attack, stroke or other major cardiac events because my coronary arteries go into transient contrictions.

Patients living with NOCAD go under recognised.

In recent years the rate at which women under 60 years are dying from heart attacks has not reduced unlike for men.


Because everyone cannot see beyond the blockages.

Steambunny profile image
Steambunny in reply to Milkfairy

Yes I was reading about that in the Angela Maas book. How did that finally get diagnosed for you?

Milkfairy profile image
MilkfairyHeart Star in reply to Steambunny

I had a functional angiogram when they injected a chemical acetylcholine to see if it would induce coronary vasospasms.

It did! I had spontaneous and acetylcholine induced coronary vasospasms, ST elevations and depressions accompanied by chest pain.

Very few centres carried out this testing in 2014 when I had my angiogram.

However there is now more awareness about microvascular and vasospastic angina amongst Cardiologists.

There are various research trials taking place which offer functional assessment of the coronary blood vessels to diagnose microvascular dysfunction and/ or vasospastic angina.

Chappychap profile image
Chappychap in reply to Milkfairy

Hello Milkfairy. I don't mention Microvascular Angina because that's not my lived experience and I have no knowledge of the condition. Luckily the forum has you to share your knowledge in this area.

Following your post I did however go back to the QRisk III risk assessment questionnaire, a major tool that British GP's use to initially compute heart attack/stroke risk, sure enough there's no mention of a pre-existing diagnosis of Microvascular Angina.

Kidney Disease, Diabetes, Lupus, Arthritis, and Bipolar Disorder...all yes. Microvascular So I can understand your frustration.

Milkfairy profile image
MilkfairyHeart Star in reply to Chappychap

Thank you for your reply and taking the time to look at the scoring system used by GPs.

The current scoring systems used by GPs and Cardiologists have been shown to underestimate the risk of heart disease in women and those from different ethnic groups.

Many in particular women will have ongoing symptoms such as breathlessness or chest pain however end up being incorrectly told ' it's not your heart!'

I live with vasospastic angina rather than microvascular angina which is even more difficult to diagnose.

Thankfully in the over 10 years of living with the condition I have seen a gradual recognition of MVA and VSA amongst the staff.

I have a supportive Cardiologist and Nursing Team.

Nobody disputes my diagnosis anymore.

The strength of the forum is the depth and breadth of knowledge we can all bring to the forum to help support others.

I always appreciate your knowledge about obstructive coronary artery disease

honeybubs profile image
honeybubs in reply to Milkfairy

I agree

Steambunny profile image

Thank you Chappychap. In my most rational moments I can understand all of that - but then when the anxiety demons raise their ugly heads I think about all the opposites to that! My dad was only 35 when he had his first HA - and he was playing football at the time! He was apparently fit and well. Then one of the coaches in my running club (who had run competitively all of his life) dropped dead of a HA without warning at 60. And reading here of the number of fit people who are experiencing heart disease is scary. Add to that left arm discomfort and starting to struggle on the hills, an abnormal ECG and I think the worst. I am really trying not worry unduly and I appreciate your comments. Thank you 😊

IamAli_R profile image
IamAli_R in reply to Steambunny

Hello Steambunny,

Great news about the normal finding on the Echocardiogram.

I see you have had some excellent advice and information from the ever excellent duo ChappyChap and Thatwasunexpected which I am sure is reassuring.

I am by no means an expert but I have suffered from health anxiety and Cardiophobia for many years. I recommend a self-help book called The Happiness Trap. It's based on Acceptance and Commitment Therapy (ACT). This book was a game changer in my battle with anxiety. I would also recommend guided meditation. There are many excellent meditations apps available. I am currently using a app called Balance and it gives you free access for 12 months.

Steambunny profile image
Steambunny in reply to IamAli_R

Thanks IamAli_R

I’ll order that book now. I’ve been using Headspace which has been helping. I sat and did it in the car before my appointment today.

IamAli_R profile image
IamAli_R in reply to Steambunny

Headspace is a good app but I think it's a little overpriced. Try the Balance app if you get a chance. The most important thing with meditation is to be consistent and practice every day.

I'm sure you'll find the book extremely useful. Download and print the worksheets from the website when you get the book and go through it slowly. There are also excellent videos on YouTube explaining all the different concepts in the book.

Good luck and feel free to get in touch if you have any questions.

Steambunny profile image
Steambunny in reply to IamAli_R

Thank you so much 😊

Green1964 profile image
Green1964 in reply to IamAli_R

hi I would love to get over my cardiac anxiety I had a stent fitted over 15 months ago and started just getting over the last few months a stabbing pain in my left side of the chest around my nipple area and it takes my breath away for a few seconds so I went to see my cardiologist and he ordered a CT angiogram which came back normal the stent is fine and no other stenosis of the other arteries but I can’t get the worry out of my head and convinced my heart is going to stop my dad died of heart disease at 63 so I find I’m constantly checking my pulse my blood pressure and worry when I get a aching sensation in my lower jaw it as taken over my life and I can be sat resting and I suddenly get breathless which starts the panic off again I thort the reassurance from the cardiologist would stop me worrying but it as not im a 58 year old man so feel like i cant voice my worries with my family so im suffering in silence i just think if my heart is ok why am i suffering with symptoms so i understand the anixety and worry people feel and is overwhelming i know

Steambunny profile image
Steambunny in reply to Green1964

Hi Green1964

I feel for you. I think we are in a similar situation. On better days I can be more rational but as you say sometimes the anxiety and catastrophic thoughts take over. I really think that some of the suggestions I’ve had here in the last few days - counselling, apps, books might also be helpful for you? Certainly I know my body responses physically when the thoughts start!

Good luck to you finding a way to manage xx

Green1964 profile image
Green1964 in reply to Steambunny

thanks for your kind reply there is so many kind people on here that have there own worries and problems but still make time to come and share there advice you go to the doctors and all they want to do is put you on anti depressed medication I have always suffered with health anxiety even before my heart scare but this as made it much worse and I forgot the last time I have felt well anxiety causes so many other symptoms foggy head vision disturbances lightheaded feeling it’s endless I’m searching for the reassurance for someone to tell me hay it’s ok your fine but the cycle continues you feel great after the reassurance then bang the twinge or symptoms start and the alarm bells start ringing and you find yourself back to we’re you start I wish you good things and hope you get the answers your also looking for and this community is a fine lovely place to come and share everyone’s worries and concerns

IamAli_R profile image
IamAli_R in reply to Green1964

Hello Green1964,

I'm sorry to hear you are suffering from health anxiety and Cardiophobia.

I can understand how debilitating Cardiophobia can be, but I can reassure you that it is possible to manage it. When I first developed Cardiophobia I didn't exercise for 5 years, and I could not even manage a brisk walk. However, with time and effort, I managed to run 3 times a week for 2 years until my recent setback in October 2022. I am suffering from anxiety again and I have stopped exercising but it's not as bad as the first time around.

What helped me to manage my Cardiophobia was self-help books that helped me understand how anxiety takes hold over us. Once we understand how anxiety affects us mentally and physically then we can begin to challenge it and start moving out of our comfort zones we'll build up. If your doctors have given you the all-clear then you need to believe them and stop looking for reassurance from others. I spent a couple of years continuously looking for reassurance and it just made things worse.

The two following loins are two self-help books that helped me move and confront my anxiety.

The Happiness Trap

Dare: The New Way to End Anxiety and Stop Panic Attacks Fast

Green1964 profile image
Green1964 in reply to IamAli_R

hi Ali R I thank you for your kind reply and advice it means a lot to me and a little comfort knowing that I’m not the only one that as experienced this I use to play football and go to the gym every week and since the shock of the stent being done I’m to scared to even get into a fast walk I try to tell myself I have it u set control but I’m only kidding myself what makes it worse is when the ectopic heart beats kick in and intermittent breathlessness like someone as quickly cut off my oxygen supply that makes me gasp out I suspect it’s the clopidogrel as I took myself off them for a couple of days and the ectopic beats disappeared so a visit to the docs again I just want to feel normal without the feeling that im going to have a cardiac arrest and die I will have to try and find some effective reading books or CBT because this thing will end up killing me i hope you are feeling more in control of your health too it’s so hard to try and explain to doctors or people close around you that your feeling terrible when medically we shouldn’t be feeling this way curse this anxiety thanks again and stay well also kind regards Andrew

Thatwasunexpected profile image
Thatwasunexpected in reply to Steambunny

On the subject of "fit people suffering heart attacks" on here, keep in mind two things:

(1) this one's important: the fact they're here massively skews the statistics because just about everyone here has heart issues, or is involved with someone who does. It is NOT a random selection of the population!

More than that (this is supposition but logical supposition) a "fit person" who has a heart attack is probably more likely to come online looking for answers, and end up here, than someone who was the stereotypical "at risk" individual and knows exactly why it happened.

(2) a lot of the "fit people who've had heart attacks" on here weren't fit when they had the attack. Mine came after 25+ years of deliberately avoiding exercise, accidentally getting a very sedentary job, and eating whatever junk I could stuff down my neck in between jobs (I was 110kg when they weighed me in hospital). I'd also been smoking for well over 30 years, and had family history on mum's side to back all that up.

Any fitness I have now has come since the attack - admittedly helped by the time in the distant past when I was fit, so knew how much work would be involved if I wanted to regain it.

Several others you'll see being really active on here have similar stories to explain how things happened!

Steambunny profile image
Steambunny in reply to Thatwasunexpected

Good point, well made. 😊

Jack2019 profile image
Jack2019 in reply to Thatwasunexpected

A persons fitness level is not a reliable indicator of artery health, you can be thin and fit and still have coronary artery disease. Exercise is great for the heart muscle and an important lifestyle choice especially if your heart issues are something to do with the heart itself not the arteries. There are many many seemingly unhealthy unfit people who never have a heart attack, go figure, you can drive yourself crazy trying to reason why this happened to one person and not another. This is my layman opinion.

Thatwasunexpected profile image
Thatwasunexpected in reply to Jack2019

It's not an indicator as such (nothing short of an angiogram is) because there are so many other factors involved. But, other things being equal, fitness does mitigate strongly against heart problems.

Blackknight57 profile image

i didnt get my echocardiogram at 6 weeks!? Seeing cardiologist follow up on Monday.

Avdi profile image

My cardiologist explained to me that an Angiogram is the gold standard to determine what’s going on with your heart arteries. All tests showed my heart to be normal, the angiogram revealed the artery damage after which I had a double bypass.

Steambunny profile image
Steambunny in reply to Avdi

Hi Avdi

So were you having symptoms for which you sought help or did you have a HA?

Heartfairy profile image

Hello Steambunny. I’m glad you got the echo out of the way yesterday and am sure cardiology will be in touch with the next test appointment. I’m so glad you’ve had a reply from Mr Thatwasunexpected - he’s the guy I mentioned to you in my last reply who is really into his running and I knew you would be encouraged by his posts. Chappychap is also excellent in providing us with statistics and encouragement and that’s good that we have been told about a book that can help with the health anxiety (the happiness trap as I could also gain from getting help with that side of things). Do let us know what happens next and I really hope your outcome isn’t as bad as what you were very fearful off. I’m sure you will be back running and back in your happy place very soon. Thinking of you ❤️🧚🏼‍♀️

Steambunny profile image
Steambunny in reply to Heartfairy

Thank you Heartfairy. I’ve got the appoint to with the cardiologist on Tuesday.

Livelovelife56 profile image

Good to hear so far so good

RichardUK2 profile image

Great news on the echo. If you’re keen to dig deeper ( I would probably do the same being a worrier myself!) I’d go Cardiac MRI first rather than angiogram if you can.

The Cardiac MRI with dye does give a clear image of your heart and also looks at the bloody supply to your heart. It’s non invasive and relatively quick (30 minutes in and out) and low risk.

An angiogram is an invasive procedure (you’ll be in hospital for most of the day) and carries a little more risk (although still very low risk).

Naturally they both give insight into different areas and arguably if you’re having one perhaps you should have both.

However if your cardiologist doesn’t think you need more tests, the Cardiac MRI is a very low risk option to give you more peace of mind. A green light on both an echo and Cardiac MRI would be very comforting in my opinion.

Good luck 😊

RichardUK2 profile image
RichardUK2 in reply to RichardUK2

Also a random thought.. have you had a repeat ECG and did it show the same? Incorrect lead placement by the GP could also show inverted T waves.

Steambunny profile image
Steambunny in reply to RichardUK2

No, no repeat 🤷🏽‍♀️

Steambunny profile image
Steambunny in reply to RichardUK2

Thanks RichardUK2. I guess I’ll be guided by the cardiologist as to what next??? I’m still having symptoms so there must be something wrong??? 🤷🏽‍♀️

RichardUK2 profile image
RichardUK2 in reply to Steambunny

Absolutely. They are the experts! And definitely worth pursuing if you’re still having symptoms then.

chickeninthewood profile image

Would a stress test be a final decider after your echocadiogram proved your heart is structural normal? I was told that.

Steambunny profile image
Steambunny in reply to chickeninthewood

I don’t know? I think (and I didn’t take it all in properly initially) that the cardiologist said something about because I run and the symptoms are sporadic - often at rest, not necessarily with exertion that it might not show anything??? I will ask on Tuesday. Thank you 😊

firstlight40 profile image

It's excellent the echo has shown there is no functional issue with your heart pumping. They would have looked for valve issues and the pumping efficiency of your heart; all apparently normal from what you are saying.

The area I'm sure your cardiologist would look at in more detail is the ECG where you reported some inverted T waves. This feature on my ECG was something I had and the cause and the pain in your shoulder should be investigated to rule out any issues. I would ask your cardiologist what they are going to do to find the cause of the inverted T waves.

If the cardiologist is not looking to do a CT angiogram (and I suspect they will if the scan operator thinks you should get one) then I would suggest at the least you insist on a cardiac stress test which essentially is monitored exercise on a treadmill (ECG and blood pressure) where the exercise difficulty is increased every 3 minutes by raising the treadmill angle and speed. If they find any anomalies they stop immediately.

leach234 profile image

An echocardiogram just tells you whether your heart is structurally normal and if your valves are regurgitating. Have a PET stress test if your insurance pays for it. Otherwise have an echo stress test. Checks for artery blockage under stress.

nilmonisikdar40 profile image

However, just the opinion of radiographer is not enough. The cardiac radiologist or cardiologist will search further detail for example ejection factor. I think for people over 80 years CT angiogram can give a hazy picture because of calcium plaque. If you are under 80 years CT angiogram is okay.

Felly12 profile image

I think we have all been there with health anxiety. Especially when it is to do with one of your major organs. From my experience so far, the tests that seemed to find my congenital heart issue was the echo, which saw the faulty tricuspid valve, which has been put in the wrong place since birth. The mri which showed better details of the heart, and clarified the faulty valve. Also from mri they worked out blood flows and volumes. I did not have the contrast agent so I assume they saw what they wanted. But the best test which highlighted the cyanosis, due to faulty valve was the stress test on the bike. The stress test also showed that the heart was working fine electrically right up to 146 beats a minute. Only stopped because my legs hurt. Due to the gas exchange in the lungs. Lungs are fine this showed up on ct scan. Lung capacity is good it is just the faulty valve which does not get the volume out to the lungs. Of cause we all have different issues but what we have to try and keep in mind. They have found the problem and fortunately I will be on medication.

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