Questions about reports

[Mindyt]

Hello Dr. Fett,
I hope you are well. I finally (it only took me 18 months!) requested copies of my medical record. I am hoping that you can clarify a few things for me.

My initial echo showed normal heart size. Then listed is MMOde/2d EF which is 55% then EF estimated is 35%. What is the difference between these two measurements? Why would one be essentially normal and the other be 20 percentage points lower?

An angiogram (heart cath) one week later shows normal heart pressures and normal cardiac output with normal to low left heart filling pressures. When they say "normal cardiac output" what does that mean? I would have guessed that would be the same as EF because isn't EF a measure of cardiac output? At that same angiogram my EF was estimated at 40-45% with only mild global hypokinesis. That can't be "normal", can it?

My latest echo shows EF around 50% with everything else being normal so I am doing really well. I just wish I had more answers regarding DCM vs. PPCM. I struggle a lot with the decision about one more pregnancy.

Thank-you so much for your advice.
Mindy Thompson

[JAMESFETT]

M-mode echo determines left ventricular end-diastolic dimension and end-systolic dimension, from which fractional shortening can be calculated, and then extrapolated to an ejection fraction. The difference between 55 % and 35 % is larger than I expect to see, and from all data given it sounds like your EF is in the 50 to 55 range, so that is very good. "Mild global hypokinesia" indicates that the movement is not quite normal, so you are right, that means it is not quite normal. But nevertheless very good. Cardiac output comes from a different formula and deals with the volume pumped in millileters, so that is differenct from ejection fraction and fractional shortening. In any case, you are doing very well, and maybe a bit more time will with subsequent results will help you make a good decision about pregnancy.

James

[Mindyt]

When you say "from all data given it sounds like your EF is in the 50-55% range" do you mean from that first echo with the MMode2d EF of 35% and estimated EF 55%? This was my very first echo and the basis for my diagnosis. I was told at diagnosis that my EF was 30-35% after the echo that gave those above numbers. I guess I am confused as how they came to a conclusion that my EF was 30-35% with those numbers on the report. Also, the comment "mild global hypokinesis" was given one week after my diagnosis during the heart cath. If that is "not normal, but still quite good", does it still fit the criteria for cardiomyopathy? My EF at the heart cath was 40-45%, again one week after I was told I had cardiomyopathy.

I think my frustration comes from feeling that my life has forever changed, dreams of more children crushed all because of a few percentage points on a test. In my case, my EF was somewhat decreased at diagnosis but other than that, my heart is normal in size, etc. I had mild symptoms of fatigue and shortness of breath on exertion but never had any CHF symptoms-no fluid overload, pressures all normal, very well compensated. I maybe am still in denial that I really have a problem.

Thanks again for your advice and kindness. You will never know how much it means to all of these women on this board to have someone so knowledgeable to turn to in their time of need. Thank-you.
Mindy Thompson

[JAMESFETT]

Thanks, Mindy for the clarification. In fact, I thought that the "mild global hypokinesia" referred to your latest exam. So what I now understand from your description is this:

1)your initial data fit very well with a cardiomyopathy, you don't need to doubt that diagnosis at all. You do fit the criteria necessary for a diagnosis of PPCM.

2)your most recent studies verify that you are doing very well. Are you completely healed? I am not sure, but it certainly seems you are well along that road. Is your "shortness of breath on exertion" a manifestation or some residual heart function abnormality? Or is it just a matter of conditioning? Many people with normal hearts will have shortness of breath on exertion, depending upon the amount of conditioning

With time you will realize that healing has come, that you can face a normal life expectancy. Could you safely have another pregnancy? It's not yet possible to answer that question with certainty, but I can tell you that I have observed many PPCM mothers with less favorable function who have experienced one uneventful subsequent pregnancy. Maybe in 6 months you will have a more clear idea as you see results from another echo?

James