What on an echo can indicate potential cardiac arrest

Assuming a ct scan shows no Coronary Artery Disease, what specifically on an echo would indicate potential cardiac arrest? I know Carey has mentioned cardiac arrest is ventricular and not atrial so I'm assuming the Left Ventricle would be a very specific area to watch closely. I'm sure Ejection Fraction is also very Important but other than that is there anything specifically that would be overly concerning to potential cardiac arrest?



Edited 1 time(s). Last edit at 03/07/2024 01:23AM by cornerbax.

Sure, anything that indicates heart failure. A low EF is the primary measure, but ventricular wall thickness, motion, and filling time are all important too. But heart failure only increases the risk of cardiac arrest. There isn't really a test that points specifically to cardiac arrest.

The things in this world that clearly point to a high risk of arrest are well known by cardiologists and if you've got one of them, they'll most likely want to implant an internal cardiac defibrillator (ICD). In the meantime, if they judge the risk to be high they'll have you wear what's known as a life vest. It's a vest-like garment that serves as an external defibrillator until an ICD can be implanted.

A key culprit is often the LAD (Left Anterior Descending) artery, but that one's a widow maker. Other arteries will show blockages, and if they're well and truly blocked per imaging, you can assume their cargo's destination has been starved of oxygen and of nutrients.

[my.clevelandclinic.org]

I don't believe arterial blockages can be seen on echo. You need an angiogram for that.

Carey is right you need an angiogram or CT Angiogram scan. I did the scan and fortunately all is great. All valves from the echo are either no or Trace Regurgitation the only issue is my Mitral Valve Prolapse and Severe Mitral Regurgitation. I ask this question about echo because I'm likely going to have to have surgery but BOTH my EP and the Thoracic Surgeon said Several times it is NOT URGENT. I had so many other questions I never asked them to pin point what they mean it isn't Urgent and what time frame they expect. They both asked me if I ever get tired or short of breath just sitting or laying down and the answer is no. I'm nearly 100% asymptomatic of 100% Afib and 50% Mitral Regurgitation. That was one of the key things they both wanted to know. I have another appt. in a few weeks with my EP so I will ask these questions
Specifically in regards to time frame. They mentioned my EF at 50% is low normal and only mentioned my Severely enlarged Left Atria and my Severe Mitral Regurgitation. From my echo my Left Ventricle is moderately enlarged and everything else is normal.

As Carey pointed out in another post, Severe Mitral Regurgitation trumps Pacs and Afib. I mean HALF the blood (50%+) is going backwards to nowhere. My entire body is being robbed of half its blood with each and every pump. I'm just honestly confused as to what not urgent meant and how long I could hold the surgery for the Mitral Repair off without causing any Significant issues? I am sure nothing can guarantee 100% but if I got a regular echo and nothing deteriorated Worse than why would I want to rush the Mitral Valve Repair Surgery?



Edited 1 time(s). Last edit at 03/07/2024 01:27AM by cornerbax.

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cornerbax
Assuming a ct scan shows no
Coronary Artery Disease, what
Specifically on an echo would
Indicate potential cardiac arrest?

I know Carey has mentioned cardiac
Arrest is ventricular and not atrial so I'm
Assuming the left ventricle would be
A very specific area to watch closely.
I'm sure Ejection Fraction is also very
Important but other than that is there
Anything specifically that would be overly
Concerning to potential cardiac arrest?

Dr Natale thought because of my afib areas were multiplying and I was unsuccessful in remaining in nsr, perhaps I had cardiac amyloidosis disease so I saw the HF specialist at cedar Sinai in Los Angeles and had this test which was equivocal-which is neither a yes nor no but she speculated I don’t have it nor HF.

NUCLEAR MEDICINE CARDIAC PYROPHOSPHATE SCAN CLINICAL INDICATION: AMYLOIDOSIS

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cornerbax
I am sure nothing can guarantee 100% but if I got a regular echo and nothing deteriorated Worse than why would I want to rush the mitral valve Repair surgery?

Yes, nothing is likely to change right after you get an echo but I got a sudden surprise with bilateral pulmonary edema developing suddenly.

They didn't mention that test to me but I'll ask my EP about it when I ask very specific questions regarding time frame and what they are looking
at from my echo to determine time frame of surgery. They just stated it isn't "Urgent" as of right now this minute. I think they were happy enough with my Ejection Fraction and Left Ventricle function. It's definitely confusing as I'd obviously Want the afib gone (and an ablation
would likely do nothing for me since my afib is deemed valvular) but since I'm mostly asymptomatic with Afib and the Severe Regurgitation I would
rather monitor with Echos and tests vs. doing the Mitral Valve Surgery immediately. I will know a lot more in a few weeks when I speak with my
EP. It's definitely an emotional roller coaster as Psychologically I want little to no regurgitation and no Afib and even though the Robotic Repair Surgery great results it's still open heart surgery. So if I can safely monitor my heart without Surgery that would be my option right now.



Edited 2 time(s). Last edit at 03/07/2024 01:30AM by cornerbax.

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cornerbax
And the severe regurgitation I would Rather monitor with Echos and tests Vs doing the mitral valve surgery
Immediately.

My question is "Why wait," unless it would be difficult for you to schedule surgery in the near future. What would be the advantage of waiting and monitoring it as we have both read and been told that Afib and severe Mitral Valve Regurgitation are interactive. I'd think that severe regurgitation would do no favors to your severely dilated left atrium.

Echocardiograms, themselves, do not show blockages, but they do reveal where the blockages are by measuring velocity at the stenosed points. This is the very nature of 'echo' and Doppler. It's why I was offered a Doppler ultrasound of my carotid arteries.

Quote
My question is "Why wait,"

Because I have a child (my only child) a 4 year old son that I want to be around for as long as I can. When I asked about all Risks associated with the Minimally Invasive Robotic Mitral Valve Repair Surgery I was told in my case I could keep my valve which was a relief which was great as there's little to no Life Expectancy reduced when your own Valve can be repaired vs. replaced. That was all great, but then the doctor told me it is still Open Heart Surgery, there is some risk and there is a 1 in 300 chance of Death from the Robotic Valve Repair.
Either by stroke from the surgery or cardiac arrest, (from all Mitral Valve Repairs) is about 1 in 300. This was from a top Surgeon at Cedars-Sinai, so my very next question was are those the numbers HERE AND WITH YOU? They said at Cedars, the number is about 1 in
1500.

Obviously those numbers are much better and I am no mathematician, but I know whether it's 1 in 300 or 1 in 1500, those definitely aren't bad numbers at well less than 1%. But those still aren't exactly Mega Millions odds if you know what I mean. I know enough to know that with my heart function the way it is right now and my overall health (no other issues at all thankfully) I am nowhere near a 1 in 300 or 1 in 1500 chance of death every day I wake up. If it were just me, I would already have the surgery scheduled as I don't want to be on medications all my life and I don't want to be in AFIB 100% of the time either. However, those mortality numbers (when I am almost completely Asymptomatic to the Regurgitation and AFib) aren't exactly encouraging. If I could go another 3, 5 or 10 years (and hopefully my EP will give me a much better idea on this in 3 weeks) before Surgery and where my Son were older, I'd feel much more comfortable. It really comes down to the risk vs. reward. The only reward right now is attempting to rid (no guarantee) the Afib,and correcting the Mitral Valve Prolapse/Regurgitation. But doing other research i've found many people who have severe regurgitation and are just monitored for years or indefinitely. This is what Is not clear and
what I MUST have understood before I just say let's schedule Surgery. For those people with Severe Regurgitation and who are just monitored, their Echos and overall health must warrant things that allow their Cardiologist/EP to say you're perfectly safe to be monitored indefinitely with routine Echosand tests. I MUST have this understood more clearly before I schedule Surgery.

What are your thoughts on all of this in my case?



Edited 3 time(s). Last edit at 03/07/2024 01:31AM by cornerbax.

I am in a somewhat similar situation. Asymptomatic on both fronts and faced with the “let’s continue to monitor” and the “risk/reward” dilemma. Something akin to being caught between a rock and a hard place. You seem to have done a lot more research and “asking.” While I have read an article or two suggesting it’s better to have the heart surgery before the heart is in a more “critical” state the decision is no less difficult. In my case the cardiac interventionalist recommends waiting. He also mentioned that some insurances may not pay for a non-symptomatic or less urgent diagnosis or surgical need. I am truly sympathetic to your predicament and wish you the best. Your family is lucky to have someone who cares so much about them.

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cornerbax
What are your thoughts on all of this in my case?

Number 1, I think you're overthinking it. Number 2, I think you're forgetting that as those 3, 5, 10 years progress your valve issues will cause more deterioration in other areas of your overall health. Number 3, I think you're ignoring the mortality risks you face on a daily basis just going about living your life.

Quote
cornerbax
then the doctor told me it is still Open Heart
Surgery,
there is some risk and there is a 1 in 300 chance of Death from the Robotic Valve Repair.
Either by stroke from the surgery or cardiac arrest, (from all Mitral Valve Repairs) is about
1 in 300. This was from a top Surgeon at Cedars-Sinai, so my very next question was are
those the numbers HERE AND WITH YOU? They said at Cedars, the number is about 1 in
1500.

I really appreciate your concern for your family—evaluating the risks with your medical team and family is an important aspect as you make decisions on how to deal with this. Given the greater risk of open heart procedures over transcatheter procedures, how about having another discussion with your surgeon on whether the anatomy of your mitral valve could be repaired with a MitraClip—certain types of prolapse are well-suited to the transcatheter procedure, and others not. If your situation is a good fit, it would be a less risky option and could be followed later by an ablation. I know that your surgeon said that it was recommended for the older population but, it is certainly a less risky procedure with virtually no recovery time so might fit your needs if it were approved. Interventional cardiologists generally do this procedure rather than surgeons.

@Mark,

thank you for your response, kind words and information. Do you have BOTH Severe Mitral Regurgitation and AFIB as well? If so, what is your EF and level of Regurgitation?

Quote
Number 1, I think you're overthinking it. Number 2, I think you're forgetting that as those 3, 5, 10 years progress your valve issues will cause more deterioration in other areas of your overall health. Number 3, I think you're ignoring the mortality risks you face on a daily basis just going about living your life.

Carey, I want to flat our state that I am not afraid of death. I never have been and understand every day can be the last.
I am well aware of this and try to treat people the way I want to be treated and to live life without being afraid of things.
The issue right now is that I have a far less chance of death doing nothing (today right now) then the mortality numbers
of Open Heart Surgery. If I were told this is critical, my EF is 10-20%, my Left Ventricle is severely enlarged, it would be
a completely different situation. I don't talk about this often but I had a VERY difficult Childhood where I did not have
either my mother or father present for much of it. Being that I have a wife and a 4 year old son,I want to be here as long
as I can for them. I have worked 6 day work weeks for more than 10 years, and in many cases 7 day work weeks.

I do this to provide the best quality of life I can give. I don't want my son ever worrying about a meal and I am the main
provider in our home. Again, I understand tomorrow is not guaranteed, but without having a better understanding on time
frame of my Mitral Valve, assuming I COULD go several years or longer without any significant damage being caused, I
would prefer to do that. At this point I have to wait a few weeks before my next appointment, but these are the questions
I will ask and pros and cons to this. Both my EP AND the Thoracic Surgeon said this isn't "URGENT" and I had my mind
all over the place with other questions I never asked them specifically what they are seeing to say this isn't "URGENT" and
what kind of time frame they are thinking. I will do this now on my next visits. As Mark said, it's kind of a rock and a hard
spot but if they tell me to monitor it for "x amount of time" and I'd be safe doing this, especially mostly asymptomatic, I'd
prefer to do that at this point.

@Daisy,

Thank you once again for your response and kind words, it's very much appreciated. It was actually my "EP" that didn't
think that many doctors would want to do a "MitraClip" at my age of 48 and in overall solid health besides the Afib and
Mitral Valve issues. It definitely can't hurt to get a 2nd opinion on that, and PROS/CONS at my age for the MitraClip vs.
and Ablation. I never asked the Surgeon about the MitraClip but I know that they don't do MitraClips which correlates with
what you said in that this is with an Interventional Cardiologist. I will check into this as well as time frame, and report back
when I know. Once again, thank you all for the responses, they are extremely helpful and I will be donating to this forum
later today.



Edited 2 time(s). Last edit at 03/07/2024 01:32AM by cornerbax.

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cornerbax
It definitely can't hurt to get a 2nd opinion on that, and PROS/CONS at my age for the MitraClip vs.
and Ablation. I never asked the Surgeon about the MitraClip but I know that they don't do MitraClips which correlates with
what you said in that this is with an Interventional Cardiologist. I will check into this as well as time frame, and report back
when I know.

Actually your surgeon should be able to tell you if your particular form of mitral valve prolapse could be fixed with a MitraClip, even though he himself doesn't place them. It was Dr. Trento (cardio-thoracic surgeon at Cedars Sinai) who recommended the MitraClip for me. EPs, in general, may not know so much about it. Probably one of the reasons that they haven't been placing many MitraClips in younger people is that it is fairly new (2003 in Europe and approved in the US in 2013), so they don't have long-term data. However, I was told that if for some reason it failed down the road, they would then simply go in and do the minimally invasive robotic procedure.

I would recommend a second opinion from an interventional cardiologist.

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Actually your surgeon should be able to tell you if your particular form of mitral valve prolapse could be fixed with a MitraClip, even though he himself doesn't place them. It was Dr. Trento (cardio-thoracic surgeon at Cedars Sinai) who recommended the MitraClip for me. EPs, in general, may not know so much about it. Probably one of the reasons that they haven't been placing many MitraClips in younger people is that it is fairly new (2003 in Europe and approved in the US in 2013), so they don't have long-term data. However, I was told that if for some reason it failed down the road, they would then simply go in and do the minimally invasive robotic procedure.

I know the MitraClip has been great for you (and hopefully continues to be great) so I will absolutely look into this
further. Instead of just being told "nobody is going to want to do that at your age" I should get more clarity.

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I would recommend a second opinion from an interventional cardiologist.

I will do this and "Daisy" has suggested this as well. It seems to make the most sense as if you remember the first
4 combined Doctors and EP's when I was in the hospital all suggested an ECV and if that doesn't work, an ablation.
I checked my first Echo from August of 2022, and my EF and all areas of my heart are nearly unchanged from my most
recent Echo in late September (overa a year later.) All Echos have an EF of between 50-52% and on the top it says
Moderate Mitral Valve Prolapse with moderate to severe Mitral Regurgitation, and on the bottom specifies "severe mitral
regurgitation." None of those doctors (I don't believe) were Interventional Cardiologists and my EP i'm sure is far more
knowledgeable in arrhythmias. I've met with him twice and the first time around he did not even say a word about my mitral
valve.

I will look into a highly rated interventional cardiologist and from that I should defiintely have more than enough
info to know what I need to do and when I need to do it. Thank you again.



Edited 2 time(s). Last edit at 10/26/2023 06:05PM by cornerbax.

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cornerbax
I will look into a highly rated interventional cardiologist and from that I should defiintely have more than enough
info to know what I need to do and when I need to do it. Thank you again.

I was referred to Dr. Mamoo Nakamura at Cedars Sinai for the MitraClip. He is a highly rated Interventional Cardiologist. [youtu.be]

I did not end up going to him as Cedars Sinai doesn’t make it easy for out-of-town patients and there was an excellent Interventional Cardiologist locally with a lot of experience placing MitraClips. Good luck with this.

Quote
cornerbax
@Mark,

thank you for your response, kind words and information. Do you have BOTH
Severe Mitral Regurgitation and AFIB as well? If so, what is your EF and level
of Regurgitation?


I am dealing with an aortic valve vs mitral valve. i am not eligible for a TAVR. I do have aFib as well. LVEF in the 62/67 range. This was improved from my last echo which was in the mid 50 range. Regurgitation currently described as moderate. This was better than “moderately/severe on my last echo. So results of my last echo are more encouraging than the previous one. Not that I want to rain on my parade, but I don’t know how reliable or accurate echos are from one testing to another. Don’t know what the measurement error is or how tech experience fits into subsequent administrations. Maybe someone can comment on this. As a sidelight, I was placed on Losartan several years ago. Apparently Losartan and similar medication are related to the concept of “remodeling” which purportedly allows the heart to do some “healing” by helping to reduce its workload. My cardiologist thought perhaps “remodeling” may have played a part on the improvement from my last echo. Don’t know if that applies to mitral valve regurgitation or not.



Edited 1 time(s). Last edit at 10/26/2023 11:20PM by Mark.

Thanks for the detailed post, Mark. Your EF seems actually "NORMAL" not LOW-NORMAL like mine in the low 50's.
You didn't mention your Left Atria size, left Ventricle, Right Ventricle or Right Atria. Are any of those enlarged, or
severely enlarged? I was actually surprised to read your severe regurgitation showed as "moderate" on the most
recent echo and I was going to ask what you did for that to be the case. It sounds like the Losartan is helping.

I actually was just prescribed Jardiance 3 weeks ago and haven't had any side effects that I know from it. It's FDA
approved and It was initially a diabetes drug but has been proven to increase ejection fraction and decrease heart failure.
My bloodwork came back good so they prescribed it. My blood work 10 days later came back great so I am remaining on it.
It is a very expensive medication and my Insurance company did some type of interview with my Doctor before they
approved it. Within 12-24 weeks I'm hoping my EF increases into the 60% range and my Echo looks better as well. Either
way, I am reaching out to an Interventional Cardiologist as suggested here to see what they say. I think after that
conversation, I should know very definitively a time frame and course of action.



Edited 2 time(s). Last edit at 10/27/2023 03:09PM by cornerbax.

All my other readings were “normal” except one cited as upper limits of the normal range. As I mentioned, I’m not sure what the measurement error is from one echo to another. The interventionalist I consulted does not put much stock in echos and prefers a TEE to make his recommendations which makes a lot of sense at that decision making level. But I understand that TEEs probably can’t be given on a regular basis—for a variety of reasons.



Edited 1 time(s). Last edit at 10/27/2023 10:45PM by Mark.

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Mark
All my other readings were “normal” except one cited as upper limits of the normal range. As I mentioned, I’m not sure what the measurement error is from one echo to another. The interventionalist I consulted does not put much stock in echos and prefers a TEE to make his recommendations which makes a lot of sense at that decision making level. But I understand that TEEs probably can’t be given on a regular basis—for a variety of reasons.

I have had 3 different cardiologists read the same TEE and each give slightly different determinations on the level of regurgitation, ejection fraction and extent of dilation of the left atrium—they “eyeball” them as they can’t make exact measurements. Same for transthoracic echoes. I was told that TEEs are better for visualizing valves and Transthoracic for evaluating the size of the left atrium—but other cardiologists may have different opinions on this. I believe that a difference of 5% in ejection fraction is within the margin of error. I had one cardiologist read my echo and say moderate to severe regurgitation and another read the same echo and say severe regurgitation, so it is not an exact science. TEEs cost more as a cardiologist and an echo tech work together to administer them, as well as an anesthesiologist. The anesthesia aspect also gives a slight risk factor.

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I was told that TEEs are better for visualizing valves

Do you think it's odd that Cedars did NOT request a TEE? I am in no rush to
have a tube down my throat, as you've said before that wasn't a pleasant experience,
lol.

They did show me my ECHO and they have 3D imaging, they used both 2D and 3D to
show all areas of my heart and my Mitral Valve and it appeared extremely clear. Do you think
they still should of requested a TEE? I'm thinking that's a question I should DEFINITELY ask,
but being they already suggested a non "urgent" surgery of my mitral valve, i'm guessing they
would say they saw the Mitral Valve clear enough to NOT request a TEE? What do you think?

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Cornerbax
Do you think
they still should of requested a TEE? I'm rthinkingr that's a question I should DEFINITELY ask,
but being they already suggested a non "urgent" surgery of my mitral valve, i'm guessing they
would say they saw the Mitral Valve clear enough to NOT request a TEE? What do you think?

You could ask them whether they think that a TEE would show them more, but it seems that some cardiologists want a TEE and others a Transthoracic so you would need to go with what they feel gives them the best view. A TEE is not unpleasant if they give you propofol—you don’t feel a thing. I had one where I was awake, and that was unpleasant, the one with propofol was fine.

Daisy thanks for your response. Cornerbax, i think that depending on their training and experience one cardiologist could be confident with one set of diagnostics while another could prefer a different set of diagnostics. And they both could be right. We are both treading water or in a sort of limbo. Asking if there are any additional diagnostics that would help clarify your diagnosis or help in your decision making would not be unreasonable. After that, as someone upthread said, overthinking and paralysis by analysis sets in. I think you’re doing your due diligence and while your decision will be a “difficult” one it will be the right one.

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Daisy thanks for your response. Cornerbax, i think that depending on their training and experience one cardiologist could be confident with one set of diagnostics while another could prefer a different set of diagnostics. And they both could be right. We are both treading water or in a sort of limbo. Asking if there are any additional diagnostics that would help clarify your diagnosis or help in your decision making would not be unreasonable. After that, as someone upthread said, overthinking and paralysis by analysis sets in. I think you’re doing your due diligence and while your decision will be a “difficult” one it will be the right one.

Same to you. I agree, I am going to check on a couple of other tests and get more precise details on time frame on everything. I will update this thread when I know. Thanks again for the response and all the great info.



Edited 1 time(s). Last edit at 03/07/2024 01:32AM by cornerbax.