Submitted by Dr T on February 14, 2011 – 4:04pm
History: August 2004 (age 53) diagnosed with moderate to severe MR but no MVP (echo and stress echo test). Started lisinopril, walking and lost 30 pounds. Had a cardiac MRI in May 2006. Dx changed to mild MR. Continue to see a cardio every 6 months with yearly echos all showing mild MR until Aug 2010 when echo showed “mild MVT with mild to moderate MR and small pericardial effusion”. “Compared to 7/09 echo MR was slightly worse and the pericardial effusion was new.” Cardio told me to return for echo in 6 months.
Current: Had sinus surgery 12/28 and next day at noon passed out and fell and spent 8 hours in ER getting IV fluids and potassium pills due to being dehydrated. Saw my PCP the next week and he sent me for an echo at the cardio office he is affiliated with. PCP called me and said I should follow-up with my cardio because this echo showed differences from 7/09 echo: Mild to Moderate MR but also showed some differences i.e. it showed MVP and mild diastolic dysfunction present.
Brought the echo on CD to my cardio and after he scolded me for having an echo at another facility (he can’t trust if the echo technician did the echo correctly) he told me I do not have MVP and there is no DD because there are 4 criteria needed for DD and I only have one which is minor. He actually said the tech did a good job but couldn’t say that about cardio who read the echo. He did say he would schedule me for a cardiac MRI since my last one was 5 years ago.
Who do I believe at this point? I asked my PCP for a referral to another cardio (I have an HMO) and he said that wouldn’t help because that would give me a possible 3rd opinion. Will MRI be more definitive?
While it is true that differences between one well-trained technician and another will be present, in general these are very minor. I just don’t buy the argument that this last result cannot be trusted because it was performed somewhere else. It that were true, I would not have been able to practice, most if not all tests on my patients were performed in another office/hospital. I would also say that the results you mention are not that different from each other, especially if not associated with any symptoms, such as shortness of breath or decreased exercise tolerance. The best way to settle this argument is to repeat the test. I don’t think an MRI will make much difference. Personally I’d prefer a stress ECHO.
You can read more here:
Depending on how confident you are with your present Cardiologist, you should make a decision to stay with him or not.
Hope this helps,