Has anyone seen Dilated Left Atrium on their Echos?

[Birdlady]

I had an echo done recently and my doctor said everything was good. But I looked at the report and it said I have moderately dilated LA. I don't remember seeing that before. My last echo was about 9 years ago. I was curious if anyone else here has ever seen this with POTS. 

Thanks!

[MikeO]

I have had Transient ischemic dilatation of the left ventricle but that ia a different animal. I would think that your Dr is saying that the echo looks good based on other parts of the test being normal. I know high blood pressure, age, and weight can affect the left atrium size. As to POTS or a component of POTS being the cause I do not know.

[Birdlady]

Thanks for responding! Maybe POTS has nothing to do with it. Everything else was normal. Only trace regurg on tricuspid valve which isn't a problem. I did a bit more digging and the dimensions of my Left Atrial are normal, but the Left Atrium Volume Index (LAVi) was high at 48 ml/m2. Apparently this is something they calculate now and it isn't listed on any of the echos I've had in the past. Perhaps it's always been high but I didn't know.

I'm 37. My BP is low or normal most of the time. I've been med free the past year or so. My EP is completely against using meds in POTS. I know that's out of the ordinary, so I have high heart rates all the time now.  I have osteoporosis, pre-diabetes and am a normal weight, but I am not fit by any means. lol LAVI has poor prognosis if you have a cardiovascular event, so I guess I have to keep myself as healthy as possible to not have one of those. Afib runs in my family, so that is another thing to keep an eye out for too.

[MTRJ75]

I had an echo once that said I had pulmonary hypertension and an enlarged heart. Went through a series of tests, including catherization and cardiac MRI, very invasive and uncomfortable to finally realize it was probably nothing to worry about. Pretty scary potential diagnosis though. Ever since, my cardiologist says that echos don't come out very clearly for me for some reason. We do a cardiac MRI once every 5 years and she's otherwise unconcerned. 

[MikeO]

2 hours ago, Birdlady said:

Thanks for responding! Maybe POTS has nothing to do with it. Everything else was normal. Only trace regurg on tricuspid valve which isn't a problem. I did a bit more digging and the dimensions of my Left Atrial are normal, but the Left Atrium Volume Index (LAVi) was high at 48 ml/m2. Apparently this is something they calculate now and it isn't listed on any of the echos I've had in the past. Perhaps it's always been high but I didn't know.

I'm 37. My BP is low or normal most of the time. I've been med free the past year or so. My EP is completely against using meds in POTS. I know that's out of the ordinary, so I have high heart rates all the time now.  I have osteoporosis, pre-diabetes and am a normal weight, but I am not fit by any means. lol LAVI has poor prognosis if you have a cardiovascular event, so I guess I have to keep myself as healthy as possible to not have one of those. Afib runs in my family, so that is another thing to keep an eye out for too.

I did look up my past echo's not sure what the LAVi means. I did see references that looked close but can't figure out what the results are. i did recently have a stress test the notable items were  Left ventricular ejection fraction (LVEF) post stress attenuation corrected is 62% and is visually normal without regional wall motion abnormalities.  The post-stress left ventricular end systolic volume (ESV) is 29 mL. Did you have a good LVEF number? If your Doc is ok with it i would get exercising it will help with heart issues and only help in the long run.  

[Birdlady]

LAVi is short for Left Atrium Volume Index. I've never had a stress test or anything like that, so not sure what happens when my body is under stress or strain. My ejection fraction is 55%.  I guess I won't worry about it unless some new symptoms come on.

[MikeO]

@BirdladyI am sure with a ejection fraction of 55% you are ok. Get your mojo on you can improve it

[Birdlady]

I'm 20 years into POTS, so there is no mojo left. 😂 

[cmep37]

On 10/22/2021 at 9:20 PM, Birdlady said:

I'm 20 years into POTS, so there is no mojo left. 😂 

At least you still have a sense of humour though....!   I'm about 30 years in - first had mild symptoms as a teenager, which worsened until I had a complete collapse in my mid-twenties although I was only diagnosed with POTS and hEDS 5 years ago when I was 38.  I'd seen about 20 consultants from a wide variety of different specialities over the years, none of whom ever suggested POTS or HEDS as a possibility - instead they told me I had ME/CFS, fibromyalgia, depression, anxiety, burnout etc etc.  I ended up diagnosing myself after reading an article online and realising that I had every single symptom of POTS which then led me to hEDS!

[Birdlady]

18 hours ago, cmep37 said:

At least you still have a sense of humour though....!   I'm about 30 years in - first had mild symptoms as a teenager, which worsened until I had a complete collapse in my mid-twenties although I was only diagnosed with POTS and hEDS 5 years ago when I was 38.  I'd seen about 20 consultants from a wide variety of different specialities over the years, none of whom ever suggested POTS or HEDS as a possibility - instead they told me I had ME/CFS, fibromyalgia, depression, anxiety, burnout etc etc.  I ended up diagnosing myself after reading an article online and realising that I had every single symptom of POTS which then led me to hEDS!

Yeah I diagnosed myself too in 2009. I walked into the EP's office and said, I have POTS. I want tested. lol He thought I was nuts, but I wasn't wrong...My first TTT I was already on meds they use to treat POTS. He also put me on a saline IV! I seriously think he was trying to prove me wrong, but despite all of that I still tested for POTS within 1 minute of being tilted. Unfortunately the doctors I have seen over the years don't know what to do with me, but also don't seem interested in digging any further either. After a while, I got disinterested in it too, so when something like moderate left atrium shows up, it makes me wonder again. My EKGs have been saying possible left atrium enlargement for a year if not longer. Apparently if nothing else is wrong with your heart, it is ignored.

[cmep37]

Do you ever wonder if you'd been diagnosed earlier whether you'd have responded better to treatment?  By the time I was diagnosed I'd had severe POTS for about 15 years (after standing about 5 minutes my HR more than doubles to 140BPM+, on my TTT I reached 172BPM at 13 minutes before the doctor got worried and decided to stop the test as there was no sign of my HR slowing) - I think my body thinks this was how things are supposed to work!  I have failed every single med I have tried - Fludrocortisone (no change), Midodrine (great for 4 months then I developed rebound hypertension and had to stop), BBs (lowered HR a little but dropped BP too low), Ivabradine (lowered HR better but gave me bad bradycardia in the afternoons and evenings).    I often wonder if I'd been prescribed meds when I was first symptomatic if they would have worked better or if I'd still be in the same boat!  I guess I'll never know...

2 hours ago, Birdlady said:

Unfortunately the doctors I have seen over the years don't know what to do with me, but also don't seem interested in digging any further either.

Same old story isn't it!  My cardiologist has basically given up - he says I just have to live with it.  I'm seeing him again in a few weeks and am considering pushing him to refer me to one of the big London hospitals but maybe that's a waste of time - I honestly don't know.  I am just so fed up of always having to be the one driving things and suggesting things that he usually shoots down - he won't let me try Mestinon (doesn't understand how it works!) or IV saline (risks of infection too high).  Is it possible for you to get a second opinion on the left atrium enlargement?

[Birdlady]

6 hours ago, cmep37 said:

Do you ever wonder if you'd been diagnosed earlier whether you'd have responded better to treatment?  By the time I was diagnosed I'd had severe POTS for about 15 years (after standing about 5 minutes my HR more than doubles to 140BPM+, on my TTT I reached 172BPM at 13 minutes before the doctor got worried and decided to stop the test as there was no sign of my HR slowing) - I think my body thinks this was how things are supposed to work!  I have failed every single med I have tried - Fludrocortisone (no change), Midodrine (great for 4 months then I developed rebound hypertension and had to stop), BBs (lowered HR a little but dropped BP too low), Ivabradine (lowered HR better but gave me bad bradycardia in the afternoons and evenings).    I often wonder if I'd been prescribed meds when I was first symptomatic if they would have worked better or if I'd still be in the same boat!  I guess I'll never know...

Same old story isn't it!  My cardiologist has basically given up - he says I just have to live with it.  I'm seeing him again in a few weeks and am considering pushing him to refer me to one of the big London hospitals but maybe that's a waste of time - I honestly don't know.  I am just so fed up of always having to be the one driving things and suggesting things that he usually shoots down - he won't let me try Mestinon (doesn't understand how it works!) or IV saline (risks of infection too high).  Is it possible for you to get a second opinion on the left atrium enlargement?

I honestly don't think anything would have been different with treatment response if I was diagnosed sooner. It first started when I was in my junior year of high school after having EBV. I had to quit band/marching band. Couldn't do it anymore. I was so weak, tired and fatigue while standing. After high school, I was a little better, but it got really bad again in 2005.

I've been seeing the same cardiologist since 2012. It's nice to stick with someone who has seen you for a long time, but he doesn't have any magical ideas and has told me there is no miracle drug. He flat out told me he isn't god and can't fix me. I do appreciate him saying that to me. I now see him once a year. I have stuck with him and he has been a blessing to me with filling out forms for social security and other things.  He is the one who ordered the echo. This doctor will give me any med I want. Midodrine (which was terrible for me), any beta blocker etc. He has suggested ivabradine which I told him I will try the moment I am past childbearing years. 

But since this cardiologist moved offices so much in the past 3 years, I started to see an EP that is about 5 mins away from me. This guy doesn't believe in using any medication for POTS. He says they don't work. He said midodrine can be helpful, but he hates using beta blockers in POTSies because it just causes too many other issues. It diminishes stroke volume or something like that (maybe I'll need that diminished stroke volume lol) and makes the sinus node even weaker. He got into the details about it and why he doesn't like beta blockers.

I don't think I can bring myself to seeing a 3rd doctor. Maybe I can put in a message to the cardiologist's nurse and just make sure he saw the left atrial enlargement. They were the ones who called me and said everything was normal. See even writing that out, I sound like a crazy person. Of course he saw it on the report.

[MikeO]

17 hours ago, Birdlady said:

Maybe I can put in a message to the cardiologist's nurse and just make sure he saw the left atrial enlargement.

I would send the Cardiologist and have them clarify any questions that you may have.  I do have a Lipomatous hypertrophy of the
interatrial septum that is noted each time i have an echo done on my heart, it never gets mentioned when i get the results and as usual i do send a message inquiring about. The Cardio team has always responded. 

[Birdlady]

Thought I'd follow up on this. I had a telehealth appt with my cardiologist in August 2022 and I brought up the echo report. He had not seen that on the report. He said that is really weird because I don't have any other issues (left ventricle dysfunction, EF is preserved) that generally would cause enlargement. I guess there is some concern of the accuracy of that measurement on echos. We may do a cardiac MRI this year or next to see if the echo was accurate.

Apparently athletes can get this. I'm not an athlete but when your heart is always racing, it makes me wonder. I'm on a low dose of a beta blocker again since last May. I just cannot live with the insane heart rates all of the time. EP will be mad at me, but I can't live in his fantasyland. 

[MikeO]

From the sound your heart structurally wise is in good shape.

I am sorry to hear the tacharda has kicked in again. I have gone thru this as well and did take a few drugs to sort it out or keep it at bay.

If it was me i would go thru with the cardiac MRI (out of caution) or revisit with the EP. When i would always be tacky for hours on end that would take the life out of me.