“My mother is suffering from breathlessness but the 2-d echo shows normal. Why?”
My mother is 70 years old and is out of breath even when doing the slightest activity. We had taken her for a 2-d echogram which showed a normal breathing pattern with slight irregularities due to aging. What are the tests that we should do now to understand the cause of this breathlessness?
6 Answers
CardiologistBreathlessness
By "normal echo," you must mean that her ejection fraction as reported is normal and that no significant valvular heart disease was noted on the echocardiogram. Shortness of breath can be either due to her heart, her lungs, or a combination of both.
If we are to assume that she has no issues with her lungs, a "normal ejection fraction" does not rule out heart related causes of shortness of breath. One of the often missed or under recognized but very common causes of shortness of breath is what is referred to as diastolic dysfunction. Putting it simply, how "complaint" is the heart or how "stiff" has the heart become over time. As we age and with other risk factors, the heart becomes less complaint and it is the commonest cause of shortness of breath and cause of heart failure what we now refer to as Heart Failure With Preserved Ejection Fraction (HFPEF).
Secondly, severe coronary artery disease can often present just as shortness of breath with exertion in the presence of normal ejection fraction (although over time the ejection fraction will slowly decline).
If we are to assume that she has no issues with her lungs, a "normal ejection fraction" does not rule out heart related causes of shortness of breath. One of the often missed or under recognized but very common causes of shortness of breath is what is referred to as diastolic dysfunction. Putting it simply, how "complaint" is the heart or how "stiff" has the heart become over time. As we age and with other risk factors, the heart becomes less complaint and it is the commonest cause of shortness of breath and cause of heart failure what we now refer to as Heart Failure With Preserved Ejection Fraction (HFPEF).
Secondly, severe coronary artery disease can often present just as shortness of breath with exertion in the presence of normal ejection fraction (although over time the ejection fraction will slowly decline).
The echo was probably misread. Have the patient call my office to schedule a consultation to evaluate her symptoms.
*Robert P. Reichstein, M.D., F.A.C.C.*
*Robert P. Reichstein, M.D., F.A.C.C.*
She may have diastolic dysfunction (heart does not relax), would get pulmonary function tests, a good history, physical exam, blood tests, and make sure no sleep apnea or hypertension, and excessive weight.
Julia G. Ansari
Cardiologist
She can have diastolic heart disease which gives shortness of breath. Also, an echo is not going to address if there is any significant blockage of arteries and in appropriate risk factor patients, a stress test is needed.
Nuclear stress testing to rule out underlying coronary occlusive disease - even with a normal 2-d echocardiogram
Chest X-ray
Stress test
Stress test
