HEART FUNCTION TESTS

[email hidden] (John Wendel) wrote in message news:<[email hidden]>...

Quoted message said:

Dr.Chung 1. Do you mean by isolated early repolarization = normal
variant early repolarization?

Yes.

Quoted message said:

2. Would an normal variant early
repolarization diagnosis stop an athletic and generally healthy pilot
from flying an aircraft (termination of employment)?

Shouldn't.

Quoted message said:

3. Would an sinus
bradycardia finding on EKG be called abnormal?

Yes.

Quoted message said:

4. Would an sinus
bradycardia on EKG be called normal if characterized by an otherwise
normal EKG and the reason for low heart rate top fitness?

Normal variant perhaps.

Quoted message said:

5. You said
that LVH can cause ER,but would disappearance of LVH(if it caused ER)
cause also ER to disappear?

Should.

Quoted message said:

6. Cardiologist told me during echo exam that
heart thickness is at upper normal limits and EF is between 65% and
70%.Should I stop intervals and decrease amount of exercise in order for
heart thickness to decrease and thus early repoarization to disappear(if
caused by LVH)?

Exercise does not cause LVH but should actually reverse it.

Quoted message said:

Thank you

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

Dr. Chung 1. Are you sure heart thickness at upper normal limits (1.1
cm) or mild LVH is not caused by an exercise when a person is jogging
and running 60 minutes 6 days a week,plus 1-2 times a week at maximal
effort (100%) is running 100 meters dash several times?If yes what
other things would cause heart thickness (LVH) if a person has a normal
heart and blood pressure? 2. You said top fitness does not cause ER,but
LVH can cause it and once LVH disappears so does ER with it and you
also said that "it is an EKG diagnosis that stays for life." Would you
explain when and what conditions cause it to "stay for life?" 3. What
would be better for the heart and the health exercising hard ,having EF
65-70% and as result having heart thickness at upper normal limits (1.1
cm) to mild LVH on one hand and exercising,but not hard, having EF
<65% and a normal heart thickness (.8--.9 cm) without mild LVH? 4. Do
normal Axis: P, QRS, T on ECG excludes left axis deviation
diagnosis?If yes what would normal limits be for the above three
parameters? 5. If EKG computer prints NSR .Normal EKG on tracing would
it be possible for cardiologist,by looking at tracing, to find any
abnormality on the same EKG tracing?If yes what ? 6. What's the
difference between EKG computers that do not print words and
numbers,like NSR.Normal ECG ,HR,P, PR.QRS,QT,QTc, Axis: P, QRS, T and
the one that do(and are they the same) and why would doctor use the
EKG that does not print the above things? Thank you

[email hidden] (John Wendel) wrote in message news:<[email hidden]>...

Quoted message said:

Dr. Chung 1. Are you sure heart thickness at upper normal limits (1.1
cm) or mild LVH is not caused by an exercise when a person is jogging
and running 60 minutes 6 days a week,plus 1-2 times a week at maximal
effort (100%) is running 100 meters dash several times?If yes what
other things would cause heart thickness (LVH) if a person has a normal
heart and blood pressure?

Normal blood pressure is 115/75 or less.

Other things that cause concentric LVH are diabetes and obesity.

Quoted message said:

2. You said top fitness does not cause ER,but
LVH can cause it and once LVH disappears so does ER with it and you
also said that "it is an EKG diagnosis that stays for life." Would you
explain when and what conditions cause it to "stay for life?"

It is not predictable whether early repolarization will remain present
lifelong on someone's EKG.

Quoted message said:

3. What
would be better for the heart and the health exercising hard ,having EF
65-70% and as result having heart thickness at upper normal limits (1.1
cm) to mild LVH on one hand and exercising,but not hard, having EF
<65% and a normal heart thickness (.8--.9 cm) without mild LVH?

The exercise did not cause the concentric LVH.

Quoted message said:

4. Do
normal Axis: P, QRS, T on ECG excludes left axis deviation
diagnosis?If yes what would normal limits be for the above three
parameters?

0 to 90.

Quoted message said:

5. If EKG computer prints NSR .Normal EKG on tracing would
it be possible for cardiologist,by looking at tracing, to find any
abnormality on the same EKG tracing?If yes what ?

Depends on the software.

Quoted message said:

6. What's the
difference between EKG computers that do not print words and
numbers,like NSR.Normal ECG ,HR,P, PR.QRS,QT,QTc, Axis: P, QRS, T and
the one that do(and are they the same) and why would doctor use the
EKG that does not print the above things?

Personal preference.

Quoted message said:

Thank you

You're welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung 1. Would IVSD 1.1cm and LVPWD 1.1 cm with a normal limits
0.8--1.2 cm as well as IVSD 1.0 cm and LVPWD 1.0 cm with a normal
limits 0.6--1.1 cm be normal and not concertic LVH and any other LVH and
would being 20 pounds over ideal weight increase heart thickness by at
least 0.2 to 0.3 cm? 2. Does above FIT exercise,especially 100 meters
dash sprints increase heart thickness by at least any amount (0.1 cm)?If
yes by at most what number? 3. Do Axis: P, QRS, T normal numbers on
ECG excludes left axis deviation?4. If a healthy person trained his
heart to the outermost point or to the greatest degree possible and has
achieved his goal,but also did get as result mild LVH and than suddenly
stops all exercise (not because of the heart,mild LVH or other health
conditions) at the achieved peak goal for two months . Would this person
be at the above average risk of getting an heart attack in the two
months following sudden stoppage of all exercise and would and also
should by and chance PAC or PVC start would it be better for this
person to start exersing again ,at lower FIT at first? 5. Would you call
early repolarization (normal variant) ECG Normal ECG?

John Wendel said:

Dr.Chung 1. Would IVSD 1.1cm and LVPWD 1.1 cm with a normal limits
0.8--1.2 cm as well as IVSD 1.0 cm and LVPWD 1.0 cm with a normal
limits 0.6--1.1 cm be normal and not concertic LVH

Depends on your whole clinical picture including physical exam.

Quoted message said:

and any other LVH and
would being 20 pounds over ideal weight increase heart thickness by at
least 0.2 to 0.3 cm?

Not typically.

Quoted message said:

2. Does above FIT exercise,especially 100 meters
dash sprints increase heart thickness by at least any amount (0.1 cm)?

Not typically.

Quoted message said:

If
yes by at most what number? 3. Do Axis: P, QRS, T normal numbers on
ECG excludes left axis deviation?

Yes.

Quoted message said:

4. If a healthy person trained his
heart to the outermost point or to the greatest degree possible and has
achieved his goal,but also did get as result mild LVH

LVH by EKG is not the same as LVH by echo. The Echo finding would be more
specific.

Quoted message said:

and than suddenly
stops all exercise (not because of the heart,mild LVH or other health
conditions) at the achieved peak goal for two months . Would this person
be at the above average risk of getting an heart attack in the two
months following sudden stoppage of all exercise

Shouldn't be.

Quoted message said:

and would and also
should by and chance PAC or PVC start would it be better for this
person to start exersing again ,at lower FIT at first?

Should consult with his doctor first.

Quoted message said:

5. Would you call
early repolarization (normal variant) ECG Normal ECG?

No.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung 1. How would you write on patient report early repolarization
(normal variant) diagnosis if found on EKG? 2. Is it normal for LVPWD
to be greater than IVSD by 0.1 to 0.2 cm and other way around and what
causes this small differences? 3. If a patient has on his stess echo
report "No evidence of myocardial ischemia,pericarditis,Dressler's
syndrome,or other cardiovascular abnormality" and I guess no indentified
heart disease why would according to you Dr.Chung "nonspecified st-t
wave changes,wnl" on the same report be abnormal? 4. Would exercising
at 80 to 88 %mhr at above FIT cause mild LVH? 5. Do any leads change
shape and form from lying on the back standard EKG to 12 lead pretest
stress echo supine and standing EKG and which leads are most affected by
a change in position,which are not effected and how are the effected
reflected in a shape and form?Thank you

John Wendel said:

Dr.Chung 1. How would you write on patient report early repolarization
(normal variant) diagnosis if found on EKG?

"early repolarization - possibly a normal variant if heart is known to be
structurally normal"

Quoted message said:

2. Is it normal for LVPWD
to be greater than IVSD by 0.1 to 0.2 cm and other way around and what
causes this small differences?

Inter-observer variability.

Quoted message said:

3. If a patient has on his stess echo
report "No evidence of myocardial ischemia,pericarditis,Dressler's
syndrome,or other cardiovascular abnormality" and I guess no indentified
heart disease why would according to you Dr.Chung "nonspecified st-t
wave changes,wnl" on the same report be abnormal?

It would remain an abnormal EKG finding even if refuted by further cardiac
testing.

Quoted message said:

4. Would exercising
at 80 to 88 %mhr at above FIT cause mild LVH?

Shouldn't.

Quoted message said:

5. Do any leads change
shape and form from lying on the back standard EKG to 12 lead pretest
stress echo supine and standing EKG and which leads are most affected by
a change in position,which are not effected and how are the effected
reflected in a shape and form?

The precordial leads would be the most affected primarily by voltage
amplitude but not "non-specific ST-T wave changes."

Quoted message said:

Thank you

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

Dr.Chung 1. Would you addend two words "ECG: Normal." to your
diagnosis so your diagnosis is written as "ECG: Normal. Early
repolarization - possible a normal variant if heart is known to be
structurally normal?" If no.why.If yes why. 2. Are you sure exercising
at upper 80s %mhr and doing 100 meters dash sprints 1-2 a week does not
cause heart thickness(LVH),because according to my cardiologist it
does,but also with cessation of the activity heart thickness does return
to <1.0 cm which is normal? 3. At what number in cm would you diagnose
LVH?Thank you

John Wendel said:

Dr.Chung 1. Would you addend two words "ECG: Normal." to your
diagnosis so your diagnosis is written as "ECG: Normal. Early
repolarization - possible a normal variant if heart is known to be
structurally normal?" If no.why.If yes why.

No, too many "normals"

Quoted message said:

2. Are you sure exercising
at upper 80s %mhr and doing 100 meters dash sprints 1-2 a week does not
cause heart thickness(LVH),

Yes.

Quoted message said:

because according to my cardiologist it
does,

His/her experience may be different from mine. Athletic hearts do get
bigger but I not seen them get thicker.

Quoted message said:

but also with cessation of the activity heart thickness does return
to <1.0 cm which is normal?

It should not hypertrophy with exercise in the first place, ime.

Quoted message said:

3. At what number in cm would you diagnose
LVH?

Greater than 1.1 cm at end-diastole.

Quoted message said:

Thank you

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung 1. If an patient comes to you and you examine this person
(history,physical etc) and also do an stress echo and find no
abnormality ,except on a resting ECG early repolarization (normal
variant).Would you write on this patient report your only diagnosis on
resting ECG as early repolarization (normal variant) in this way; "ECG:
Normal. Normal sinus rhythm at 71. Normal axis,intervals and waveforms.
Early repolarization (normal variant)." ? If no why.If yes why? 2. Are
you saying when person is sedentary and does not exercise at all (none)
and when this same person exercises at the above FIT level and is in a
top fitness condition that this person will have the same wall
thickness (LVPWT and IVSD).If no would you explain? 3.In your
experience as a cardiologist does above FIT exercise increase heart
thickness by any (small) amount ,but still within normal limits of 0.6
to 1.1 cm? If yes by at most what number?4. Dr.Chung you said "Athletic
hearts do get bigger but I not seen them get thicker." Cardiologist
agrees with you that indeed athletic hearts do get bigger,but they also
get thicker than non athletic hearts and by the way what would an
average athletic heart thickness be in cm? (LVPWD and IVSD)5. If an
healthly olympic athlete has a slightly elevated heart thickness at 1.2
to 1.3 cm would you urge this athlete even though he has won medals to
stop further training until heart thickness falls below 1.1 cm and at
what level in cm would you consider heart thickness pathology?Thank you

John Wendel said:

Dr.Chung 1. If an patient comes to you and you examine this person
(history,physical etc) and also do an stress echo and find no
abnormality ,except on a resting ECG early repolarization (normal
variant).Would you write on this patient report your only diagnosis on
resting ECG as early repolarization (normal variant) in this way; "ECG:
Normal. Normal sinus rhythm at 71. Normal axis,intervals and waveforms.
Early repolarization (normal variant)." ? If no why.If yes why?

No. It is either normal or normal variant. Imho, isolated early
repolarization is normal variant.

Quoted message said:

2. Are
you saying when person is sedentary and does not exercise at all (none)
and when this same person exercises at the above FIT level and is in a
top fitness condition that this person will have the same wall
thickness (LVPWT and IVSD).If no would you explain?

Ime, yes.

Quoted message said:

3.In your
experience as a cardiologist does above FIT exercise increase heart
thickness by any (small) amount ,but still within normal limits of 0.6
to 1.1 cm? If yes by at most what number?

No.

Quoted message said:

4. Dr.Chung you said "Athletic
hearts do get bigger but I not seen them get thicker." Cardiologist
agrees with you that indeed athletic hearts do get bigger,but they also
get thicker than non athletic hearts and by the way what would an
average athletic heart thickness be in cm? (LVPWD and IVSD)

about 1 cm.

Quoted message said:

5. If an
healthly olympic athlete has a slightly elevated heart thickness at 1.2
to 1.3 cm would you urge this athlete even though he has won medals to
stop further training until heart thickness falls below 1.1 cm and at
what level in cm would you consider heart thickness pathology?

No. However, I would look into the possibility of said athlete having
hypertension. Heart thickness over 1.1 cm would be a concern for pathology.

Quoted message said:

Thank you

You're welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

Dr.Chung 1. You wrote that "The precordial leads would be the most
effected primarely by voltage amplitude but not "non-specific ST-T wave
changes" Are leads II, III,,AVL and AVF also affected by change in
position from lying on back standard EKG to 12 lead pretest strss echo
supine and standing position and in what way,especially QRS and ST?
2..What would the difference between the resting ECG:Normal. Normal
sinus rhythm.Normal axis,intervals and wave forms.Early repolarization
(normal variant) and the resting ECG:Normal Normal sinus rhythm be other
than one being called a normal and other normal variant? 3. If top
fitness causes early repolarization (normal variant) and sinus
bradycardia (normal variant) and I guess abnormal ECG would it be
better not to exercise at all,not to be in top fitness condition and
therefore have an normal ECG? 4. Are there any scientific studies that
did show whether it is better to have early repolarization (normal
variant) than normal ECG and the other way around? 5 Can early
repolarization (normal variant) be called an enigma by doctors?Thank you

John Wendel said:

Dr.Chung 1. You wrote that "The precordial leads would be the most
effected primarely by voltage amplitude but not "non-specific ST-T wave
changes" Are leads II, III,,AVL and AVF also affected by change in
position from lying on back standard EKG to 12 lead pretest strss echo
supine and standing position and in what way,especially QRS and ST?

Not typically.

Quoted message said:

2..What would the difference between the resting ECG:Normal. Normal
sinus rhythm.Normal axis,intervals and wave forms.Early repolarization
(normal variant) and the resting ECG:Normal Normal sinus rhythm be other
than one being called a normal and other normal variant?

No other difference except commenting on the variance.

Quoted message said:

3. If top
fitness causes early repolarization (normal variant) and sinus
bradycardia (normal variant) and I guess abnormal ECG would it be
better not to exercise at all,not to be in top fitness condition and
therefore have an normal ECG?

Not imho.

Quoted message said:

4. Are there any scientific studies that
did show whether it is better to have early repolarization (normal
variant) than normal ECG and the other way around?

Not that I am aware of.

Quoted message said:

5 Can early
repolarization (normal variant) be called an enigma by doctors?

Shouldn't be.

Quoted message said:

Thank you

You're welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung. 1. Would an athlete whose resting ECG is a normal and does
not have early repolarization and sinus bradycardia normal variants be
in better fitness condition and heart health than an athlete who has
both above normal variants and does not have any symptoms nor any
symptoms of heart disease? 2. Do most athletes who are in top fitness
conditions also have normal variants,like early repolarization and
sinus bradycardia? 3 If there is no other difference oter than one
being called normal and other normal variant why would you not write
diagnosis as: ECG: Normal. Normal sinus rhythm. Normal axis,intervals
and waveforms.Early repolarization (normal variant)? 4. If you are not
sure whether (your findings) is normal or normal variant would you write
it as above? If no, how would write it and define it? 5. You wrote that
on a scale from 0 to 10 zero being the lowest and ten the highest
abnormality (on a resting ECG) early repolarization would be a 1,but
what about an normal ECG,what would it be between 0 and 1?Thank you

John Wendel said:

Dr.Chung. 1. Would an athlete whose resting ECG is a normal and does
not have early repolarization and sinus bradycardia normal variants be
in better fitness condition and heart health than an athlete who has
both above normal variants and does not have any symptoms nor any
symptoms of heart disease?

Unknown.

Quoted message said:

2. Do most athletes who are in top fitness
conditions also have normal variants,like early repolarization and
sinus bradycardia?

The latter more than the former.

Quoted message said:

3 If there is no other difference oter than one
being called normal and other normal variant why would you not write
diagnosis as: ECG: Normal. Normal sinus rhythm. Normal axis,intervals
and waveforms.Early repolarization (normal variant)?

Style.

Quoted message said:

4. If you are not
sure whether (your findings) is normal or normal variant would you write
it as above? If no, how would write it and define it?

As described in an earlier post.

Quoted message said:

5. You wrote that
on a scale from 0 to 10 zero being the lowest and ten the highest
abnormality (on a resting ECG) early repolarization would be a 1,but
what about an normal ECG,what would it be between 0 and 1?

0

Quoted message said:

Thank you

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.. Chung 1. If an board certified cardiologist,like you except older
than you had written the above findings of early repolarization, do you
think that he was wrong in his findings and unqualified to be
cardiologist? If no would you explain? 2. You wrote that normal blood
pressure is <115/75,but what about normal blood pressure when lying and
sleeping and also taken standing? 3. By what number should diastolic
fall (from sitting position) when measured lying as well by what number
should it increase when measured standing and the same for systolic? 4
What would normal pulse pressure limits be : at rest and during
(maximal) stress test? 5. Does having BP 180/76 at stage 5 Bruce exclude
abnormal blood pressure for this person in the near future?Thank you

John Wendel said:

Dr.. Chung 1. If an board certified cardiologist,like you except older
than you had written the above findings of early repolarization, do you
think that he was wrong in his findings and unqualified to be
cardiologist?

No.

Quoted message said:

If no would you explain?

Older does not mean less qualified :-)

Quoted message said:

2. You wrote that normal blood
pressure is <115/75,but what about normal blood pressure when lying and
sleeping and also taken standing?

Actually, goal of treating hypertension is less than 115/75. Most
physicians don't make the diagnosis of hypertension until there are more
than 2 independent readings of blood pressure greater than 135/85.

Quoted message said:

3. By what number should diastolic
fall (from sitting position) when measured lying as well by what number
should it increase when measured standing and the same for systolic?

The decrease with upright positioning for systolic is typically less than 10
mmHg. It is considered abnormal if the drop is 20 mmHg or more. The
diastolic typically will rise a bit (around 5 mmHg) or stay the same.

Quoted message said:

4
What would normal pulse pressure limits be : at rest and during
(maximal) stress test?

At rest, 50 mmHg or less. During stress, it will vary widely from
individual to individual.

Quoted message said:

5. Does having BP 180/76 at stage 5 Bruce exclude
abnormal blood pressure for this person in the near future?

No.

Quoted message said:

Thank you

You are welcome.

Many similar answers to similar questions can be found on my web site.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung 1. I do not know if I understood you,because according to you
and your "style" it is "either normal or abnormal variant",but than
you also said that an cardiologist did not make mistake in his diagnosis
when he wrote " ECG: Normal..........(normal variant)." Why would you
say something like that? 2. By what an average numbers should diastolc
blood pressure decrease from sitting to when measured in lying position
and also systolic? 3. What would (noctural) normal blood pressure limits
be during sleep? 4. What would mean arterial pressure normal limits be
at stage 5 and 6 on Bruce? 5. What blood pressure number at stage 5 and
6 excludes abnormal blood pressure in the next 5 to 10 years? Thank you

John Wendel said:

Dr.Chung 1. I do not know if I understood you,because according to you
and your "style" it is "either normal or abnormal variant",but than
you also said that an cardiologist did not make mistake in his diagnosis
when he wrote " ECG: Normal..........(normal variant)." Why would you
say something like that?

To answer your question.

Quoted message said:

2. By what an average numbers should diastolc
blood pressure decrease from sitting to when measured in lying position
and also systolic?

0 to 5 mmHg

Quoted message said:

3. What would (noctural) normal blood pressure limits
be during sleep?

85-135/45-85

Quoted message said:

4. What would mean arterial pressure normal limits be
at stage 5 and 6 on Bruce?

135-200/85-100

Quoted message said:

5. What blood pressure number at stage 5 and
6 excludes abnormal blood pressure in the next 5 to 10 years?

Stress blood pressure does not predict future blood pressure.

Quoted message said:

Thank you

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

Dr. Chung 1. In your experience as board certified cardiologist, do you
think when on an stress echo report is written "No evidence of
myocardial ischemia,pericarditis,Dressler's syndrome, or other
cardiovascular abnormality." and on the same echo report under the
resting ECG is written "normal sinus rhythm, nonspecific st-t wave
changes,wnl" that above, according to you Dr.Chung abnormality, would
be and is with an absolute certainty and most likely "ECG: Normal.
Normal sinus rhythm. Normal axis,intervals and waveforms.Early
repolarization (normal variant)."? If no (I do know it is difficult for
you to know witout seeing the ECG tracing) in your honest opinion,if you
had to guess what other abnormality other than early repolarization
(normal variant) would you pick and would you explain? 2.Why would ECG
taken in atheletic top fitness persons often show early repolarization
(normal variant) as well as other variant patterns which experience as
you well know has shown not to be associated with underlying heart
disease? 3. What would left ventricular EDV(ml) and ESV(ml) echo
measurements normal limits be in athlete and non athlete? Thank you