HEART FUNCTION TESTS

John Wendel said:

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)."?

No.

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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?

It is likely that the early repolarization changes are a "normal variant"
given the normal stress echo.

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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?

Upregulation of potassium channel number in the myocytes.

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3. What would left ventricular EDV(ml) and ESV(ml) echo
measurements normal limits be in athlete and non athlete?

These limits should be uniformly applied independent of the athleticism of
the patient.

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Thank you

You are welcome.

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

Dr.Chung 1. You wrote "Unregulation of potassium channel number in the
myocytes." Would you explain what you mean by the above and why would
early repolarization normal variant show up on an resting ECG of a
person who does not have any evidence of heart disease? 2. How would
call olympics gold medal winners early repolarization normal variant ECG
diagnosis during the games: ABNORMAL ECG, NORMAL ECG, BORDERLINE ECG? 3.
What would left ventricular EDV(ml) and ESV(ml) echo measurements be in
an average healthy sedentary adult male and in person who exercises,but
is not addicted to exercise? 4. What should normal (limits) BP be at
stage 3.4.5 Bruce and than 1,2,3,4,5 minutes during cooling down? 5.
What would mitral valve area normal limits be in cm2(optimal
number)Thank you

John Wendel said:

Dr.Chung 1. You wrote "Unregulation of potassium channel number in the
myocytes." Would you explain what you mean by the above

Potassium channels are involved in repolarization. The more you have, the
quicker the repolarization.

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and why would
early repolarization normal variant show up on an resting ECG of a
person who does not have any evidence of heart disease?

That's why we call it a normal variant.

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2. How would
call olympics gold medal winners early repolarization normal variant ECG
diagnosis during the games: ABNORMAL ECG, NORMAL ECG, BORDERLINE ECG?

Normal variant.

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3.
What would left ventricular EDV(ml) and ESV(ml) echo measurements be in
an average healthy sedentary adult male and in person who exercises,but
is not addicted to exercise?

These are actually calculations based on LVEDD and LVESD measurements.
We've discussed the normal limits for these measurements already in the
past. These normal limits are applied uniformly without regard to
athleticism.

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4. What should normal (limits) BP be at
stage 3.4.5 Bruce and than 1,2,3,4,5 minutes during cooling down?

100-200/50-100

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5.
What would mitral valve area normal limits be in cm2(optimal
number)

Normal mitral valve area is typically greater than 3 cm2. There is no
"optimal" number.

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Thank you

You are welcome.

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

Dr.Chung 1. After left ventricular EDV(ml) and ESV(ml) are calculated
what would their normal limits be and by the way,how are they
calculated(equation)?2.By what BP number does diastolic BP increase or
decrease from a rest to 100+% PMHR on a stress test in top fitness
condition persons and would it be better if it decreased slghtly (10)
than if it stayed the same or increased? 3. By what BP number should
systolic BP decrease from achieved 100+% PMHR and into a recovery,at
first,second,third,fourth and fifth minute to be called normal BP
decrease? 4. If a Aorta is not sclerosed at all (none) does it mean that
person is less likely to have and have CAD? 5. By what number in cm
would healthy Aorta increase in 25 years in healthy male adults and at
what size in cm should person stop high intensity exercise,because of
the size of Aorta? 6. What would "mitral pressure halftime (doppler)
/sec" normal limits be?Thank you

Dr.Chung Would you answer last questions?

John Wendel said:

Dr.Chung 1. After left ventricular EDV(ml) and ESV(ml) are calculated
what would their normal limits be and by the way,how are they
calculated(equation)?

Normal limits and method of calculation will vary somewhat from center to
center.

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2.By what BP number does diastolic BP increase or
decrease from a rest to 100+% PMHR on a stress test in top fitness
condition persons and would it be better if it decreased slghtly (10)
than if it stayed the same or increased?

This will vary widely.

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3. By what BP number should
systolic BP decrease from achieved 100+% PMHR and into a recovery,at
first,second,third,fourth and fifth minute to be called normal BP
decrease?

The BP should return to baseline within a few minutes.

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4. If a Aorta is not sclerosed at all (none) does it mean that
person is less likely to have and have CAD?

No.

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5. By what number in cm
would healthy Aorta increase in 25 years in healthy male adults

0 cm

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and at
what size in cm should person stop high intensity exercise,because of
the size of Aorta?

greater than 4 cm

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6. What would "mitral pressure halftime (doppler)
/sec" normal limits be?

These normal limits will also vary somewhat from center to center.

Quoted message said:

Thank you

You are welcome.

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

Dr.Chung 1. At your center what would EDV(ml) and ESV(ml) normal limits
be and what's the equation? 2 What should normal BP (upper limts) be
during exercise and also during high intensity exercise and thus not
cause heart thickness? 3. What should an ideal Aorta size,like ideal BP
115/75 be in top fitness persons? 4. What would .1 U V4 and .1 U V5
during stages 2,3,4,5 mean and at what number is significant? 5. When
systolic BP was 170 at stage 5 what should it be at 2 and 3 minute
into revovery to be called normal BP decrease? Thank you

John Wendel said:

Dr.Chung 1. At your center what would EDV(ml) and ESV(ml) normal limits
be and what's the equation?

These would not apply to you unless we performed your echocardiogram.

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2 What should normal BP (upper limts) be
during exercise and also during high intensity exercise and thus not
cause heart thickness?

It is elevated resting BP that causes hypertrophy (thickening of the heart).

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3. What should an ideal Aorta size,like ideal BP
115/75 be in top fitness persons?

2-3 cm.

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4. What would .1 U V4 and .1 U V5
during stages 2,3,4,5 mean and at what number is significant?

U waves during a stress test are of unclear significance..

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5. When
systolic BP was 170 at stage 5 what should it be at 2 and 3 minute
into revovery to be called normal BP decrease?

150 at 2 and 135 or less at 3.

Quoted message said:

Thank you

You are welcome.

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

Dr.Chung 1. Do you think an athlete having a Aorta size between 2-3cm
on Echo (normal limits 2--3.7cm) would be in better fitness and heart
health than an athlete who has Aorta size between 3- 3.5cm ? If no why
if yes why? 2.You wrote "U waves during a stress test are of unclear
signifiance" but would the above .1 on ECG stress test mean that st
depression is .1? If no what does it mean? How would you write normal
heart sounds on an patient examination?Thank you

John Wendel said:

Dr.Chung 1. Do you think an athlete having a Aorta size between 2-3cm
on Echo (normal limits 2--3.7cm) would be in better fitness and heart
health than an athlete who has Aorta size between 3- 3.5cm ?

No. Aortic diameter says nothing about either fitness or heart health.
Someone with upper limits of normal aortic diameter is probably more likely
to have a history of elevating resting blood pressures.

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If no why
if yes why?

See above.

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2.You wrote "U waves during a stress test are of unclear
signifiance" but would the above .1 on ECG stress test mean that st
depression is .1?

Not sure.

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If no what does it mean?

Don't know. If there was 1 mm ST depression anywhere, it should have been
clearly written.

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How would you write normal
heart sounds on an patient examination?

Normal S1 S2. No murmurs, gallops, clicks, or rub.

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Thank you

You are welcome.

Humbly,

Andrew

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

Dr.Chung 1. Are you saying if a person has BP <115/75 high intensity
exercise should not cause heart thickness,but if a person has arond
120/80 BP than high intensity will cause heart thickness and would you
explain? 2. Does diastolic BP causes thicker heart than systolic BP and
the other way around? 3. Why does high intensity exercise causes higher
diastolic BP when measured next day at rest? 4. Would decrease of
systolic BP from peak exercise to 2nd minute recovery of 54 be normal
and wold the above be,like with the heart rate recovery at first minute,
the higher the drop the better? If no what would upper normal limits be?
5.What should normal BP be during exercise and not increase BP when
measured next day at rest?6. What would normal BP be when person is
walking around the house?Thank you

John Wendel said:

Dr.Chung 1. Are you saying if a person has BP <115/75 high intensity
exercise should not cause heart thickness,but if a person has arond
120/80 BP than high intensity will cause heart thickness and would you
explain?

Thickening of the heart would be caused by the higher resting BP rather than
the exercise. Optimize the resting BP and you reduce the likelihood of
hypertrophy.

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2. Does diastolic BP causes thicker heart than systolic BP and
the other way around?

Both play a role.

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3. Why does high intensity exercise causes higher
diastolic BP when measured next day at rest?

It shouldn't unless you are predisposed to having hypertension. This
predisposition seems to be genetic though the gene loci have not been
identified. If your mother has hypertension, it is more likely that you are
going to be susceptible.

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4. Would decrease of
systolic BP from peak exercise to 2nd minute recovery of 54 be normal
and wold the above be,like with the heart rate recovery at first minute,
the higher the drop the better?

Yes.

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If no what would upper normal limits be?
5.What should normal BP be during exercise and not increase BP when
measured next day at rest?

One would anticipate a 50% rise in blood pressure with exercise.

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6. What would normal BP be when person is
walking around the house?

A little higher (10-20%) than at rest.

Quoted message said:

Thank you

You are welcome.

Humbly,

Andrew

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

Dr.Chung 1. I do not about you,but I do know from experience that
exercising at high intensity causes heart thckness,but not pathology nor
life threatening heart thickness and with the cessation of high
intensity exercise heart thickness does return to a normal level at 0.8
to 1.0 cm. In your opinion what would cause this increase in heart
thickness and than decrease to a normal level, when exercising at 70% to
80% mhr when person's BP is 115/75 (no diabetes) and would being 20
pounds over ideal weight cause the above? 2. In your experience as an
cardiologist does heart thickness at upper normal limits and above also
causes diastolic BP to increase (but wnl) and would an decreased heart
thickness cause diastolic BP to decrease? If no what would cause an
increased diastolic BP but wnl?If yes would you write approximate
numbers? 3. Would it be possible for an athletic fitness person to know
whether he has heart thickess at upper normal limits and above by
checking for any signs of increased diastolic BP at rest and would you
explain(increased diastolc BP at rest =heart thickness; no change to
decreased diastolic BP at rest =normal heart thickness)?4. If an adult
athletic person was to have carotid ultasound(duplex) of both internal
carotid arteries,how would an diameter reduction be written on the
person's report: as an exact number,normal limits and what would normal
limits be? 5. Does having an best result between 0--10,for example on
carotid ultrasound mean that the same person would less likely have
blockages in the heart's coranary arteries that are 20% to 30% ? If no
why not and would you explain? 6. How would you optimize resting BP and
thus reduce the likelihood of hypertrophy?Thank you

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

Quoted message said:

Dr.Chung 1. I do not about you,but I do know from experience that
exercising at high intensity causes heart thckness,but not pathology nor
life threatening heart thickness and with the cessation of high
intensity exercise heart thickness does return to a normal level at 0.8
to 1.0 cm. In your opinion what would cause this increase in heart
thickness and than decrease to a normal level, when exercising at 70% to
80% mhr when person's BP is 115/75 (no diabetes) and would being 20
pounds over ideal weight cause the above?

Yes to the latter.

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2. In your experience as an
cardiologist does heart thickness at upper normal limits and above also
causes diastolic BP to increase (but wnl) and would an decreased heart
thickness cause diastolic BP to decrease?

You are putting the horse before the cart.

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If no what would cause an
increased diastolic BP but wnl?

Susceptibility to hypertension.

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If yes would you write approximate
numbers? 3. Would it be possible for an athletic fitness person to know
whether he has heart thickess at upper normal limits and above by
checking for any signs of increased diastolic BP at rest and would you
explain(increased diastolc BP at rest =heart thickness; no change to
decreased diastolic BP at rest =normal heart thickness)?

Higher blood pressure, either systolic or diastolic will increase the
likelihood of LV hypertrophy.

Quoted message said:

4. If an adult
athletic person was to have carotid ultasound(duplex) of both internal
carotid arteries,how would an diameter reduction be written on the
person's report: as an exact number,normal limits and what would normal
limits be?

Would vary from center to center.

Quoted message said:

5. Does having an best result between 0--10,for example on
carotid ultrasound mean that the same person would less likely have
blockages in the heart's coranary arteries that are 20% to 30% ?

No.

Quoted message said:

If no
why not

Carotid arteries are not the same as coronary arteries.

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and would you explain?

The above should be self-explanatory.

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6. How would you optimize resting BP and
thus reduce the likelihood of hypertrophy?

For someone 20 pounds above ideal body weight and no other risk
factors, I would recommend weight loss.

Quoted message said:

Thank you

You are welcome.

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

Dr.Chung 1. What should a normal as well as ideal body weight be for
5' 11.5 to 6.0 feet tall fitness adult person? 2. If a person in top
fitness condition has BP 100/70 is not fat almost all muscle,but is 20
pounds over ideal body weight, should he lose 20 pounds of body weight
to optimize resting BP and therefore have an ideal body weight and even
lower BP?Would you explain? 3. What's the best BP (and the lowest
without symptoms of low BP) that an healthy man can have? 4. Do you
know what would internal carotid arteries diameter reduction normal
limts be at some centers and also EDS(ml) , ESV(ml)? If yes would you
write it? 5. Why does exercising at high intensity level causes higher
wnl resting diastolic BP,but not systolic? 6. What would average mean
BP normal limits be during rest and exercise?Thank you

John Wendel said:

Dr.Chung 1. What should a normal as well as ideal body weight be for
5' 11.5 to 6.0 feet tall fitness adult person?

Ideal would be 160 pounds.

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2. If a person in top
fitness condition has BP 100/70 is not fat almost all muscle,but is 20
pounds over ideal body weight, should he lose 20 pounds of body weight
to optimize resting BP and therefore have an ideal body weight and even
lower BP?

No.

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Would you explain? 3. What's the best BP (and the lowest
without symptoms of low BP) that an healthy man can have?

Will vary.

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4. Do you
know what would internal carotid arteries diameter reduction normal
limts be at some centers and also EDS(ml) , ESV(ml)? If yes would you
write it?

5-10 mm for ICA diameters.

Calculated LV volumes:

ED: 50-100 mls
ES: 0-50 mls

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5. Why does exercising at high intensity level causes higher
wnl resting diastolic BP,but not systolic?

It doesn't.

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6. What would average mean
BP normal limits be during rest and exercise?

Rest:

100-125/50-75

Exercise:

150-200/50-85

Quoted message said:

Thank you

You are welcome.

Humbly,

Andrew

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

Dr.Chung 1. At what level (best ,ideal optimal not normal limits) should
wbc and rbc be for best heart function and prevention of heart disease?
2. At what level should hemoglobin,creatinine and iron be for the best
heart function and would it be better if they are at upper normal limits
or lower? 3. As you well know,there are subfractions of t.cholestrol
(hdl,ldl) and there are also hdl subfractions (hdl 2, hdl 3). If hdl 2
is linked to increased risk of heart disease while hdl 3 is not would it
be logical to measure only hdl 2 and not total hdl and what would ratio
between hdl 2 and hdl 3 be? If no why not? 4. When person in top fitness
condition has a normal BP of 100/70 would being over ideal body weight
cause diastolc BP to be higher,that is instead of being 60 it is at
70.If no what would cause it to be higher and would it be helthier (and
thus lest risk of heart disease) if it is was 100/60 instead of 100/70?
5. What would be better and therefore heart healthier in fitness healthy
person having a BP pulse pressure of 25 to 35 or 35 to 45? 6.If a person
in to fitness condition lowered his BP pressure by weight loss (no BP
drugs) from 100/70 to the upper 80's systolic and the upper 50's
diastolic (without any symptoms of low BP) would he also have lowered
his risk of CAD and other heart diseases?If yes would you write
approximate lowered risk % and would lowred BP risk be significant?Thank
you

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

Quoted message said:

Dr.Chung 1. At what level (best ,ideal optimal not normal limits) should
wbc and rbc be for best heart function and prevention of heart disease?

Within normal limits should be fine.

Quoted message said:

2. At what level should hemoglobin,creatinine and iron be for the best
heart function and would it be better if they are at upper normal limits
or lower?

Within normal limits should be fine.

Quoted message said:

3. As you well know,there are subfractions of t.cholestrol
(hdl,ldl) and there are also hdl subfractions (hdl 2, hdl 3). If hdl 2
is linked to increased risk of heart disease while hdl 3 is not would it
be logical to measure only hdl 2 and not total hdl and what would ratio
between hdl 2 and hdl 3 be? If no why not?

Imho, subfractions are not as important as cigarette smoking, weight,
CRP, and Total cholesterol/HDL ratios.

Quoted message said:

4. When person in top fitness
condition has a normal BP of 100/70 would being over ideal body weight
cause diastolc BP to be higher,that is instead of being 60 it is at
70.If no what would cause it to be higher and would it be helthier (and
thus lest risk of heart disease) if it is was 100/60 instead of 100/70?

Conventional wisdom is lower the better and that increasing weight
will increased both systolic and diastolic numbers. YMMV.

Quoted message said:

5. What would be better and therefore heart healthier in fitness healthy
person having a BP pulse pressure of 25 to 35 or 35 to 45?

Pulse pressure is a marker rather than a cause of anything.

Quoted message said:

6.If a person
in to fitness condition lowered his BP pressure by weight loss (no BP
drugs) from 100/70 to the upper 80's systolic and the upper 50's
diastolic (without any symptoms of low BP) would he also have lowered
his risk of CAD and other heart diseases?

In theory, yes. However, being that 100/70 is a normal blood
pressure, few would expect much lowering with weight loss.

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If yes would you write
approximate lowered risk % and would lowred BP risk be significant?

Probably less than 1%. No to the latter part of the question.

Quoted message said:

Thank
you

You are welcome.

Humbly,

Andrew

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

Dr.Chung 1. You wrote that leads AVF and III are not typicaly affected
by a change in position from lying on the back standard ECG to 12 leads
pretest stress echo supine and standing position.What would cause on a
standard lying on the back ECG, Q to go first upward and than QRS to go
downward in leads AVF and III,but when taken during 12 leads pretest
stress supine and standing position to go upward and be as good (perfect
normal) as they can be? 2. What would "mitral pressure halftime
(doppler)/sec" normal limits be at some centers? 3. What would normal
limts of internal carotid arteries PSV and EDV in cm/sec be at some
centers? 4. You wrote that diastolic BP should decrease 0-5 mmHg when
taken in lying position (from sitting) but what would cause it not to
decrease and even sometimes to increase by 0-5 mmHg in persons with a
normal BP at sitting? 5. You wrote "Pulse pressure is a marker rather
than a cause of anything.' Would you explain what you mean by above and
would with pulse pressure as with BP be--the lower the pulse
pressure(within normal limits) the better? If no why not? 6. Why does
diastolic pressure tends to not change after (age) 50's and even tends
to decline after 50's? 7. Is the BP 100/60 healthier(less the risk of
cardiovascular diseases) than BP of 100/70 in healthy men?If no why if
yes why? 8. As you know,if in fact the Framingham study showed that,as a
general rule, the lower the BP the longer you'll live, althrough the
risk of cardiovascular disease is,oddly enough,somewhat higher for
people with diastolic pressure aroud 70 than for those with diastolic
pressure >70?Why would risk of cardiovascular diseases be higher for
people with diastolic pressure around 70 than >70? 9. Which BP numbers
is more important--the systolic or diastolic? 10. During sleep what
should an average normal dip of systolic and diastolic BP be?Thank you

John Wendel said:

Dr.Chung 1. You wrote that leads AVF and III are not typicaly affected
by a change in position from lying on the back standard ECG to 12 leads
pretest stress echo supine and standing position.What would cause on a
standard lying on the back ECG, Q to go first upward and than QRS to go
downward in leads AVF and III,but when taken during 12 leads pretest
stress supine and standing position to go upward and be as good (perfect
normal) as they can be?

Not sure without looking at the EKGs, firsthand.

Quoted message said:

2. What would "mitral pressure halftime
(doppler)/sec" normal limits be at some centers?

The implications for this value depends on the valvular lesion that is
present.

Quoted message said:

3. What would normal
limts of internal carotid arteries PSV and EDV in cm/sec be at some
centers?

You'll have to ask someone who routinely evaluates carotids. Perhaps Dr.
Patrick Blanchard can help you.

Quoted message said:

4. You wrote that diastolic BP should decrease 0-5 mmHg when
taken in lying position (from sitting) but what would cause it not to
decrease and even sometimes to increase by 0-5 mmHg in persons with a
normal BP at sitting?

Anasarca.

Quoted message said:

5. You wrote "Pulse pressure is a marker rather
than a cause of anything.' Would you explain what you mean by above

It is as simply written as I can write it.

Quoted message said:

and
would with pulse pressure as with BP be--the lower the pulse
pressure(within normal limits) the better?

It's a marker.

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If no why not?

See above.

Quoted message said:

6. Why does
diastolic pressure tends to not change after (age) 50's and even tends
to decline after 50's?

It tends to increase albeit more slowly than systolic.

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7. Is the BP 100/60 healthier(less the risk of
cardiovascular diseases) than BP of 100/70 in healthy men?

No.

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If no why

The difference in diastolic pressure is not clinically significant.

Quoted message said:

if
yes why? 8. As you know,if in fact the Framingham study showed that,as a
general rule, the lower the BP the longer you'll live, althrough the
risk of cardiovascular disease is,oddly enough,somewhat higher for
people with diastolic pressure aroud 70 than for those with diastolic
pressure >70?

Wider pulse pressure is a marker of aortic stiffness.

Quoted message said:

Why would risk of cardiovascular diseases be higher for
people with diastolic pressure around 70 than >70?

Wider pulse pressure.

Quoted message said:

9. Which BP numbers
is more important--the systolic or diastolic?

Systolic.

Quoted message said:

10. During sleep what
should an average normal dip of systolic and diastolic BP be?

10-15

Quoted message said:

Thank you

You're welcome.

Humbly,

Andrew

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