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Enlarged atrium

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Mellie137 Diagnosed 2009. Left asymmetric septal myopathy. No surgery, no device. COE University of Texas Health Science Center at San Antonio. Find out more about Mellie137
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  • Enlarged atrium

    I feel like I don't clearly understand my condition and concerns. Just saw Dr. Feldman at COE UTHSCSA. I have frequent PVCs that I don't always feel. It improved when I cut caffeine from my diet, but I still have them. My atrium is "severely enlarged" according to recent echo. It was normal(ish?) 2 years ago. My septum is about 2cm and hasn't changed much since my Dx in 09. My Ef is normal--65% I think. I exercise almost daily 20-60 minutes. Some cardio, but I'm cautious. We're doing a 24hr holter. High cholesterol--224, so I'm working on that. What is the concern with a large atrium? What causes it? What questions can I ask to clarify my risk? Started daily baby aspirin with COE cardio's approval. Thoughts?

  • #2
    Hi Mellie,
    1) PVCs: The number of PVCs per minute and whether you are having runs of PVCs.... several in a row ..... Is what they will be looking for on the holter.Even normal people without HCM have PVCs. So with risk of vtach that sometimes accompanies HCM that is what they are evaluating
    2) enlarged atrium: First thing is to know that you have 2 atriums... right and left. I'm assuming it is left atrial enlargement, as that is most common in HCM. In HCM you can develop very high pressures in the left ventricle due to thickening, stiffness and obstruction to outflow. These high pressures can cause chronic back up of blood flow into the atrium, causing it to enlarge. An enlarged atrium can more easily go into atrial arrhythmias.... like atrial fibrillation. ( they will look for this on holter also). Persistent atrial fibrillation requires anti coagulation therapy for stroke prevention. or may be treated with an ablation procedure.
    It sounds to me if you are able to exercise 30-60 mins a day that you may not have too many symptoms at this time....is that right?
    You need to sit down with your doctor, tell him you do not understand your condition completely and want all your risk factors explained: Risk for Vtach, risk for afib, do you have obstruction? What is their plan, is there a role for septal reduction surgery? What parameters are they watching for that would change their plan. Ask them to go over your echocardiogram and explain what is going on.
    Read up on HCM, they offer an easy to understand paperback through this website. Also COEs like Mayo and Cleveland clinic have some comprehensive explanations of HCM on their websites and their experts often have U tube presentations.
    Hope this helps.
    I had enlarged left and right atriums....I never went into afib. After my septal myectomy the pressures in my heart went down and within a year and a half, both atriums remodeled to a normal size.
    Hope this helps
    After years of symptoms:
    Officially Diagnosed HOCM 2006
    Myectomy 3/11/13 at non-COE
    Extended Myectomy 7/23/14
    At Mayo with Dr. Joseph Dearani

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    • #3
      Thank you for responding quickly. My symptoms are mostly arrhythmia. Several months ago I had 100 PVCs per hour. COE cardio told me to cut out caffeine, which reduced PVCs to normal. I occasionally have more uncomfortable symptoms, and head to the urgent care to get checked out. This is maybe once a year. No consistent results. Nothing serious. I had a chronic cough that turned out to be neuropathic and resolved with several months of Baclefen. I have occasional SOB and fatigue that usually resolves with attention to sleep hygiene and hydration. Had a full stress test a few years ago, and a battery of tests including color MRI. At the time, I was told no obstruction, no activity limitations. Just stay on metoprolol (100 mg ER). In January, had some loss of balance that alarmed my husband. Urgent care ruled out stroke and serious things, but recommended admission for more tests. 3 days later: good blood work, no stroke, heart or brain event, strong Romberg positive. No diagnosis. Went home, symptoms just resolved with no explanation. Flu the next day. My ENT suggests it was vestibular neurosomething. Cardio is concerned it may be related to a clot. So,here we go. I have the book and will re-read. It was very helpful when I was first diagnosed. I remember most the statement that HCM is consistent with normal life span. That helped to keep things in perspective. I'll bring your suggested questions to my next appointment.

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