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  • gradient

    Hi everyone, I just got back from picking up packet from my cardiologist to take with me to Cleaveland next week. The packet was taped shut so I ,of course had to open it.
    In it was a tape of my echos, a written report of my last echo and a letter written by my cardiologist and a final interpretation. I wonder if anyone can help me decipher some of this information?
    1. The written echo report says resting LVOT of 40mmHg , but the letter says that I have a resting OVT gradient of 73 mmHg and that it is actually a bit higher than I had previously. Why the different numbers?
    2.What is SBE prophylaxis ?
    3.The Final Interpretation by the D.O. who read the echo says that the findings are similar to the last echo except for mild reduction of the LVOT gradient.
    4. What is the definition of gradient?
    Any information to help me understand this would be greatly appreciated. Thanks

  • #2
    Re: gradient

    I'll try to help.

    1. Gradients vary and may be a little different each time they're measured.

    2. SBE prophylaxis is taking preventative antibiotics before any invasive work such as dental procedures, even cleanings.

    3. You haven't changed much since last visit, except gradient might be a little less.

    4. Gradient is the pressure inside the heart.

    Hope this helps.


    Husband has HCM.
    3 kids - ages 23, 21, & 19. All presently clear of HCM.


    • #3
      Re: gradient


      Your gradient is a measure of pressure in mmHg (or millimeters of mercury) that builds up inside your left ventricle as a result of the obstruction caused by your HCM. It is directly proportional to your LVOT velocity (in meters per second), which you may also have seen on your reports. If you take your LVOT velocity, square it, then multiply that number by four, it should roughly approximate your gradient.

      Basically, all of this means that because of your enlarged septum, your mitral valve does not make good contact with the septum and as a result, there is a buildup of pressure behind it. Think of it like taking a garden hose and holding your thumb across the opening. The more you close the opening, the higher the pressure there is behind it (your gradient) and the faster the water tends to squirt out (your LVOT velocity).

      I myself have been recorded with a resting gradient of over 100mmHG with an LVOT velocity of 6 meters/sec or more. My doctors will not even try to test it under stress because it would be too dangerous. We're currently treating it with beta-blockers in the hope that my heart will relax and my gradient will go down below 30mmHg, but it is unlikely. We'll exhaust every drug-therapy available, then begin talking about surgery.

      I hope that this has answered your question,

      "Some days you're the dog... some days you're the hydrant."


      • #4
        Re: gradient

        Thank you both for your help. I,m trying to make sense of all this and prepare myself for my evaluation at CCF.


        • #5
          Re: gradient

          I was in Cleveland in January. If you are seeing Dr. Lever, don't be afraid to ask any questions you have on what these things mean. He was very willing to explain things in terms you can understand. Tthey are very thorough, good luck.