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Query about echo interpretation.

Resolved Question:


I performed 2 heart echos recently:

- August 2012
IVS thickness: 0.9cm

- November 2013:
IVS thickness: 1.5cm

The difference between August 2012 echo and November 2013 echo is that I was anxious for the last echo with heart racing during the exam (with hyperventilation because really stressed out).

What can explain such a difference for the IVS thickness between both echos?

Thank you/

Category: Cardiologist

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Category: Cardiologist
 19 Doctors Online

Thank you for your query at
Are you hypertensive?
What is your age?
Do you have family history of sudden cardiac deaths or hypertrophic cardiomyopathy?
What is the thickness of posterior wall?
What is the ejection fraction?
What are your complaints or symptom?

The best possible explanation for this sudden increase in IVSis an interobserver or interobserver error. Other possible explanation are new onset hypertension though unlikely to progress so rapidly.
IVS can be thickened in hypertrophic cardiomyopathy but that is already evident in adolescent period. So if you are already past the age of 20 22 then hypertrophic cardiomyopathy doesn't explain the IVS showing increase in thickness. Also the ivs should be more than 18 mm for it to qualify as hypertrophic cardiomyopathy.
You can reply as a follow up. Thankyou
Dr Vivek Mahajan
DM Cardiology

Patient replied :

Thank you.

Hypertensive? Well, I'd say I have been very emotive and stressed out those last 2 years with periods of anxiety and hyperventilation. In this situation, my blood pressure can be around 145/70.
In relaxed situations, none of those phenomena happen and I am consistently around 125/70 or 130/75

Age: 34 (was 34 for the 2013 echo and 33 for the 2012 echo)

No family history of sudden cardiac deaths or hypertrophic cardiomyopathy (but history of high blood pressure and stroke)

Complaints of symptoms: none but sometimes I can feel (when I think about it or feeling worried, tired, overworked by my job) like a missing heart beat and a stronger heart beat not followed by palpitation (I did my 2013 echo because of that as I started worrying - my 2012 echo was because those anxiety attacks I never had before)-

Here are all the numbers for my 2013 (performed in November) echo:
As you will see, some numbers are different between 2013 and 2012 (IVS, LVPW, RV, IVC and EF)

Thank you.
IVS Thickness
DIA: 1.5 (in 2012, it was 0.93)

LV Diameter
DIA: 5.1
SYS: 3.1
FS: 39%

LVPW Thickness:
DIA: 1.1 (in 2012, it was 0.93)

D-E: 2.1
E-F: 21.4

Ao DIAd: 3.1
LA/DIAS: 3.7

RA: 3.8 cm

RV: 3.9cm (it was 2.2 cm in 2012)

IVC: 2cm (it was 1.6cm in 2012)

EF: 69%

4 CH EF: 75% (was 66.4% in 2012)
2 CH EF: 73%
DECEL TIME: .190 sec
E/A: 1.18
MVA: 3.5
LA/AO: 1.20
IVRT: .080
e1PRIME: 5.7

LV size appeared norma
IVS looked thick (1.5cm)

No wall abnormalities

LA appeared normal size

RA et RV upper limits of normal

Trace to mild PI
Aortic valve looked sclerotic good excursion and no AI seen
Mild TR (est. PaP = 28.3 mmHg)

IVC = 2cm and did collapse with inspiration

Mitral valve shows good excursion

Trivial MR

No masses, thrombi or PE's noted

You dont seem to have hypertrophic cardiomyopathy from your history profile. And neither is the hypertension severe to such an extent that it will cause such rapid progression of ivs thickening.
So the best explanation is an observer error in all likelihood.
So you may please get a second opinion on the echo .Kindly get a repeat echo done by an independent examiner. Most likely it would show normal thickness of ivs

Dr Vivek Mahajan
DM Cardiology

Patient replied :


Thank you for your advice that I will follow.

Also because this period of intense stress and palpitations I had last November (reason why I did an echo), a Holter monitor study was performed on me during 48hrs.
The results are:
The patient's predominant rhythm was normal sinus rhythm.
There were occasional pauses of less than 2 seconds {with any significant PVCs or SVT} and occasional bouts of tachycardia with sinus tachycardia with spontaneous resolution.

Are those "less than 2 seconds pauses" 'normal' ?

Thank you -


Pauses less than 3 seconds need not be treated and are not a cause of alarm and specially more so if they do not cause symptoms like syncope or dizziness
Dr Vivek Mahajan

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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