Spontaneous Contrast On Echo

[CT529]

I'm a 42 year old white male in overall good health.  Non Smoker, runner (9 - 12 miles per week) and healthy diet.  No history of heart disease in my family but on 20 mg of Lipitor (chol. 145 at last physical with 60 HDL).  Two years ago I had an abnormal EKG during a routine physical that was indicative of mild LVH.  My GP referred me to a Cardiologist and I had an Echo which turned up negative for LVH, but she did see a spontaneous contrast in the Inferior Vena Cava.  As a result, I underwent a thallium stress test, (ran for 15 minutes and scored 111% of normal and had an ejection fraction of 65%+) wore a holter monitor for 24 hours and went through an extensive workup of blood tests for my hypercoagulable state.  All tests came back fine and my cardiologist asked me to come back in two years.

One year later my EKG during my physical again came back indiciative of LVH but my primary care said I was fine due to the heart echo one year prior.  This year (now two years from the original event) I returned to my cardiologist for a checkup.  The EKG was again abnormal and the heart echo showed exactly the same results (spontaneous echo) as it did two years ago.  My cardiologist told me she would be more concerned if something on the echo had changed in the past two years. I asked her if she had ever seen something like this in a patient that otherwise appeared normal and she had not.

I have no syptoms other than a mild sensation (almost feels like a small burning/tearing feeling under left armpit).  I never felt this condition until after the discovery of the abnormal EKG three years ago so I wonder if its not just in my mind.  I will tell you I have some pretty signficant white coat syndrome and my BP does go up 140/90 when I go to any Doctor's office.  Continue to excercise routinely (just ran a 9 mile race six weeks ago) and never feel any issues.

Any ideas on what this might be.....how concerned should I be? would you suggest I solicit a second opinion?

[Lee Kirksey, MD]

Hello
Without seeing the study for myself, this finding appears to be an anatomically normal finding for you. It clearly is unrelated to the heart structures. All of your labs appear to be normal. I tend to agree with your doctors that your work up is unremarkable

[CT529]

Thanks for your response.  During both echocardiograms she saw a swirling of blood in the inferior vena cava ---- the term they used on the echo report was a spontanteous contrast.  

The bloodwork I referenced included  Prothrombin Gene Analysis, Partial Thromplastin Time, Protein C Activity & Antigen, Protein S Acitivity & Antigen, Anitthrombin Activity,  Homocysteine, Full CBC and many others --- all came back within normal ranges.

[Lee Kirksey, MD]

Hello
First, congratulations on your effort and attention to your health. Im not quite sure what this term sponaneous echo and spontaneous contrast means. I am going to speak to one of my colleagues with expertise in echo.

Clinically, it appears that there is a low liklihood that this actually represents a significant problem. Based upon the lack of any other finding

I think that a second opinion to review the test and the results might allay some of your concerns.

The mind is very powerful and it is certainly possible that there is some somatic component to your new symptoms.

Please confirm the accuracy of these terms and Ill do some due diligence on my side to investigate.