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Question:
Why are there still regional wall motion abnormalities even after my bypass surgery?
Hi. I am 35 years old. I had a quintuple bypass surgery a year ago. My doctor said I had a heart attack before and that my 3 main arteries are blocked including my Obtuse Marginal 1. My Ejection Fraction at that time was 40%. A year later it is 47%. Will my EF still increase? Also, I have regional wall motion abnormality in 3 different parts of my heart (I think it's hypokinesia). I'm worried about this. Why is still there a regional wall motion abnormality even after my bypass surgery? Can this be reversed? I believe I have Class I NYHA because I can do normal activities and I can even play basketball. I hope to hear from you.
submitted by Alan from Seoul, Korea, on 11/11/09
Answer:
by Texas Heart Institute cardiologist, Andres Mesa, MD
After revascularization with coronary bypass, the left ventricular function improves. Regional wall motion abnormality is a term commonly used in echocardiography and other modalities that image the motion of the cardiac structures. It means that the motion of a region of the heart muscle is abnormal. It can be reduced (hypokinesia), absent (akinesia) or increased (hyperkinesia). Occasionally it can be opposite of what is expected; for example, moving out in systole rather than moving in. This type of abnormal motion is termed dyskinesia. The regional wall motion abnormalities give a hint to the coronary arteries which are diseased. For example, if the lower region of the left ventricle (inferior wall) is hypokinetic, this means that the right coronary artery is involved. If the whole left ventricle is hypokinetic, then it is called global hypokinesia. This occurs in dilated cardiomyopathy. Persistent wall motion abnormalities could represent previous scar. Given you have CHF NYHA function I, that's an excellent prognosis.
[In order to determine the best course of therapy, physicians often assess the stage of heart failure according to the New York Heart Association (NYHA) functional classification system. This system relates symptoms to everyday activities and the patient's quality of life.]
Class I (Mild)—No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath).
Class II (Mild)—Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.
Class III (Moderate)—Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.
Class IV (Severe)—Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.
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Updated November 2009
