HEART FUNCTION TESTS

Dr..Chung 1. What blood test is the best test in diagnosing an accute myocardial infraction: GOT, LDL, troponin I, CKMB, index, CPK? 2.
What blood test is the best test in diagnosing an accute myocardial infraction at 12--18 hours(since onset of symptoms)? 3 Would troponin I < 0.1 ng/ml and troponin I < 0.15 ng/ml mean the same? 4. Does troponin I measures anything < 0.1 ng/ml,like 0.05 ng/ml, with a normal limits of 0.00--1.5ng/ml? 5.Does jogging 60 minutes x 6 days a week plus inteerval training 2 x a week (fastest running as possible)
increase CKMB from 0.0 to 2.0 or 3.0 ng/ml ,but still within normal limits of 0.0--6.0 ng/ml?If yes why? Thank you

Dr.Chung 1. Do you think an athlete having a Aorta size between 2-3cm on Echo (normal limits 2--3.7cm) would be in better fitness and heart health than an athlete who has Aorta size between 3- 3.5cm ? If no why if yes why? 2.You wrote "U waves during a stress test are of unclear signifiance" but would the above .1 on ECG stress test mean that st depression is .1? If no what does it mean? How would you write normal heart sounds on an patient examination?Thank you

Dr.Chung Would you answer last questions?

Dr.Chung 1. First (a year ago) CKMB was 1.0 ng/ml and the second (this month) was 2.3 ng/ml thus laboratory measurement variance is 1.3 ng/ml.
Would CKMB variance of 1.3 with normal limits of 0.0--6.0 ng/ml be within manufacturer specs? 2 Would very hard exercise (racing) for extended period of time increase CKMB by at least 0.5 to 1.0 ng/ml? 3.
Are there any medically differences between 0.0, 0.1 and 0.15 ng/ml
Troponins I results and would there be an high probability that above all three numbers mean the same? 4. Would BNP blood test with normal limits of 0--100 pg/ml detect anything less than 5.5 pg/ml? 5. Would
BNP of < 5.0 pg/ml be helpful in diagnosing LVH,CAD,CHF etc?If yes how?Thank you

You are welcome.

Dr.Chung 1. What should a normal as well as ideal body weight be for
5' 11.5 to 6.0 feet tall fitness adult person? 2. If a person in top fitness condition has BP 100/70 is not fat almost all muscle,but is 20 pounds over ideal body weight, should he lose 20 pounds of body weight to optimize resting BP and therefore have an ideal body weight and even lower BP?Would you explain? 3. What's the best BP (and the lowest without symptoms of low BP) that an healthy man can have? 4. Do you know what would internal carotid arteries diameter reduction normal limts be at some centers and also EDS(ml) , ESV(ml)? If yes would you write it? 5. Why does exercising at high intensity level causes higher wnl resting diastolic BP,but not systolic? 6. What would average mean
BP normal limits be during rest and exercise?Thank you

Left ventricular hypertrophy can cause it. Typically there are no symptoms associated with early repolarization.

Dr.Chung 1. You wrote that "The precordial leads would be the most effected primarely by voltage amplitude but not "non-specific ST-T wave changes" Are leads II, III,,AVL and AVF also affected by change in position from lying on back standard EKG to 12 lead pretest strss echo supine and standing position and in what way,especially QRS and ST?
2..What would the difference between the resting ECG:Normal. Normal sinus rhythm.Normal axis,intervals and wave forms.Early repolarization (normal variant) and the resting ECG:Normal Normal sinus rhythm be other than one being called a normal and other normal variant? 3. If top fitness causes early repolarization (normal variant) and sinus bradycardia (normal variant) and I guess abnormal ECG would it be better not to exercise at all,not to be in top fitness condition and therefore have an normal ECG? 4. Are there any scientific studies that did show whether it is better to have early repolarization (normal variant) than normal ECG and the other way around? 5 Can early repolarization (normal variant) be called an enigma by doctors?Thank you

Normal blood pressure is 115/75 or less.

Other things that cause concentric LVH are diabetes and obesity.

It is not predictable whether early repolarization will remain present lifelong on someone's EKG.

Higher blood pressure, either systolic or diastolic will increase the likelihood of LV hypertrophy.

For someone 20 pounds above ideal body weight and no other risk factors, I would recommend weight loss.

No. Aortic diameter says nothing about either fitness or heart health.
Someone with upper limits of normal aortic diameter is probably more likely to have a history of elevating resting blood pressures.

Don't know. If there was 1 mm ST depression anywhere, it should have been clearly written.

Dr.Chung 1. You wrote "Unregulation of potassium channel number in the myocytes." Would you explain what you mean by the above and why would early repolarization normal variant show up on an resting ECG of a person who does not have any evidence of heart disease? 2. How would call olympics gold medal winners early repolarization normal variant ECG diagnosis during the games: ABNORMAL ECG, NORMAL ECG, BORDERLINE ECG? 3.
What would left ventricular EDV(ml) and ESV(ml) echo measurements be in an average healthy sedentary adult male and in person who exercises,but is not addicted to exercise? 4. What should normal (limits) BP be at stage 3.4.5 Bruce and than 1,2,3,4,5 minutes during cooling down? 5.
What would mitral valve area normal limits be in cm2(optimal number)Thank you

His/her experience may be different from mine. Athletic hearts do get bigger but I not seen them get thicker.

You are welcome.

Dr.Chung 1. How would you write on patient report early repolarization (normal variant) diagnosis if found on EKG? 2. Is it normal for LVPWD to be greater than IVSD by 0.1 to 0.2 cm and other way around and what causes this small differences? 3. If a patient has on his stess echo report "No evidence of myocardial ischemia,pericarditis,Dressler's syndrome,or other cardiovascular abnormality" and I guess no indentified heart disease why would according to you Dr.Chung "nonspecified st-t wave changes,wnl" on the same report be abnormal? 4. Would exercising at 80 to 88 %mhr at above FIT cause mild LVH? 5. Do any leads change shape and form from lying on the back standard EKG to 12 lead pretest stress echo supine and standing EKG and which leads are most affected by a change in position,which are not effected and how are the effected reflected in a shape and form?Thank you

Dr.Chung 1.Do you agree with me that CRP (not HS CRP) can not detect levels <0.30 mg/dl? 2. What would on echo report "There is no evidence of IHHS or dynamic left ventricular outflow tract obstruction " mean and what do IHHS letters stand for? 3. "No valvular abnormality. Trivial mitral regurgitation is normal." How can there be a trivial mitral regurgitation which is normal? 4. "No evidence of myocardial ishemia,pericarditis,Dressler's syndrome,or other cardiovascular abnormality" What would no evidence of myocardial ischemia and
Dressler's syndrome mean and would the above sentence mean that there is no evidence of old heart attacks? 5. "RESTING ECG; NSR,NONSPECIFIC ST-T
WAVE CHANGES, WNL'' What would nonspecific st-t wave changes wnl meanThank you

You are welcome.

Dr.Chung 1. If an patient comes to you and you examine this person (history,physical etc) and also do an stress echo and find no abnormality ,except on a resting ECG early repolarization (normal variant).Would you write on this patient report your only diagnosis on resting ECG as early repolarization (normal variant) in this way; "ECG:
Normal. Normal sinus rhythm at 71. Normal axis,intervals and waveforms.
Early repolarization (normal variant)." ? If no why.If yes why? 2. Are you saying when person is sedentary and does not exercise at all (none)
and when this same person exercises at the above FIT level and is in a top fitness condition that this person will have the same wall thickness (LVPWT and IVSD).If no would you explain? 3.In your experience as a cardiologist does above FIT exercise increase heart thickness by any (small) amount ,but still within normal limits of 0.6 to 1.1 cm? If yes by at most what number?4. Dr.Chung you said "Athletic hearts do get bigger but I not seen them get thicker." Cardiologist agrees with you that indeed athletic hearts do get bigger,but they also get thicker than non athletic hearts and by the way what would an average athletic heart thickness be in cm? (LVPWD and IVSD)5. If an healthly olympic athlete has a slightly elevated heart thickness at 1.2 to 1.3 cm would you urge this athlete even though he has won medals to stop further training until heart thickness falls below 1.1 cm and at what level in cm would you consider heart thickness pathology?Thank you

Dr. Chung 1. The ECG findings is from the resting ECG written on Echo report.It is not from a stress-echo ,done 10 minutes later and which was normal and I guess it is not from an ECG tracing that computer prints out,because on almost all tracings that computer prints out is written
NSR.NORMAL ECG with the eception of 2 to 3 false borderline ECG tracing and they were found to be normal by an Echo. 1. Do you think if there is no evidence of myocardial ischemia and if it is not caused by top fitness that it can most likely represent early repolarization? 2.
Are there any other possible causes other than CAD blockages that can cause nonspecific st-t wave changes wnl ? 3.Would it be possible to have on ECG,only st segment elevation,but no other abnormality and never have had heart attack? 4.What would early repolarization mean,how is it diagnosed and does it ever go away or stays for life? 5. How would early repolarization findings be called: normal,abnormal and if abnormal on scale from 1 to 10 what would it be (in terms of life threatening)Thank you

You can use any measuring equipment and do multiple serial measurements of the same thing/sample and not get exactly the same number. This is ok as long as the variance in within manufacturer specs.

Dr.Chung 1. Would IVSD 1.1cm and LVPWD 1.1 cm with a normal limits
0.8--1.2 cm as well as IVSD 1.0 cm and LVPWD 1.0 cm with a normal limits 0.6--1.1 cm be normal and not concertic LVH and any other LVH and would being 20 pounds over ideal weight increase heart thickness by at least 0.2 to 0.3 cm? 2. Does above FIT exercise,especially 100 meters dash sprints increase heart thickness by at least any amount (0.1 cm)?If yes by at most what number? 3. Do Axis: P, QRS, T normal numbers on
ECG excludes left axis deviation?4. If a healthy person trained his heart to the outermost point or to the greatest degree possible and has achieved his goal,but also did get as result mild LVH and than suddenly stops all exercise (not because of the heart,mild LVH or other health conditions) at the achieved peak goal for two months . Would this person be at the above average risk of getting an heart attack in the two months following sudden stoppage of all exercise and would and also should by and chance PAC or PVC start would it be better for this person to start exersing again ,at lower FIT at first? 5. Would you call early repolarization (normal variant) ECG Normal ECG?

Imho, subfractions are not as important as cigarette smoking, weight,
CRP, and Total cholesterol/HDL ratios.

Conventional wisdom is lower the better and that increasing weight will increased both systolic and diastolic numbers. YMMV.

In theory, yes. However, being that 100/70 is a normal blood pressure, few would expect much lowering with weight loss.

Trace amounts of regurgitation involving the mitral valve are likely inconsequential.

No evidence means that nothing was seen that would lead to the diagnosis of either.

wnl usually means "within normal limits," however ST-T wave changes (even non-specific ones) are not normal, imo.

"early repolarization - possibly a normal variant if heart is known to be structurally normal"

It would remain an abnormal EKG finding even if refuted by further cardiac testing.

The precordial leads would be the most affected primarily by voltage amplitude but not "non-specific ST-T wave changes.

Dr.Chung 1. At what level (best ,ideal optimal not normal limits) should wbc and rbc be for best heart function and prevention of heart disease?
2. At what level should hemoglobin,creatinine and iron be for the best heart function and would it be better if they are at upper normal limits or lower? 3. As you well know,there are subfractions of t.cholestrol (hdl,ldl) and there are also hdl subfractions (hdl 2, hdl 3). If hdl 2 is linked to increased risk of heart disease while hdl 3 is not would it be logical to measure only hdl 2 and not total hdl and what would ratio between hdl 2 and hdl 3 be? If no why not? 4. When person in top fitness condition has a normal BP of 100/70 would being over ideal body weight cause diastolc BP to be higher,that is instead of being 60 it is at
70.If no what would cause it to be higher and would it be helthier (and thus lest risk of heart disease) if it is was 100/60 instead of 100/70?
5. What would be better and therefore heart healthier in fitness healthy person having a BP pulse pressure of 25 to 35 or 35 to 45? 6.If a person in to fitness condition lowered his BP pressure by weight loss (no BP drugs) from 100/70 to the upper 80's systolic and the upper 50's diastolic (without any symptoms of low BP) would he also have lowered his risk of CAD and other heart diseases?If yes would you write approximate lowered risk % and would lowred BP risk be significant?Thank you

Dr.Chung 1.Your answer to my last number two question was "Laboratory measurement variance." Would you explain what do you mean by the
Laboratory measurement variance since both CKMB tests were done at the same lab,but only a year apart? 2. I do know that standard CRP blood test cannot detect CRP levels <0.30 mg/dl . Is the same true with
Troponin I levels <0.1 ng/ml and <0.15 ng/ml (that is , Troponin I cannot detect Troponin I levels < 0.1 ng/ml and at some labs <0.15 ng/ml)? 3. If Troponin I cannot detect Troponin I levels <0.1 ng/ml and at some labs < 0.15 ng/ml than I guess an result reported as <0.15 ng/ml can mean any number from 0.00 to <0.15 ng/ml? 4. What would average levels of Troponin I and CKMB be in men who do not have heart disease and who do have CAD? 5. In men who had large and small heart attacks,how long after heart attacks do Troponin and CKMB stay elevated,at what levels and would 6 weeks later they still be slightly elevated,but within normal limits.Thank you

Dr.Chung. 1. Would an athlete whose resting ECG is a normal and does not have early repolarization and sinus bradycardia normal variants be in better fitness condition and heart health than an athlete who has both above normal variants and does not have any symptoms nor any symptoms of heart disease? 2. Do most athletes who are in top fitness conditions also have normal variants,like early repolarization and sinus bradycardia? 3 If there is no other difference oter than one being called normal and other normal variant why would you not write diagnosis as: ECG: Normal. Normal sinus rhythm. Normal axis,intervals and waveforms.Early repolarization (normal variant)? 4. If you are not sure whether (your findings) is normal or normal variant would you write it as above? If no, how would write it and define it? 5. You wrote that on a scale from 0 to 10 zero being the lowest and ten the highest abnormality (on a resting ECG) early repolarization would be a 1,but what about an normal ECG,what would it be between 0 and 1?Thank you

Potassium channels are involved in repolarization. The more you have, the quicker the repolarization.

These are actually calculations based on LVEDD and LVESD measurements.
We've discussed the normal limits for these measurements already in the past. These normal limits are applied uniformly without regard to athleticism.

Normal mitral valve area is typically greater than 3 cm2. There is no
"optimal" number.

Dr.Chung 1. If the Troponin I result is reported as 0.1 ng/ml with a normal limits of 0.0--1.5 ng/ml would one have to assume that above result is anywhere from 0.05 to 0.15 ng/ml or is the above result 0.10 ng/ml? 2. If a person has jogged 60 minutes and plus within this time has also done interval running (fastest racing) and that after 12 to 18 hours is tested and CKMB blood test is 2.3 ng/ml with normal limits of
0.0--6..0 ng/ml,what would have caused CKMB to increase to 2,3 ng/ml from 1,0 ng/ml when this same person is jogging 45 minutes,but has not done interval racing? 3. Does fast running (racing) increase CKMB by at least 1.5 ng/ml?4.Do skeletal muscle injuries cause CKMB to increase by
1.3 ng/ml to 2,3 ng/ml with normal limits of 0,0--6.00ng/ml? 5. Would having Troponin I <0.1 ng/ml and CKMB 2.3 ng/ml at 12 to 18 hours since symptoms started be enough to diagnose an accute myocardial infraction or more blood tests like GOT ,LDH is needed?Thank you

Dr.. Chung 1. If an board certified cardiologist,like you except older than you had written the above findings of early repolarization, do you think that he was wrong in his findings and unqualified to be cardiologist? If no would you explain? 2. You wrote that normal blood pressure is <115/75,but what about normal blood pressure when lying and sleeping and also taken standing? 3. By what number should diastolic fall (from sitting position) when measured lying as well by what number should it increase when measured standing and the same for systolic? 4
What would normal pulse pressure limits be : at rest and during (maximal) stress test? 5. Does having BP 180/76 at stage 5 Bruce exclude abnormal blood pressure for this person in the near future?Thank you