Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 35 yo female 5'7" (170 cm) 180lbs (81.6kg) Caucasian and Native American I have previously had high blood pressure, but as of the last year or so my blood pressure has become very LOW for undetermined reasons, with my most recent reading being 101/60Primary symptoms: Decreasing general health for the past ~3 years, primarily presenting as severe fatigue, syncope + nausea when overheated or standing up too quickly, needing a minimum of 10-12 hours of sleep every night to feel rested, general malaise.I have asthma, ADD, MDD. Drink occasionally; previous occasional smoker but quit ~5 years ago. Same for recreational drugs -- on occasion when I was younger, but none for at least 5 years. I had previously been diagnosed with Rheumatic Fever in 2015, which seems VERY relevant here, but every doctor I've tried to discuss it with brushes it off when I mention it.So, last month I finally got a referral to a cardiologist, after years of trying to get one, and I was given a heart monitor to wear at home for two weeks, and then on Dec 23rd I had an echocardiogram ultrasound done. After trying and failing to get ahold of them by phone, Friday I FINALLY received a letter in the mail with my results. The front page of that letter states that all my tests were normal, and no follow-up is needed.THEN, that same letter goes on to detail in the next few pages that I have a small left ventricle, sinus tachycardia with an average heartbeat ranging from 90-150 bpm, paradoxical septal motion, mild pulmonary valve regurgitation, a thickened mitral valve, mild mitral valve regurgitation, trivial tricuspid valve regurgitation, and then it states that my "right ventricular systolic pressure could not be estimated due to inability to detect peak tricuspid regurgitation" and that my pulmonary valve stats were also inconclusive due to "poor visualization".The "inconclusives" I suppose could go either way, and I don't know if those are something I should try to get more testing for to clear up or not. But the rest definitely does not sound "normal" to me, and based on a quick Google search most of those things seem to be more common in someone who has had previous cardiac surgery, which I have not, and/or they usually go hand-in-hand with severe pulmonary hypertension, and as previously mentioned, my blood pressure has been consistently LOW, to the point of being almost abnormally so, for at least the past year.So, is there anyone who can confirm that all those abnormalities could be found, while still falling within the "normal" range of test results? Am I just reading too much into this, or am I right in thinking that my cardiologist didn't do his job properly, and a second opinion is needed?Update: Wow this really took off way more than I expected! I went to bed early last night, was busy with other stuff this morning, and then I'm American, so I have been thoroughly distracted by the absolute shitshow going on in DC ever since..., so I haven't logged on to Reddit to check back on responses until just now. Thank you to everyone for what looks like some very educated replies; I'm working my way through them and will try to respond more thoroughly tomorrow after a good night's (hopefully) sleep!. ### Response: Nearly all of the things youve described are seen on essentially every echo report. Trivial and trace and mild regurgitation are seen in one or more valves of (what I estimate to be) the vast majority of healthy people. The regurgitation is only really abnormal if its significant (moderate or severe). Its important to mention any at all, though, so the previous report can be compared to any future ones (among other reasons). The reason theres a lot of could not assess...poor visualization all over the report is because this was a transthoracic echo. If they need better visualization of those structures, they would need to do a transesophageal echo which is a really not-fun procedure which requires you to be sedated, and is usually reserved for people with high suspicion for infective endocarditis or severe cardiac disease involving the poorly visualized structures.The rest of the findings could be related to pulmonary arterial HTN, which youve already mentioned. PAH is not the same as hypertension in general. The lung circulation is separate from the systemic circulation (though obviously the two are connected) and PAH is usually due to changes in the lung structure or function. For example, COPD, pulmonary fibrosis (scarring in the lungs), or - my attendings personal favorite underdog in the world of heart/lung issues - sleep apnea.The full report of any diagnostic study, like an echo, is always going to have something that doesnt sound completely normal in it - the wonderful world of incidental findings. Thats why its important to go by what the cardiologist or other ordering physician interprets from the echo. Its also why every diagnostic report has a disclaimer along the lines of correlate with clinical findings. In the context of your presentation, the echo that you had done was essentially normal. Its what my own echo report said despite results that could have been used to diagnose someone with heart failure with reduced ejection fraction had they been a 68 year old with blood pressure of 155/100 for the past 25 years, extra heart sounds, and shortness of breath.Your echo was done, I presume, to look for rheumatic heart disease in the context of your clinical findings (which could be consistent with that, though its rare to get this from only having rheumatic fever once). These findings arent really consistent with RHD. The mitral valve is slightly thickened, which may be the result of the rheumatic fever, but the report does not show mitral stenosis (the expected consequence of RHD).What Id recommend doing is writing down the findings youve seen on the report, including your concerns about what they could mean, and other good questions youve asked in your post here (like about pulmonary artery hypertension, and the poor visualization of certain structures on the echo and how important these inconclusive findings would be to a diagnosis) and take them with you to the next appointment. Because your cardiologist has a more complete picture of your clinical presentation and other health info, they are the best person to help guide you through the report, why they do not feel this echo has shown the underlying problem, and the next steps to take.Best of luck to you, and thank you for the question! Echo reports are always confusing and concerning to many who arent aware that many of the abnormal findings are often normal variants, so this is a great post to discuss that with..