Can you explain in plain language what my echocardiogram results—normal biventricular size and function with left ventricular ejection fraction 63%, normal diastolic function, mildly enlarged left atrium, normal right atrium, no significant valve disease, and mildly enlarged ascending aorta measuring 4.2 cm (indexed 1.9 cm/m²)—mean and what treatment or follow‑up is needed?

Your Heart Ultrasound Results Explained

Your heart is functioning normally overall, but the mildly enlarged left atrium requires attention and regular monitoring because it signals chronic stress on your heart that increases your risk of atrial fibrillation, stroke, and heart failure—even though your heart's pumping function is excellent. 1

What Each Finding Means

1. Normal Heart Pumping Function (LVEF 63%)

• Your left ventricle (main pumping chamber) has an ejection fraction of 63%, which is normal (normal range is ≥54% for men, ≥57% for women using 3D measurement). 2, 3
• Both the right and left sides of your heart are pumping blood effectively with normal chamber sizes. 2
• Your heart muscle contracts and relaxes normally, meaning blood flows in and out of your heart properly. 2

2. Mildly Enlarged Left Atrium (The Important Finding)

• Your left atrium (the upper chamber that receives blood from your lungs) is mildly enlarged. 1
• This enlargement reflects chronic elevated pressure in your heart over time, even though your pumping function is normal. 1
• This is the most significant finding because it independently increases your risk of developing atrial fibrillation (irregular heartbeat), stroke, heart failure hospitalization, and mortality—regardless of your normal ejection fraction. 1
• The enlargement provides independent prognostic information with measurably higher hazard ratios for adverse cardiovascular outcomes. 1

3. Normal Heart Valves

• All four heart valves are working properly with no significant leakage or narrowing. 2
• The trace amounts of leakage mentioned are physiologically normal and clinically insignificant—they occur in healthy hearts. 4

4. Mildly Dilated Ascending Aorta (Normal When Adjusted for Body Size)

• Your ascending aorta (the main blood vessel leaving your heart) measures 4.2 cm, which is mildly enlarged by absolute measurement. 5
• However, when adjusted for your body surface area (indexed measurement), it is 1.9 cm/m², which falls within the normal range. 5
• Normal indexed values are typically <2.1 cm/m² for most adults. 5

What Treatment or Follow-Up You Need

Immediate Actions

1. Blood Pressure Control (Critical)

• Have your blood pressure checked immediately; if it is ≥130/80 mmHg, you need aggressive blood pressure control to prevent progression to heart failure. 1, 4
• Chronic hypertension is the most common cause of left atrial enlargement and must be treated aggressively. 1

2. Identify the Underlying Cause

• Your doctor needs to determine why your left atrium is enlarged, which may include chronic hypertension, previous atrial fibrillation, mitral valve disease (though none was seen on this echo), or restrictive heart conditions. 1

Ongoing Monitoring

1. Regular Echocardiograms

• You need repeat echocardiography every 6–12 months given the mildly enlarged left atrium, or sooner if you develop new symptoms like shortness of breath, chest pain, or palpitations. 1
• These follow-up scans will track whether your left atrium continues to enlarge, monitor for any changes in heart function, and detect development of valve problems. 1

2. Atrial Fibrillation Screening

• Because left atrial enlargement strongly predicts atrial fibrillation, you should have routine ECG monitoring or consider ambulatory (Holter) monitoring to detect irregular heart rhythms early. 1
• Catching atrial fibrillation early allows for stroke prevention with blood thinners if needed. 1

3. Aortic Monitoring

• Your aorta should be monitored with echocardiography every 2 years since it measures 4.2 cm (even though it's normal when indexed). 5
• If your aorta grows by more than 0.5 cm per year, you would need more frequent imaging and potentially earlier intervention. 5

Watch for Warning Symptoms

Contact your doctor immediately if you develop:

• Shortness of breath with exertion or at rest
• Reduced exercise tolerance or unusual fatigue
• Palpitations (sensation of irregular or racing heartbeat)
• Chest discomfort
• Lightheadedness or fainting

These symptoms would warrant cardiopulmonary exercise testing to evaluate your functional capacity and hemodynamic response. 1

Critical Points to Understand

• Do not be falsely reassured by your normal ejection fraction; the left atrial enlargement itself indicates significant chronic cardiac stress that requires investigation and management. 1
• The enlargement of your left atrium reflects chronic diastolic dysfunction (stiffness in your heart's filling phase) independent of other measurements. 1
• This condition signals a high likelihood of progression to heart failure with preserved ejection fraction (HFpEF) if the underlying cause is not addressed. 1

Bottom Line

Your heart's pumping function is excellent, but the mildly enlarged left atrium is a red flag that your heart has been under chronic stress. The priority is to identify and aggressively treat the underlying cause (most commonly high blood pressure), monitor for atrial fibrillation, and perform regular follow-up echocardiograms every 6–12 months to prevent progression to more serious heart conditions. 1