u/Weak-Rain-7917

Looking for honest opinions on my heart testing because I’ve been stressing myself out over this.

I had an echocardiogram done that showed:

• Left ventricle normal size
• Normal wall thickness
• EF 55-59% but the Actual was 52.5
• Normal systolic function
• No regional wall motion abnormalities
• Normal diastolic function
• Right ventricle normal size and function
• TAPSE 1.7 cm
• Both atria normal size
• No significant valve abnormalities

After the echo, I later went to the ER for shortness of breath and they did a chest X-ray. The X-ray impression said:

“Cardiomediastinal silhouette is mildly enlarged.”

That finding really scared me because I started worrying about heart enlargement or heart failure. They didn’t check a BNP.

Since then I’ve also had:

• occasional shortness of breath
• random upper back pains
• occasional pulsating feeling in my neck
• anxiety over the X-ray finding

My question is: if the echo showed normal chamber sizes and normal heart function, how concerning is the “cardiomediastinal silhouette is mildly enlarged” finding on the chest X-ray? Does the echo usually give a more accurate picture of heart size and function?

Confused about echo results (EF change from 60–64% to 52.5%) + X-ray saying “mild enlargement” but echo normal — should I worry?

Hey everyone,

I’m trying to understand my heart test results because I’ve been feeling short of breath and got a bit stuck in my head reading everything.

For context: • I’m a 24M • Had chest pain / shortness of breath • Got two echocardiograms and a chest X-ray

🫀 My echo results:

2024 echo: • EF: 60–64% • Normal heart structure • Normal function

2026 echo: • EF (biplane): 52.5% • Other readings: ~51–54% range across views • Conclusion: normal size, normal wall thickness, normal diastolic function, normal valves, normal atria, no structural disease

Everything else on the echo looked normal: • Normal chamber sizes • Normal filling pressures • No wall motion abnormalities • Normal valves • No fluid around heart

🩻 My chest X-ray: • Said “mildly enlarged heart” • But no pulmonary edema • Later comparison said things looked stable

❓ My confusion:

I’m trying to understand: • How can EF go from ~60–64% to ~52.5% in about 2 years? • Is that a real decline or just measurement variation? • Can a normal echo still exist if X-ray says mild enlargement? • Could anxiety or test differences explain this?

🧠 What I’ve been told so far: • EF 52.5% is still technically “normal range” • EF varies between machines and methods • X-ray can overestimate heart size • Echo is more accurate for structure and function • No signs of heart failure on echo

😕 My main concern:

Even though I’m being told everything is “normal,” I’m stuck on: • the EF drop on paper • the wording “mild enlargement” on X-ray • and my ongoing shortness of breath

🙏 Question:

Does this sound like: • normal variation between tests? • anxiety/functional symptoms? • or something that actually needs more cardiac workup?

Trying to understand if I should push for more testing or trust the echo results.

If anyone has seen similar changes between echos, I’d really appreciate insight.