Question 1

I've recently come across my TMT results, which show a mildly positive reaction with horizontal ST depression up to 2mm in some leads, but it normalizes quickly in recovery. My echo came out normal, and I don't smoke, drink, or have any early CAD family history. My lipid profile reads LDL at 101, triglycerides at 139, HDL at 33, and a total of 157. I'm quite sedentary, and lately, I've noticed pinpoint pain and pressure in my chest, shoulders, and upper abdomen. It flares up intermittently during brisk walking and feels really localized. I've also been dealing with anxiety for the past four years, so I sometimes have breathing difficulties whether I'm resting or active. Is it possible to have CAD at this age without any obvious risk factors, or could this pain just be anxiety? I did have stress echo tests in the past, which were negative, just like a TMT back in 2016. Could you offer some insight?

Accepted Answer

Given your history of chest painpressure, especially with brisk walking, and the findings on your recent TMT showing mildly positive results with horizontal ST depression, it is important to consider the possibility of coronary artery disease (CAD) even in the absence of traditional risk factors. The fact that the ST depression normalizes within 15 seconds of recovery is somewhat reassuring, but further evaluation is warranted. Considering your symptoms and history of anxiety, it is also possible that the chest pain you are experiencing could be related to anxiety. However, it is crucial not to dismiss the possibility of CAD, especially with the new onset of localized chest pain and your TMT results. Given your overall profile and symptoms, I would recommend further evaluation by a cardiologist. They may consider additional tests such as a coronary angiogram to assess the extent of any possible blockages. In the meantime, it is important to continue monitoring your symptoms and seek medical attention if they worsen or become more frequent. In terms of medication, based on your lipid profile, a statin medication such as Atorvastatin (10-20mg) may be considered to help lower your LDL cholesterol levels and reduce the risk of CAD progression. Additionally, medications to manage anxiety such as Escitalopram (10mg) may be prescribed to help alleviate your symptoms. It is important to address both the cardiac and psychological aspects of your symptoms to ensure a comprehensive treatment approach.

Question 2

My dad had an angioplasty last month, and they put in a stent, but he's been feeling dizzy about 10 days afterward. Any idea what could be causing this? I'm really worried and not sure what to do next.

Accepted Answer

few side effects of angioplasty like allergic reactions, nausea,vomiting and sneezing ,,and giddiness in some cases can occur .It is normal. U need to check BP once and continue all the medications prescribed to the patient.

Question 3

I'm trying to understand the difference between the results of my echo and my CT scan regarding my heart condition. My echo shows mild concentric LVH with lvpwdd 12.2 and ivs d 12, and my LVEF is at 73. But my CT scan, which was a 128-slice MDCT of the heart, suggests normal LVH and a normal LV cavity with normal thickness, having a zero calcium score. Also, my TMT came out negative for any chest pain-related issues. I'm kind of confused here. Which result should I rely on when it comes to the left ventricular hypertrophy? Which is considered more accurate or should I be concerned about something else here?

Accepted Answer

Both CT angiography and echocardiogram are valuable tools for assessing left ventricular hypertrophy (LVH), but they provide different types of information. In your case, since the CT angiography showed normal left ventricular cavity with normal thickness and normal coronary arteries, and zero calcium score, it indicates a healthy heart without any structural abnormalities or blockages. On the other hand, the echocardiogram reported mild concentric LVH with specific measurements of left ventricular posterior wall thickness (LVPWd) and interventricular septum thickness (IVSd). Given the discrepancy between the two imaging modalities, it is important to consider the clinical context and overall picture. In this scenario, the findings from the CT angiography showing a normal heart structure and function, along with a negative TMT (treadmill test), are more indicative of a healthy heart. Therefore, the CT angiography results are more reliable in this case. To address the chest pain related problem, you can consider taking medications like Amlodipine (5mg) for blood pressure control and Metoprolol (25mg) for heart rate control. Additionally, Nitroglycerin sublingual tablets can be used for chest pain relief as needed. It is also important to follow up with your healthcare provider for further evaluation and management.

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My dad had an angioplasty last month, and they put in a stent, but he's been feeling dizzy about 10 days afterward. Any idea what could be causing this? I'm really worried and not sure what to do next.

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