Question 1

So I had this chest pain about 2 months ago, and it wasn't related to the heart. I got my ECG and 2D echo done, and they both were normal. I also got a chest X-ray, and some other blood tests like cholesterol and thyroid, and everything was normal except for high cholesterol. The pain went away after I took some medication. But now, after 2 months, I'm experiencing the same kind of chest pain. It's more moderate to mild this time, but last time it was really severe. I couldn't even lay on the bed then. This time too, my ECG checked out normal. Should I be doing more tests to make absolutely sure it's not something heart-related, or do you think it's enough for now?

Accepted Answer

Since your ECG results came back normal and you have already undergone tests like 2D echo, chest x-ray, FBS, HbA1c, and thyroid tests which were all normal except for high cholesterol levels, it is less likely that your chest pain is cardiac-related. However, if you are still experiencing chest pain, it may be beneficial to consult with your doctor to consider other possible causes such as musculoskeletal issues or gastrointestinal problems. In the meantime, you can continue taking Pantoprazole for acid reflux and Ulgel syrup for gastritis symptoms.

Question 2

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 3

I'm feeling pretty anxious because I've been experiencing shortness of breath for a few months now. I had an echo and ECG done, and the results said everything was normal except for something called grade 1 diastolic dysfunction. I'm not sure what that means, and even though my doctor said its nothing to worry about, I'm still a bit concerned. Could you help explain what grade 1 diastolic dysfunction is and whether it could be causing my symptoms? Should I be doing anything specific to manage it?

Accepted Answer

grade 1 diastolic dysfunction normal..salt restricted diet ,dash diet and regular aerobic exercises is advised to the patient.

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