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Forum Name: Ischemic Heart Disease

Question: CAROTID ARTERY STENOSIS


 BoxerBaby - Fri May 08, 2009 1:50 pm

Hello
I am a 46 yr old caucasin woman, 120 pounds, 5'4". Am a smoker, non-drinker. Past history of high cholesteral, but currently at 192 total, 55 HDL, 72 Triglycerides, but do not have my LDL numbers. Blood pressure in the past was always normal, however, is now at 146/86. My BMI is 24.9%.
Recently, I was able to attend a health fair in my area due to having no insurance and tests could be done at a great rate. I felt it important to get some testing done due to issues I've had at least over the past 3 years and in some cases longer.
I had a Vitamin D test and am deficient at a total of 12.
I also had a heart echo and carotid artery ultrasound. The heart appears to be functioning properly, altho the arteries could not be seen. My left carotid artery has a 24% stenosis and the right has less, but there is some buildup.
First, I have read that carotid artery blockage is typically secondary or comes after coronary artery blockage. Is that a possibility? How do I find out or know if I have blockages in my heart vessels?
I have had and am having many issues that appear to be related to 'heart' problems. Tingling and numbness, some weakness, in the left arm and hand, armpit, neck, also with 'hot spots and itching" on the left arm as well as at times in my left calf muscle area in which it itches deeply under the skin. I also have shortness of breath, dizziness and sometimes nausea. Slight dull headaches. My vision has gotten worse over the past couple years, but has been more like a double vision issue or I will see type on a computer for instance as a brown/green color but knowing it should be black. I see white stars sometimes too. I have chest pains that seem to be best described as a gripping, yanking, twisting, flip flopping feeling. At those times, I can't move until it has settled. There is always some kind of dullness pains in my arm or chest. My speech sometimes gets messy--more like a feeling of being scrambled, I will pronounce words backwards for instance or can't seem to find the right word. I don't think as clearly as I used to, maybe an age related issue?
As I write this, the headache is dull, the arm is tingling and has a hot spot and my chest feels deep and I am a little dizzy.
I had some blood tests run as well and all seems to be ok in most the testing. The CRP(R) was a 0.5. My CA 125 was a 5. My TSH was 2.18. Calcuim at a 9.0. Hemoglobin was 14.5, Hemorcrit at 43.5, WBC 7.1, RBC 4.41, platelets 226, MCV 98.7, MCH 32.9, MCHC 33.3 and RDW 13.7.
My Total Cholesteral was 192, HDL 55, Triglycerides 72, they didn't do the LDL. CO2 was 24.
I just a couple days ago started taking about 3000 IU of Vitamin D3 ,and also started taking low dose aspirin every other day as I don't tolerate aspirin well due to ulcers/stomach problems in the past, so I take that before bed.
I guess I am not sure what to do from here or what all this means. I know I must quit smoking as a priority and am working on this. I also think I am experiencing pre menopausal symptoms, such as occasional night sweats and irregular periods.
Any insight would be so greatly appreciated!
 John Kenyon, CNA - Sun May 10, 2009 9:11 pm

User avatar Hi there --

Your LDL, by default, is 122. HDL is known and 20% of triglycerides make up VLDL for the total of 192. Tri-G's are remarkably good, which is a plus, and HDL is high, which is a plus as well. LDL, absent heart disease, is fine.

These health fair tests are a great screening thing, but are far from the gold standard. If anything funny shows up in one of them then it needs to be followed up with a "real" exam. Your cholesterol shows up as generally very good. Blood work in general is very good. No obvious structural heart problems, which is great, but there is some beginning carotid stenosis, though not enough, according to the test you had done, to account for the symptoms you're having. However, this should be repeated to be certain it was an accurate reading. You do have some symptoms which could be attributed to carotid stenosis, so this should be explored in more depth. Also, you have some potential heart symptoms, although it's hard to say without at least a 12-lead EKG and preferably a nuclear scan/stress test. This would be appropriate anyway, with your stated symptoms and your age. You could very well be having pre or perimenopausal symptoms, but are also having some other, less specific things happen. None of your symptoms are age-specific, except those that might be related to menopausal changes. You are a smoker, so you have at leat one significant risk for heart disease. For this reason alone it would be reasonable to now have a baseline heart workup. If nothing shows up in this exam, the specific symptoms can then be addressed individually. For instance, tingling, numbness and itching are likely not cardiac related, but could be due to premenopause or neurological issues. The speech and memory problems are not age-specific at all, but could be related to carotid stenosis, which needs to be rechecked. Chest pains, in a possibly premenopausal woman must be considered potentially cardiac and so the cardio workup. I suspect there are probably several things going on separately, some almost certainly innocent, others possibly smoking-related or hormonal. A thorough physical with empasis on heart needs to be done for baseline purposes. You may find you're really quite healthy, as the tests thus far would indicate, but you do have some symptoms that deserve special attention.

I hope this is helpful to you. Good luck to you and please follow up with us here as needed.
 BoxerBaby - Tue May 12, 2009 2:07 pm

Hi Doctor
Thank you very much for your reply and information. I am still in search for some help as I have no insurance but will follow up here with any diganosis and/or results as soon as I have any to share.
Boxerbaby

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