Doctors Lounge - Cardiology Answers
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Forum Name: Cardiology Diagnostics
|JGD - Sun Dec 13, 2009 2:41 pm||
First, thank you for your tme responding to questions.
I'm a 43 y.o. caucasion male w/ no significant medical or surgical history. Family history of cancer (relatives in 60s and older) and no family history of heart issues. I'm 5'10 215 lbs, so I could lose a couple pounds but have been walking on the treadmill for @ 6 months 4x week, don't smoke or drink.
In the past 2 years, I've experienced Left side (under arm), left arm, left chest and sternum discomfort that comes and goes. I've had 3 overnight stays in the hospital to rule out heart attack and all 3 set of 24 hour enzymes came back 'negative'.
In the past 18 months, I've had several EKGs, Stress Test (on treadmill w/ dye), X-Ray, 64 slice CT Coronary Calcium Study (score of zero) and a Cardiac Echo all the tests came back "normal".
Obviously, many of these test came at my request due to my continual discomfort in the left chest and left arm.
Would the test mentioned above 'catch' a aneurysm? Also, what are your thoughts on 64 Slice CT Scan... are they an effective as a predictor for CAD?
M primary MD and Cardiologist told me he believes my discomfort is stress induced... do you think it could be heart related due to stress?
Thanks in advance for your time and consideration.
|John Kenyon, CNA - Fri Dec 25, 2009 12:31 am||
Hello -- To take your concerns in order, first the pain may well not be heart-related, but there are some other, more arcane possibilities we'll get to after the main questions: First, you've pretty well ruled out acute coronary syndrome (incipient heart attack), so you're probably in fairly good shape in terms of coronary arteries generally. Your echo and 64-slice CT have been negative as well, which is great. Now the x-ray and echo alone should have ruled out any dilation of the aortic root or ascending aorta, where your concern would be aimed right now, although this of course doesn't preclude an abdominal aneurysm, which would not be causing the current symptoms.
The 64-slice CT has recently been found to be more reliable in predicting CAD than previously believed,and this, in combination with negative stress test, echo, EKG, etc., pretty well does rule out coronary artery disease. What is left could be either a) musculoskeletal chest wall problems unrelated to your heart, b) anxiety/stress-related somatosensory perceived pain, or c) remotely possible it could be due to random spasm of one coronary artery -- something usually seen occurring on a predictable schedule but sometimes happening randomly in association with stress. I doubt this last simply because there were never any EKG anomalies to confirm this possibility. It is sometimes difficult to prove when random-occurring, and often doesn't matter anyway.
I think you've safely eliminated CAD from the picture -- for now. Because of your body mass index (BMI) constitutes obesity, you do carry one risk factor for future heart disease, so working to "lose a few" might well be a good idea. You really need to get the BMI down from your current 30.8 to below 24. That's a singular goal for future good health, since everything else currently seems to be in good order.
Hope this is helpful. Good luck to you. Please follow up with us here as needed.
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