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Chest pain, high cholesterol, LDL and VLDL. Gassy feeling. Is there a heart issue? Advice on reports?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
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Dear Sir,

Since last 1.5 years, I have been having on & off pain in chest, specially on the left side. I consulted my doc in Aug 2010 and she advised to go for 2D Eco, TMT, LIPID. 2D was ok, TMT was also ok, however, I had high Cholosteral, High LDL and VLDL. Doc then concluded it could be a Gas pain. I do have a GAS issue whenever I eat out. My Life style has been sedentary since last 4 years. I am a computer engineer and was not involved with any physical excercise for years.
Now, again in XXXXXXX 2011, the frequency of chest pain increased. Point to note here that many times, whenever I used to feel that pain, within few minutes I used to pass the GAS. But few times, it was only a Pain without any indication of any GAS. I again consulted her in Aug 2011. She again asked me to repeat 2D Eco, TMT and Lipid. Again, 2D Eco and TMT were ok, but Cholesterol, Triglycerides, LDL and VLDL were very high. The reports are attached.
I have now stopped eating junk, oily, sweet food and have started Cardio exercises in Gym. But the pain in chest keeps happening at times with GAS feeling, at times without GAS. Pains happens exactly where the heart beats. In these days, the frequency of pain has increased. What do you suggest? If 2D Eco and TMT are fine, does that mean there is no heart issue? Cholesterol, I am sure, I can bring it down in 3 months by excersing, dieting, etc. I am not taking any medicines for Cholestrol so far. I did Gastroentlogy test in 2009, it was fine then. I had the GAS and indigestion issue then.
#1, Please have a look on reports and advise your opinion.
#2 Please suggest that does 2D eco suggest that there is no blockage in heart.?
#3 Please suggest if u dont see this a heart issue, what else it could be? The pain is not severe, only lasts for less than 1 minutes and happens 3 to 4 times in a week.
#4 Please suggest anything else you wish to.

Regards
Posted Mon, 23 Apr 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Raja Sekhar Varma 11 hours later
Hello,
Thank you for your query.

I appreciate the detailed and orderly description of your problems. I have also gone through the reports that you have uploaded.

The echo test is normal. All the measured and derived values are normal. There is no evidence of any structural heart disease and the cardiac ejection fraction is also normal at rest.

The stress test is also reported as normal. However, I would like to see the ECG tracings and recordings done during the treadmill. If you could scan those images and upload them too, it would be nice. The tracings of the latest TMT alone will be adequate.

The lipid profile certainly shows that the levels of cholesterol are a little high. However, there is no cause for alarm. Good diet control and appropriate exercise can certainly help to bring them under control. If a repeat test done after 3 months does not show satisfactory control, there is definitely a role for considering treatment with appropriate drugs like ‘statins’ to control the cholesterol levels.

From the description of your pain, it is likely to be non-cardiac in origin. Such types of pain can also be due to musculo-skeletal causes, esophagitis, Gastro-esophageal reflux, acid peptic disease and rarely, neuralgia. Sometimes, stress, tension, anxiety, etc., can present with atypical chest pain lasting for seconds.

A normal 2D echo does not always mean that there is no blockage. From the 2D echo, it is possible to say that your heart function at rest has not been affected and there is no structural disease of the heart muscle and valves. Blockages of the coronary arteries which supply blood to the heart muscle cannot be identified with a resting 2D echo.

However, a Dobutamine Stress Echo can be done wherein the heart is stressed by an intravenous drug and echo is done to image the heart and see how the heart is responding to the stress induced by the drug. If there are significant blockages, there will be changes during stress testing. Stress Echo is similar to the treadmill test, but with superior sensitivity and specificity

I would also recommend doing an upper GI endoscopy to see if there are any gastric, esophageal or duodenal causes for your symptoms. A chest X-ray can tell us if there are any lung pathologies, pleural diseases, or any ribcage problems which can produce chest discomfort.

I hope this answers your query. Please upload the tracings of the latest TMT so that I can give you a specific answer on that.

With regards,
DR RS Varma
Above answer was peer-reviewed by
 
Follow-up: Chest pain, high cholesterol, LDL and VLDL. Gassy feeling. Is there a heart issue? Advice on reports? 12 hours later
Dear Sir,

Thank you so much for your reply. Please find my questions against your reply:

"The stress test is also reported as normal. However, I would like to see the ECG tracings and recordings done during the treadmill. If you could scan those images and upload them too, it would be nice. The tracings of the latest TMT alone will be adequate. "

Ankur: Sir, the file size of the complete report is 10 MB, which I am not able to upload here due to size restrictions. Please advise how else I can send it to you.

"The lipid profile certainly shows that the levels of cholesterol are a little high. However, there is no cause for alarm. Good diet control and appropriate exercise can certainly help to bring them under control. If a repeat test done after 3 months does not show satisfactory control, there is definitely a role for considering treatment with appropriate drugs like ‘statins’ to control the cholesterol levels."

Ankur: Sir, I forgot to mention that it was in April 2008; first instance of high Cholesterol is discovered (during FreeCredit Card Health Checkup). I did not take any medicine and it went down and remained normal till Aug 2010. In Aug 2010, again I did a Lipid and found that Cholesterol/Tri/LDL all were high. Due to sedentary life style and heaving work pressure, I did not get time to join the Gym. So effectively, the Cholesterol/Tri/LDL are high since 1.3 years now. I am not taking any medicines, however, from last 3 months, I have started Cardio exercises in GYM, stopped all sort of sugar, stopped all sort of fried items and junk food as well.

#1. Now since Cholesterol/Tri/LDL all are high since 1.3 years, I am just worried if they may have caused any blockages in the arteries. I just want to eliminate all sorts of doubts. Please help.

#2. I have started heavy snoring since last 10 months. This is adding to my worried.

#3 Now, as mentioned above, I am taking precautions, is it necessary to take medicines? Or Shall I continue new improved life style like Cardio exercise for 1 hour a day, plain food, no sugar, etc for 3 more months and then do a repeat of LIPID profile in March 2012?

#4 What is the difference between Basic LIPID and Complete LIPID profile? Which one is supposed to give accurate picture of LIPID?

However, a Dobutamine Stress Echo can be done wherein the heart is stressed by an intravenous drug and echo is done to image the heart and see how the heart is responding to the stress induced by the drug. If there are significant blockages, there will be changes during stress testing. Stress Echo is similar to the treadmill test, but with superior sensitivity and specificity

Ankur: #5 Where can I get this test done?

#6 What is the exact name of this test?

#7 Do I need to accompany any one while undergoing this test? I have not told my family members about this issue as they are occupied in their own health issues.

#8 Is there any alternate test which can confirm blockages? Or any other heart/cardio risk?

Please advise sir. Recently i have lost my two cousins due to various reasons. I dont want to be a third victim in the family due to this issue.

Regards.
 
 
Answered by Dr. Raja Sekhar Varma 5 hours later
Hello Mr. XXXXXXX

Thank you for the follow-up.

You could try scanning the images at a resolution of 72-100 ppi. If this doesn't work, you could scan the pre-exercise ECG, peak exercise ECG and recovery ECG at 1 minute. You can delete the other files since I have already seen those reports.

1) Since there is a family history and a long duration of high cholesterol, it will be beneficial to take atorvastatin or rosuvastatin to help you to bring down the cholesterol levels to normal levels. Once normal levels have been reached, it may be easier and less risky for you to maintain those levels with diet and exercise.

2) There are many causes for snoring. You should get yourself examined by an ENT specialist and your general physician for remediable causes.

3) You should repeat your fasting lipid profile after 3 months. However, please consider point 1.

4) Basic lipid profile and complete lipid profile are terms given by the laboratories to package their services. A fasting lipid profile that documents total cholesterol, triglycerides, HDL, LDL and VLDL is usually adequate. Derived values like ratio of total cholesterol to LDL cholesterol and HDL to LDL ratio, etc can be computed. In certain cases, apolipoprotein levels like Apo-B and Apo-A, lipoprotein (a) etc are tested.

5) You need to contact your cardiologist to get the Dobutamine Stress Echo done. I am sure all the major institutes of Delhi will be doing this test. If this is not available, you can also get nuclear stress test done (stress thallium or technetium stress imaging)

6) Dobutamine Stress Echocardiography is the name.

7) Since all cardiac stress tests do involve putting a stress on your heart, it is usually mandatory to have a responsible adult to accompany you.

8) Tests like CT (computerized tomography) coronary angiography, conventional coronary angiogram can be done to confirm and image the blockages. These are indicated if screening tests like TMT (treadmill test) or a stress echo or a nuclear stress test are positive or inconclusive.

I am sure that you can do well with a good preventive health program, emphasizing a nutritious diet and an appropriate exercise regimen. Avoid unnecessary tensions, anxiety and stress. Avoid active and passive smoking. Keep your BP, sugar, cholesterol and body weight under control so that you can lead a happy and healthy life.

Hope I answered all your questions. Please accept my answer in case you do not have further queries. Wish you Good Health.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
 
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