Brief Answer:
I would explain as follows:

Detailed Answer:
Hello,

Welcome and thank you for asking on HCM!

I passed carefully through your medical history and would like to explain that based on your pain characteristics (chest pain coupled with muscle pain) and the already performed cardiac tests (normal ECG, cardiac ultrasound, cardiac stress tests and lab tests), it is unlikely that your complaints to be explained by an ischemic cardiac disorder.

Nevertheless, I would recommend a rationale cardiac screening test such as coronary angio CT, which could definitely assure you about your coronary arteries and also give important clues on the future probability of coronary events (facing you have already coronary risk factors such as high cholesterol blood level, tendency of hypertension).

If coronary angio CT is performed using a triple rule out protocol, it may contribute in investigating possible pulmonary, aortic as well as coronary arteries disorders.

Also chest angio CT as well as other imagine tests (MRI, etc) could be helpful in the differential diagnosis workup for your chest pain.

Other alternative responsible causes of pain should be sought, like degenerative backbone disorders, esophageal spasms, mediastinal or other possible chest masses, biliary calculosis, colonic spasms, etc.

So, to conclude, I would like to assure you that a cardiac disorder is actually not likely, instead alternative causes should be investigate.

I recommend you to discuss with an internist to better guide you through the differential diagnosis process.

Hope to have been helpful to you!

In case of further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

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Brief Answer:
Coronary artery disease seems unlikely in your case: so relax!

Detailed Answer:
Hi again,

As I explained you above I don’t believe you are suffering from any cardiac disorder (acute ischemic disorder).

Your performed tests (resting ECG, cardiac stress tests, cardiac ECHO, lab analysis) are quite sufficient to draw this conclusion.

If you review again our previous discussion, you will notice I recommended you a differential diagnosis between several other (than cardiac) alternative causes.

The reason I recommended you the coronary angio CT is:

(1) Just for screening purposes. That is, because you have coronary risk factors (dyslipidemia, tendency of hypertension) it is important to investigate the probability of risk for future coronary events.

This is achieved by measuring overall coronary calcium score and also by exploring directly the coronary arteries tree.

(2) If a triple rule out protocol is applied during angioCT, it is possible to investigate also for possible pulmonary and aortic disorders, making this test a valuable tool in the differential diagnosis of you pain.

Also as a chest CT it will help in visualizing any possible chest disorders (like hiatal hernia, etc)

I explained some of the most likely non-cardiac alternative causes of your pain.

Musculoskeletal pain may be one of the most probable reasons.

Muscular spasms have nothing to do with coronary artery disease.

Coronary artery disease doesn’t seem the most probable explanation for your pain; but when need to perform a comprehensive differential diagnosis to arrive to the right responsible cause of your pain.

In case of further uncertainties feel free to contact me again.

Regards,

Dr. Iliri

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Brief Answer:
You are welcome!

Detailed Answer:
I am glad to have been helpful!

You can ask me directly at any time if you have any other uncertainties to the link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Wishing all the best for the new year,

Dr. Iliri

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