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Suggest Treatment For Severe Chest Pain And Shortness Of Breath
Question: I have been having chest pain and shortness of breath on exertion.
I have had multiple ECG's and these are all clear. Stress test was undertaken and i only lasted for 6 mins and then the test was stopped as my heart was already at 100%. (I didn't know if this was normal or not) After this cardiologist informed me I had a high heart rate (even at rest) and I was put on Metoprolol to keep this under control. I am taking 1 x 50mg tab morning and night. With this medication my symptoms still persist. Last week CT Coronary Angiogram was done and I have a calcium score of -0. My doctor (GP) is saying now that she thinks I am having panic attacks and that it is not heart related. I am not convinced with this as this shortness of breath only happens when I am walking / running etc. Last time was 1 1/2weeks ago on a 800m walk (not far). The angiogram results does mention that my Right Coronary Artery is diffusely small in calibre and that the distal portions of the distal third of the Right Coronary Artery cannot be traced. In the proximal and mid third, there is no focal plaque or stenosis. My GP didn't discuss this with me and I am wondering if this could cause any of my symptoms. I was advised to go back to exercise and living normally however I am unable to exercise due to shortness of breath etc and I am concerned. I do have a follow up appointment with my specialist however I am unable to get in for another month and in the meantime I am concerned.
I have had multiple ECG's and these are all clear. Stress test was undertaken and i only lasted for 6 mins and then the test was stopped as my heart was already at 100%. (I didn't know if this was normal or not) After this cardiologist informed me I had a high heart rate (even at rest) and I was put on Metoprolol to keep this under control. I am taking 1 x 50mg tab morning and night. With this medication my symptoms still persist. Last week CT Coronary Angiogram was done and I have a calcium score of -0. My doctor (GP) is saying now that she thinks I am having panic attacks and that it is not heart related. I am not convinced with this as this shortness of breath only happens when I am walking / running etc. Last time was 1 1/2weeks ago on a 800m walk (not far). The angiogram results does mention that my Right Coronary Artery is diffusely small in calibre and that the distal portions of the distal third of the Right Coronary Artery cannot be traced. In the proximal and mid third, there is no focal plaque or stenosis. My GP didn't discuss this with me and I am wondering if this could cause any of my symptoms. I was advised to go back to exercise and living normally however I am unable to exercise due to shortness of breath etc and I am concerned. I do have a follow up appointment with my specialist however I am unable to get in for another month and in the meantime I am concerned.
Brief Answer:
Following advice...
Detailed Answer:
Hi and thank you for asking!
I read your query adn understood your concerns.
The only risk factor for ischemic heart disease is your familiar positive history and this is why in a patient like you with chest pain and dyspnea always should be done all the needed test to exclude ischemic heart disease.
Since your doctor have done all the needed test (including ecg, echo stress and cardiac CT angiography) which didn't find everything suspicious you should stay calm and relaxed because nothing wrong is going to happen to you.
After reviewing your cardiac ct angiography I would like to say that you have a calcium score of 0 and on proximal and mid portion there was no plaque or stenosis. This findings are normal and exclude with an accuracy of 95-99% the possibility of coronary blockage and ischemic heart disease.
Moreover you have a left dominant circulation. This explain why you have a diffuse small in calibre right artery (if you have a large in calibre right artery you would be considered a right dominant) and this is a normal finding and shouldn't worry about it.
The only recommendation is to continue with medical treatment and healthy life style. Please stay calm and relaxed because to much anxiety has a negative effect on you heart. For the moment nothing is wrong with you as long as nothing is abnormal with cardiac test.
Wish you health!
Dr. Shehu
p.s: If you have more questions please don't hesitate to ask me again.
Following advice...
Detailed Answer:
Hi and thank you for asking!
I read your query adn understood your concerns.
The only risk factor for ischemic heart disease is your familiar positive history and this is why in a patient like you with chest pain and dyspnea always should be done all the needed test to exclude ischemic heart disease.
Since your doctor have done all the needed test (including ecg, echo stress and cardiac CT angiography) which didn't find everything suspicious you should stay calm and relaxed because nothing wrong is going to happen to you.
After reviewing your cardiac ct angiography I would like to say that you have a calcium score of 0 and on proximal and mid portion there was no plaque or stenosis. This findings are normal and exclude with an accuracy of 95-99% the possibility of coronary blockage and ischemic heart disease.
Moreover you have a left dominant circulation. This explain why you have a diffuse small in calibre right artery (if you have a large in calibre right artery you would be considered a right dominant) and this is a normal finding and shouldn't worry about it.
The only recommendation is to continue with medical treatment and healthy life style. Please stay calm and relaxed because to much anxiety has a negative effect on you heart. For the moment nothing is wrong with you as long as nothing is abnormal with cardiac test.
Wish you health!
Dr. Shehu
p.s: If you have more questions please don't hesitate to ask me again.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok make sense. So that fact that the report mentions that the distal portion (distal third) couldnt be traced is not a cause for concern either? I find it hard to beleive its panic attacks that is causing this.
All the times that this has happened has been related to some form of exertion, snorkling, bushwalking etc.
high heart rate can be caused by stress i know also. Thanks for the help.
All the times that this has happened has been related to some form of exertion, snorkling, bushwalking etc.
high heart rate can be caused by stress i know also. Thanks for the help.
Brief Answer:
Following advice
Detailed Answer:
Hi back,
It's a common finding in small calibre coronary arteries that the distal part couldn't be traced. As long as calcium score is zero this isn't a cause of concern.
Please stay calm and relaxed because all current examinations are normal and there's nothing to worry about. Please keep in mind that anxiety may mimic or exacerbate many sign and symptoms (including chest pain).
Hope this will be of help!
Wish you health!
Dr. Shehu
Following advice
Detailed Answer:
Hi back,
It's a common finding in small calibre coronary arteries that the distal part couldn't be traced. As long as calcium score is zero this isn't a cause of concern.
Please stay calm and relaxed because all current examinations are normal and there's nothing to worry about. Please keep in mind that anxiety may mimic or exacerbate many sign and symptoms (including chest pain).
Hope this will be of help!
Wish you health!
Dr. Shehu
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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