Brief Answer:
Blood test changes are minor- do not seem enough to justify the chest pain.

Detailed Answer:
Hello,
Thank you for asking at Healthcaremagic

I carefully read your question and understand your concern.

As for the blood results: to summarize the findings i would say you have small red blood cells (small in size compared to the norm) but in normal number and normal hemoglobine (the ingredient that transports oxygen and that also stains the red blood cells). This might be due 3 main causes: anemia (first stages when the stores start to deplete), minor thalasemia (which is ruled out with the electrophoresis you had- so it is not your case) or chronic lead poison. Other than that few other more rare causes might be thought after you have had tests to rule anemia and lead poisoning (ferritine in blood, TIBC, for the anemia and lead levels in blood for lead poison).
You also have low white blood cells in your blood and the lymphocytes are dominating (these fight mostly viral infections). This is very common when you are going through a viral infection. I would recommend you to not do any other tests at the moment but give enough time for a presumable viral infection to go away and than repeat the test. The red blood cells might be effected by viral infection also so I would strongly recommend you to repeat the CBC in 2-3 weeks before you do any other tests.

As for the chest pain it is very unlikely that these minor changes in blood test results are causing it. it is definitely a different cause of the chest pain.
it is good you have had normal ECG and hear ultrasound.
Amlodipine is first choice for hypertension only for people with dark skin color. If you are not dark skin color than amlodipine is not the best treatment for hypertension- you might need to talk to your doctor and see the chance of having ACE inhibitors or diuretics which have better heart protection and are first choice in hypertension in patients with light skin color.

The need for examination of the coronary arteries is a very complicated decision and many things should be considered. You are wright to consider the side effects of radiation and actually there are others very important also as this is an invasive procedure and you will need to tightly decide this with your cardiologist. It would be probably unsafe to decide it otherwise.

So to summarize I would say:
1. the changes in the blood test results are minor and do not seem to be the cause of the chest pain you have
2. these changes are also not that bad, so you don't need to run into other blood tests at the moment, but we can give 2-3 weeks and repeat the CBC to check again the red blood cells and white blood cells and the results come back normal we do not need to worry for the blood tests
3. If the CBC comes back abnormal again than you will need to probably have the specific tests for iron stores (ferritine in blood and TIBC) and lead levels checked in blood. ERS might be a good test to check also.
4. as for the heart and chest pain- confirm with your doctor that amlodipine is the best anti-hypertensive in your case and tightly follow the advises of the cardiologist on the need for the evaluation of the coronary arteries. You will need to evaluate and weigh with him the risk and benefits of having this examination done in your case. This is the safer way to go with it.

I hope this is helpful and answers to your questions but please feel free to write back in case anymore clarification in needed on this.

Kind regards,

Antoneta Zotaj, MD

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Brief Answer:
Seems like the tests are already done. Stress test is better first step

Detailed Answer:
Hello again,

Thank you for the reply.
The tests here in the message are copied and pasted and it seems these tests are already done and have normal results (HIV, hepatitis B and C and the Hemoglobine fraction). To be sure can you please upload as attached reports the blood tests that are in the message above?
If you have not had HIV test, HepB, HepC and hemoglobin fraction tests done than sure you will need to have these tests done.
Have you ever had a chest xray? I don't see it mentioned. It is a simple test for very important in evaluation of the chest pain.

If you have normal ECG but you have this chest pain in exercise than a good thing to do is have what we call stress test. This is a test that you do while exercising (running on a XXXXXXX carpet or exercise on a bicycle) and meanwhile your doctor monitors your heart with the ECG machine and sees if any changes in ECG with the exercise.

This is a safe and easy test to do and might give a lot of information.
Sometimes doing the angiogram of the coronary arteries is indicated if the stress test is abnormal or gives uncertain results.

I hope this is helpful and answers to your question but please feel free to write back if anymore clarification is needed on this.

Kind regards

Antoneta Zotaj, MD

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Brief Answer:
Test results seem normal (but CBC as explained above)

Detailed Answer:
Hello again,
Thank you for sending the reports.
Now I am even more clear. You seem to have had all those tests done and you have resulted negative for HIV, Hep B, Hep C and have within normal limits hemoblogine fraction. Having them done a second time will not do any harm, it will confirm the results of the first ones.

As for the angiograme of the coronary artery, the routine one done through the catheterization from a peripheral artery carries many risks due to being invasive but in your case if it is done with the CT scan method this is not invasive and has only the concern of the radiation as you mentioned but on the other hand compared to the risk of having a problem with the coronary arteries it does not compare with it. So i would say that if you have good medical insurance that is willing to cover the expenses of that examination and if the doctor highly suspects problems with your coronary arteries, than the benefit of having the CT coronary angiograme outweighs the risks it has due to radiation and it would be more beneficial to have it done.

I hope this addresses your concerns but please feel free to let me know if anymore clarification is needed on this.

Kind regards

Antoneta Zotaj, MD

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Brief Answer:
labs do not seem concerning, more explanation on heart examinations

Detailed Answer:
Hello,

The lab tests you sent i find nothing worrisome. There are a couple of minor changes that might need to be followed in time but not major and do not seem to be effecting your health. The fact that you have repeated CBC is good so to monitor how it is doing with time. It would be perfect if there was at least a 2 week time period between tests for more sure results.

For the heart- if you light skin color and the doctor has chosen a calcium blocker (amlodipine) to treat your hypertension and the chest pain probably it is due to what we call spastic coronary artery (also called Prizmental angina) which mostly happen in quietness and not in exercise. Triggers of the spasms might be tobacco, exposure to cold, emotional stress, illegal drugs like amphetamines and cocaine, etc. These are spasms of the coronary arteries that cause some ischemia and bother the patient at night time or at rest and all the tests in exercise are normal. In this case a calcium blocker is the preferred treatment as it reduces the spasms.

Monitoring your ECG for a certain time in hospital sometimes is an easy not invasive way to track for changes in time. Trans-esophageal ultrasound is also recommended to rule out other causes of the chest discomfort. Also myocardial perfusion imaging is also recommended to have done in this case. If not sufficient information with these than coronary angiograme is indicated.
Also checking your sugar level, lipids and kidney function is needed- I did not see these tests in your labs and they are very important while we do a cardiovascular evaluation.

So talk with your doctor if he is considering Prinzmental angina as the cause of the chest discomfort at rest and in this case you will need to ask for the above mentioned tests and the angiograme is left for the last if the other ones do not give enough clues.

There are also other causes of chest discomfort at rest. If you have some burping and acid feeling in your throat than acid reflux can be considered. I would try a period of 2 weeks with Omeprazole 20 mg every morning 30 minutes before breakfast and test if this is the cause if it. It is easy tolerated by the patients and would save you a lot of time and discomfort in case acid reflux is a cause of the discomfort.

I hope this is helpful and answers to your questions but please feel free to write in case more clarification is needed on this.

Kind regards

Antoneta Zotaj, MD

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Brief Answer:
Most test you had have no dangerous radiation

Detailed Answer:
Hello again,

Most of the tests you have done do not have x-ray radiation which is the dangerous one and increases risk for cancer. ECG, ECHO, stress test do not have dangerous radiation. The only tests that you have done and have radiation is the x-ray and the CT of the chest but with the recent machines doing these tests the amount of radiation is much less than before and they are safer than they used to.
I would say that even thought the CT causes some x-ray radiation, for peace of mind related to the heart issues I would do that test. The risk of cancer with one more examines increases very little and it is worthy if considering the risk of possible heart problems not being diagnosed and treated propriately.

I hope you will be more clear but still you are welcome to ask if anymore questions related to this.

Kind regards

Antoneta Zotaj, MD

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Brief Answer:
Up to 2 CT in a lifetime are OK.

Detailed Answer:
Hello,
The stress test that has radiation is called radionuclide stress test, this is not the one that is mentioned that you have had. The simple stress test that is routinely done is similar to ECG. You are connected to an ECG machine while you exercise to try to track ECG changes while exercising. So if you had the routine usual stress test there is 0 radiation there and nothing to worry.
If you had the radionuclide stress test (which is very unlikely this is the one you had) that there is radiation there involved.

It says there that 1-2 CT in a lifetime are safe. This i have found supported in other official literature so having a second one done would not be very high risk for cancer. I would say that if your cardiologist can be sure that your heart is OK only by having the CT coronarograme you might need to have it done. There are people that need to have a CT done several times in their lives and yes they have a slightly higher risk for cancer due to exposure but not many of them develop cancer (this is a language of probabilities and not that for sure this will happen) It is worthy taking that slightly increased risk when you consider serious problems with the heart that need to be ruled out or diagnosed.

The other tests are angiograme of the coronary arteries through a peripheral catheter but this is invasive and poses many risks due to that and the myocardial perfusion imaging which seems to have at least double the radiation of the CT coronarograme.

I hope this is helpful to you but if anymore clarification is needed, please feel free to write back.

Kind regards

Antoneta Zotaj, MD

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Brief Answer:
It is a priority to rule out heart issues due to the pain being still there

Detailed Answer:
Hello,
I am sorry you have needed to have a couple of CT scans due to the first one being wrong. I am not sure what is the test you have had as a stress test. The routine stress test has no radiation at all. It is true you will be exposed to higher radiation risk due to having several CT scans but it is again worthy if this is something your doctor thinks will rule out heart problems. Heart problems have bad prognosis and outcome if not diagnosed on time and treated appropriately so that is why you need to weigh the risk and benefits of having the CT and not having it and very likely in your case it is worthy having the CT of the coronary arteries especially if the discomfort (pain) is still there.

I hope this is helpful and gives more clarification to your questions.
Please feel free to write if anymore questions related to this.

Kind regards,

Antoneta Zotaj, MD

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