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Suggest Ways To Rule Out Costochondritis
Question: 32 male - morbid obese - possible hypertension (runs in family) - asthma
I have had recurring sharp chest pains for about a year. I feel they are related to over working in the yard one day with a pickaxe. Multiple doctor visits have not led me to any conclusion - most tell me to take Ibuprofen andit will eventually heal. They have also mentioned it could be costochondritis.
I had an abnormal ECG that my doctors were concerned about. They still referred me to a cardiologist on my wishes for a stress test. I have since taken a stress test to which I completed stage 2 or 6 minutes before getting tired as I am obese and out of shape. My heart rate was 175bpm when completing and the cardiac nurse indicated pressure and readings were fine. I go in for a follow up next week. I also had an echocardiogram done to which I have requested the results and will discuss with doctor next week.
I am attaching the result of the echo along with my latest ECG. Apparently my ejection fraction is fine at 55-60%, mild concentric hypertrophy of left ventricle, normal mitral valve with trace regurgitation and normal tricuspid valve with mild regurgitation.
What stands out to me is following:
LV FS (midwall): 30%
LA Volume: 84ml ?!
RVSP: 37.0 mmHg (pulmonary hypertension?)
I started a new diet a few weeks ago cutting carbs, eating better, etc. I really wanted these tests to verify if it was safe for me to exercise given I have sedentary lifestyle and morbid obese. I have lost 50lbs in the past doing this diet and I believe it will work again.
Do I possibly have pulmonary hypertension? Sounds very scary. Do any of these other numbers indicate a major problem? Should I be insisting or even allowed a XXXXXXX to verify artery pressure and check for blockages? Is it likely to have it at my age and doing OK on a stress test despite short length?
What is your analysis of my next steps and what should I be concerned about?I mistyped: "abnormal ECG that my doctors were NOT concerned about"
So far no one has given me bad/terrible news about any of these results.
I have had recurring sharp chest pains for about a year. I feel they are related to over working in the yard one day with a pickaxe. Multiple doctor visits have not led me to any conclusion - most tell me to take Ibuprofen andit will eventually heal. They have also mentioned it could be costochondritis.
I had an abnormal ECG that my doctors were concerned about. They still referred me to a cardiologist on my wishes for a stress test. I have since taken a stress test to which I completed stage 2 or 6 minutes before getting tired as I am obese and out of shape. My heart rate was 175bpm when completing and the cardiac nurse indicated pressure and readings were fine. I go in for a follow up next week. I also had an echocardiogram done to which I have requested the results and will discuss with doctor next week.
I am attaching the result of the echo along with my latest ECG. Apparently my ejection fraction is fine at 55-60%, mild concentric hypertrophy of left ventricle, normal mitral valve with trace regurgitation and normal tricuspid valve with mild regurgitation.
What stands out to me is following:
LV FS (midwall): 30%
LA Volume: 84ml ?!
RVSP: 37.0 mmHg (pulmonary hypertension?)
I started a new diet a few weeks ago cutting carbs, eating better, etc. I really wanted these tests to verify if it was safe for me to exercise given I have sedentary lifestyle and morbid obese. I have lost 50lbs in the past doing this diet and I believe it will work again.
Do I possibly have pulmonary hypertension? Sounds very scary. Do any of these other numbers indicate a major problem? Should I be insisting or even allowed a XXXXXXX to verify artery pressure and check for blockages? Is it likely to have it at my age and doing OK on a stress test despite short length?
What is your analysis of my next steps and what should I be concerned about?I mistyped: "abnormal ECG that my doctors were NOT concerned about"
So far no one has given me bad/terrible news about any of these results.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello dear XXXXXXX
Welcome back on HCM!
I passed carefully through your recent medical history and would like to explain as follows:
- 1) a sharp and well localized chest pain is not characteristic and specific for cardiac related issues (cardiac ischemia): so relax!
- 2) your ECG shows an incomplete right bundle branch block which is not a dangerous finding and may be also found in completely normal healthy individuals. In your case its presence may be related to obesity and chronic pulmonary disorder,
- 3) your cardiac ultrasound report in general represents normal and benign findings:
a) normal cardiac chamber dimensions, normal valves function, normal overall systolic cardiac function.
In addition, LVFS (left ventricular fractional shortening) is quite normal; LA (left atrial) volume is normal when indexed (divided) by body surface area (BSA) which is directly influenced by your body weight.
Also, your RVSP (right ventricular systolic pressure) 37 mmHg may be explained by your chronic pulmonary disorder (asthma) and obesity; it is quite a modest increase and does not represent any evidence of important pulmonary hypertension.
To conclude you shouldn't worry about these findings; the only point of interest in your echo report is the presence of mild diastolic dysfunction, reflected by E/E' ratio utilizing tissue Doppler techniques and a slight concentric LV hypertrophy. These are good markers for seriously considering immediate body weight reduction and properly controlling blood pressure values and pulmonary disorder.
Coming to this point, you don't need any further cardiac tests, but just to undergo through a very meticulous body weight reduction program
This can be achieved by a hypo-caloric diet coupled with a gradually increasing daily physical activity.
You should know that obesity have several adverse health effects, including hypo-ventilation syndrome, diabetes, joints and backbone column destruction and body muscles de-conditioning, hypertension, dyslipidemia, constipation, inactivity, depression, etc.
So, it seems that your greatest enemy is obesity and you should fight it without mercy.
My advice goes in favor of a dietitian consultation and a well tailored diet program, which would bring the desired beneficial health results.
I recommend to discuss with your attending doctor on the above mentioned issues.
Hope to have been helpful to you!
Please, let me know in case of any further questions.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello dear XXXXXXX
Welcome back on HCM!
I passed carefully through your recent medical history and would like to explain as follows:
- 1) a sharp and well localized chest pain is not characteristic and specific for cardiac related issues (cardiac ischemia): so relax!
- 2) your ECG shows an incomplete right bundle branch block which is not a dangerous finding and may be also found in completely normal healthy individuals. In your case its presence may be related to obesity and chronic pulmonary disorder,
- 3) your cardiac ultrasound report in general represents normal and benign findings:
a) normal cardiac chamber dimensions, normal valves function, normal overall systolic cardiac function.
In addition, LVFS (left ventricular fractional shortening) is quite normal; LA (left atrial) volume is normal when indexed (divided) by body surface area (BSA) which is directly influenced by your body weight.
Also, your RVSP (right ventricular systolic pressure) 37 mmHg may be explained by your chronic pulmonary disorder (asthma) and obesity; it is quite a modest increase and does not represent any evidence of important pulmonary hypertension.
To conclude you shouldn't worry about these findings; the only point of interest in your echo report is the presence of mild diastolic dysfunction, reflected by E/E' ratio utilizing tissue Doppler techniques and a slight concentric LV hypertrophy. These are good markers for seriously considering immediate body weight reduction and properly controlling blood pressure values and pulmonary disorder.
Coming to this point, you don't need any further cardiac tests, but just to undergo through a very meticulous body weight reduction program
This can be achieved by a hypo-caloric diet coupled with a gradually increasing daily physical activity.
You should know that obesity have several adverse health effects, including hypo-ventilation syndrome, diabetes, joints and backbone column destruction and body muscles de-conditioning, hypertension, dyslipidemia, constipation, inactivity, depression, etc.
So, it seems that your greatest enemy is obesity and you should fight it without mercy.
My advice goes in favor of a dietitian consultation and a well tailored diet program, which would bring the desired beneficial health results.
I recommend to discuss with your attending doctor on the above mentioned issues.
Hope to have been helpful to you!
Please, let me know in case of any further questions.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Iliri,
Great to hear from you - your answers are brilliant.
So it sounds like I am catching this before I've done too much damage and I need to get my weight in order. Some of this should improve with weight loss?
Is diastolic disjunction a precursor to heart failure? I guess what I mean is this likely reversible or is there some permanent damage? I noticed on treadmill stress test the nurse said my top number was going up and bottom going down exactly as it should. In fact my blood pressure was good during and after exercise but not so great before. That's an amazing wake up call to power of exercise.
My main concern was at my weight I didn't want to jump into cardio and then keel over. Nobody can promise the future but it sounds like I am clear to gradually increase my daily exercise and get in shape.
Blood work as of 3 weeks ago indicates great overall cholesterol but high to low ratio suboptimal. I am told that improves with exercise as well.
Do I have all that correct? Thanks again!
Last question: did some googling at the E/e ratio. Difficult for a non doctor to understand but my elevated ratio does not seem very good. Am I much more likely for heart attack while it's high?The ratio seems related to the deceleration time? It seems like with my fast deceleration time and high ratio I could technically have diastolic heart failure?
Sorry to jump to conclusions.
Great to hear from you - your answers are brilliant.
So it sounds like I am catching this before I've done too much damage and I need to get my weight in order. Some of this should improve with weight loss?
Is diastolic disjunction a precursor to heart failure? I guess what I mean is this likely reversible or is there some permanent damage? I noticed on treadmill stress test the nurse said my top number was going up and bottom going down exactly as it should. In fact my blood pressure was good during and after exercise but not so great before. That's an amazing wake up call to power of exercise.
My main concern was at my weight I didn't want to jump into cardio and then keel over. Nobody can promise the future but it sounds like I am clear to gradually increase my daily exercise and get in shape.
Blood work as of 3 weeks ago indicates great overall cholesterol but high to low ratio suboptimal. I am told that improves with exercise as well.
Do I have all that correct? Thanks again!
Last question: did some googling at the E/e ratio. Difficult for a non doctor to understand but my elevated ratio does not seem very good. Am I much more likely for heart attack while it's high?The ratio seems related to the deceleration time? It seems like with my fast deceleration time and high ratio I could technically have diastolic heart failure?
Sorry to jump to conclusions.
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again, dear xxxxxxxxx
You are quite right on the importance of a well-tailored weight reduction program.
It is not necessary to jump into cardio; just everyday walking is sufficient. A gradually escalating program, better under a certified expert on the field, would be highly recommended.
Weight reduction is the most important issue in fact the Achilles wheel in your case. Once you decrease it, everything could be resolved much easier.
But the most challenging issue in this regard is the patience and perseverance to go to the end. Who owns or exhibits such beneficial qualities, succeeds at the end.
I strongly encourage you to keep going that way.
Cholesterol profile would improve much easier and also you echo Doppler indexes (including E/E').
So there is nothing dangerous and uncontrollable in your clinical conditions.
An increased E/E' doesn't mean that you should have clinically apparent heart failure.
Also, there is not an increased likelihood of heart attack.
It is just an unfavorable hemodynamic profile, that may be improved through simple and continuing measures of a healthy life style and diet.
Mitral valve deceleration time is influenced also by the loading conditions and may vary greatly in the same patient. So relax and don't worry too much about.
On my personal opinion, if you are successful in the management of your body weight reduction, probably you may not need medical therapy to arrange your blood pressure values or your cholesterol profile.
Wishing you good health!
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again, dear xxxxxxxxx
You are quite right on the importance of a well-tailored weight reduction program.
It is not necessary to jump into cardio; just everyday walking is sufficient. A gradually escalating program, better under a certified expert on the field, would be highly recommended.
Weight reduction is the most important issue in fact the Achilles wheel in your case. Once you decrease it, everything could be resolved much easier.
But the most challenging issue in this regard is the patience and perseverance to go to the end. Who owns or exhibits such beneficial qualities, succeeds at the end.
I strongly encourage you to keep going that way.
Cholesterol profile would improve much easier and also you echo Doppler indexes (including E/E').
So there is nothing dangerous and uncontrollable in your clinical conditions.
An increased E/E' doesn't mean that you should have clinically apparent heart failure.
Also, there is not an increased likelihood of heart attack.
It is just an unfavorable hemodynamic profile, that may be improved through simple and continuing measures of a healthy life style and diet.
Mitral valve deceleration time is influenced also by the loading conditions and may vary greatly in the same patient. So relax and don't worry too much about.
On my personal opinion, if you are successful in the management of your body weight reduction, probably you may not need medical therapy to arrange your blood pressure values or your cholesterol profile.
Wishing you good health!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much. I greatly appreciate your candor and professional opinion.
I wish you the best.
xxxxxxxxxxxx
Oops once I replied I was no longer able to close the ticket.
No more questions.
Thanks!
I wish you the best.
xxxxxxxxxxxx
Oops once I replied I was no longer able to close the ticket.
No more questions.
Thanks!
Brief Answer:
You are welcome!
Detailed Answer:
I remain at your disposal in case of any further questions.
Regards,
Dr.Iliri
You are welcome!
Detailed Answer:
I remain at your disposal in case of any further questions.
Regards,
Dr.Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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