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What causes breathlessness while lying down in a person with high LDL?

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Posted on Wed, 27 May 2015
Question: I am a 45 year old male, weight 90kg, height 184 cm. I have dizziness and mild chest pain 2-3 months. (Slight tightness in neck while walking and breathlessness) My LDL cholestrol is 152, BP around 140/90, father has heart disease. Echo is normal, ECG abnormal. TMT test says 'TMT is positive for inducible ischemia. Fair exercise capacity 8 mets'. Achieved 79% of predicted maximum heart rate. ST segment depression of 2.5 to 3 mm in inferolateral leads at peak exercise associated with chest pain." TMT went on for 6.3 minutes.

Actually I had a lot of breathlessness at TMT and that was main reason to stop. Slight chest pain only after stopping. Is the TMT significant? What should me my next step. I also have more breathlessness while lying down.
doctor
Answered by Dr. Jignesh Gorasia (4 hours later)
Brief Answer:
Go for angiography as soon as possible, start ecosprin and sorbitrate prophylactically...

Detailed Answer:
Hello,
I had gone through your question very carefully and can understand your concern very well.
First of all, i want to tell you that you are overweight and you need to reduce weight by 10 kg at least as early as possible. Your LDL cholesterol is also high (anything above 130 is considered a risk factor for heart disease), your BP is also slightly high, abnormal ECG and also you have family history of heart disease, you are definitely coming into high risk group of people who are at risk of developing ischemic heart disease.
I have gone through your TMT report and it is significant. If i were your treating doctor, i would surely suggest you to undergo angiography to rule out any kind of blockage. I would have also started tablet ecosprin 300 mg daily and sorbitrate as prophylactic therapy.
I would also suggest you to check your fasting and 2 hour post prandial blood sugar to rule out diabetes. Also check your renal profile mainly creatinine.
You also require few life style modifications like avoid oily and processed junk food, start daily walking for at least 20 minutes (after angiography and further plan of action), avoid extra salt intake in your food, limit sugar intake, etc.
Because you are in high risk group and having breathlessness and chest pain, i would suggest you to go for angiography as soon as possible.
Hope this will help you and let me know if you have any further queries.



Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Jignesh Gorasia (46 minutes later)
Thank you for your detailed reply. I would like your valued opinion in the following:

1) My echo report shows normal and a good ejection factor of 65% and 80% (in 2 echos). Is it still possible that I may have a block in my artery?

2) I have read about procedures like 64 slice CT angio which is non-invasive. Would this be a good option.

doctor
Answered by Dr. Jignesh Gorasia (11 minutes later)
Brief Answer:
Artery blockage is possible with 65% EF.go for conventional angiography...

Detailed Answer:
Hi,
No matter how much ejection factor is there, it is still possible to have coronary artery blockage, but its good that you have normal ejection factor, because that will have good prognosis, if any intervention is required.
I would suggest you to go for conventional angiography, because CT angio has its own pros and cons and major drawback is exposure to radiation and it is less accurate than conventional angiography.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Jignesh Gorasia (58 minutes later)
Thanks a lot for your quick response doctor. Your answers are very clear and succinct.

One last query - I am also having some balancing problems / giddiness etc - for which I am being separately evaluated by a neurologist, who has said that it may be due to low vitamin B12 (my serum vitamin B12 is 171, neuro says it may be the cause of my balancing issues). The Neuro has asked me to have a nerve conduction test and perhaps some other tests. Would this have anything to do with the heart issue? In other words should I wait until all these tests etc are completed before I go for angiogram?

Based on my reports (I realise that without examining me physically, you can't really tell but still) is it somewhat risky for me to put off the angiogram for a few months, or would you advise it to be done very soon. Thanks a lot for your time.
doctor
Answered by Dr. Jignesh Gorasia (12 minutes later)
Brief Answer:
Its better to do angiography early rather than delaying un necessarily....

Detailed Answer:
Hello,
I would suggest you to go for angiography within next 3 months, if not immediate, because no one can tell the future, so its better to screen early,if you are already knowing about it.
Also would suggest you to do nerve conduction test after finishing your heart issue. Meanwhile you can take vitamin B12 orally or injections, if its the cause of your giddiness.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Jignesh Gorasia

General & Family Physician

Practicing since :2005

Answered : 430 Questions

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What causes breathlessness while lying down in a person with high LDL?

Brief Answer: Go for angiography as soon as possible, start ecosprin and sorbitrate prophylactically... Detailed Answer: Hello, I had gone through your question very carefully and can understand your concern very well. First of all, i want to tell you that you are overweight and you need to reduce weight by 10 kg at least as early as possible. Your LDL cholesterol is also high (anything above 130 is considered a risk factor for heart disease), your BP is also slightly high, abnormal ECG and also you have family history of heart disease, you are definitely coming into high risk group of people who are at risk of developing ischemic heart disease. I have gone through your TMT report and it is significant. If i were your treating doctor, i would surely suggest you to undergo angiography to rule out any kind of blockage. I would have also started tablet ecosprin 300 mg daily and sorbitrate as prophylactic therapy. I would also suggest you to check your fasting and 2 hour post prandial blood sugar to rule out diabetes. Also check your renal profile mainly creatinine. You also require few life style modifications like avoid oily and processed junk food, start daily walking for at least 20 minutes (after angiography and further plan of action), avoid extra salt intake in your food, limit sugar intake, etc. Because you are in high risk group and having breathlessness and chest pain, i would suggest you to go for angiography as soon as possible. Hope this will help you and let me know if you have any further queries.