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What causes chest pains when walking up hills or running?

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Posted on Mon, 18 May 2015
Question: I have chest pains when walking up hills or running for the bus. A CT angiogram showed I have an anamolous origin of the right artery from left sinus of vasalva. The proxinal RCA has an interarterial course between the aorta and the pulomonary trunk. The proximial RCA appears compressed between these two arteries causing about >70% diameter reduction.

My private specialist in cardiolgy suggested for a exercise thallium scan to identify the 'extend of the area' that may be affected before deciding on the way forward on long term medication or surgery. The Government cardiologist disagrees and suggest for an angiogram, followed by a by-pass (if required).

As this is congenital and probably not covered by insurance, it is likely that I will choose to be operated by Govt doctor should open heart surgey be required. I am concerned the Govt doctor may go ahead with a by-pass even without fully diagnoising my problem.
doctor
Answered by Dr. Prabhakar C Koregol (58 minutes later)
Brief Answer:
Difficult to answer but let me give XXXXXXX opinion

Detailed Answer:
Looks little tricky. both doctors and opinion are right in their own reasoning. as you are symptomatic and CT angio has shown it is likely to be significant and calls for going ahead with CAG and intervention. but sometimes the Anamalous arteries look abnormal on CT imaging without actually having lesion or block. As you will be subject to major procedure and want make sure that is cause for symptoms and you will be benefitted by surgery, thallium would help. So keeping apart financial issues my advice would be to go ahead with thallium and if it comes positive go back to govt doc and have yours treatment. if thallium shows no evidence of ischemia than you can continue medical treatment with your private cardiologist

Regards
Above answer was peer-reviewed by : Dr. Pradeep Vitta
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Follow up: Dr. Prabhakar C Koregol (2 hours later)
Thanks for your opinion. If thallium results shows I'm ok, should I still go ahead with the angiogram, as the Govt Dr says it's the Gold standard procedure to actually see the situation inside the arteries?

On the other hand, I have had CT angiogram, thallium, previous chest X-ray last Aug, mammogram in XXXXXXX this year .... Am I exposed to too much radiation?

Also, recently I am getting chest pains throughout the day, but also a lot of acid in my stomach (big big burps and farts), could this be acid reflux or related to my heart?

Lastly, can a artery bypass be carried out using keyhole surgery?

doctor
Answered by Dr. Prabhakar C Koregol (2 hours later)
Brief Answer:
yes

Detailed Answer:
Yes If the Thallium comes normal you may not have to undergo CAG. Yes Gold standard is angiogram but it would needed if there is evidence of ischemia and otherwise not.
Radiation dose should be acceptable by the tests you have mentioned
Pain that is continuously there is not generally cardiac and should be acidity as you rightly mentioned
Yes bypass can be considered through key hole but as your right coronary may require graft not everyone will be able to achieve it through key hole. You need to approach the center that specializes in Robotic key hole surgery

Regards
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Prabhakar C Koregol (22 hours later)
I have had on and off chest pains for s week mow on a daily basis which seems worse after meals. The pain is like a heavy load on the centre of my chest and under rib cage. I feel I need to breathe deep to feel better. I am worried it is the effects of my compressed RCA. Could this be the case?
doctor
Answered by Dr. Prabhakar C Koregol (8 minutes later)
Brief Answer:
May be yes may be no

Detailed Answer:
Hi,

It may be related but not for sure. You seem to be worried and that may be worsening your acidity. just review with your doctor and have ECG done

Regards
Above answer was peer-reviewed by : Dr. Pradeep Vitta
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Answered by
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Dr. Prabhakar C Koregol

Cardiologist, Interventional

Practicing since :1998

Answered : 427 Questions

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What causes chest pains when walking up hills or running?

Brief Answer: Difficult to answer but let me give XXXXXXX opinion Detailed Answer: Looks little tricky. both doctors and opinion are right in their own reasoning. as you are symptomatic and CT angio has shown it is likely to be significant and calls for going ahead with CAG and intervention. but sometimes the Anamalous arteries look abnormal on CT imaging without actually having lesion or block. As you will be subject to major procedure and want make sure that is cause for symptoms and you will be benefitted by surgery, thallium would help. So keeping apart financial issues my advice would be to go ahead with thallium and if it comes positive go back to govt doc and have yours treatment. if thallium shows no evidence of ischemia than you can continue medical treatment with your private cardiologist Regards