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What do my lab test results indicate?

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Posted on Wed, 4 May 2016
Question: I went to ER Tuesday.. Chest pains 4,5,6,7,Bp pressure 187/85 to 55/35 after catherization. The gave me , sodium,fluid, morphine, under the tongue nitro and patch. The dr said it was my stomach. Their records and mine are different. I am changing cardiologist the 11th. I see stomach specialist
Thursday. I go to XXXXXXX White March 24th. My blood pressure is back high today and mild chest pain. Do we see different records? What happened to records in hospital.
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully read your question and would explain that morphine, nitro under tongue and patch are usually used in myocardial ischemia (acute coronary artery syndrome).

Did you have any relief after receiving this therapy?

Did they perform a resting ECG and cardiac enzymes at that moment?

Could you please upload the ECG and lab tests reports for me to review?

Stomach disorders like gastritis or gastro-esophageal reflux usually do not cause raises in blood pressure and are relieved by antiacids or PPIs (omeprazole, lansoprazole, etc.). Did you take any of these drugs, followed by relief of your symptoms?

What are your coronary angiography reports?

Your blood pressure values are above the normal ranges, and this is really concerning.

You should discuss with your doctor on possible changes to your blood pressure therapy and performing some tests to exclude possible secondary causes of high blood pressure.

I would be happy to review all your medical reports for a more specific professional opinion.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (45 minutes later)
Bp flip flops. I received no records. one of 4 EKGs were abnormal when I asked the nurse .about one . I receive relief after medicine. I take pantoprazole 40 mh and culturella. trouble with diarreah . I worry about increase chest pains and harder each time over 2 year period. Bp scares me
doctor
Answered by Dr. Ilir Sharka (7 hours later)
Brief Answer:
My opinion:

Detailed Answer:
Hello again,

I carefully reviewed your medical history. Regarding your chest pain history, it is necessary to further investigate the clinical significance of those mild to moderate coronary stenosis.

It is true that generally coronary stenosis less than 70-75% are clinically insignificant, but sometimes they may be a source of myocardial ischemia and physical limitations.

I would recommend to discuss with your attending physician for additional imagine cardiac testing like:

- nuclear perfusional cardiac stress testing (CARDIOLITE),
- myocardial contrast stress echo,

which could reveal a possible provocable cardiac ischemia caused by those non-innocent coronary lesions at first sight.

Also, measurement of fractional flow reserve in the XXXXXXX lab would be an alternative valuable investigation in this regard.

In case, ischemia is confirmed (clinical significance present), then proceeding to coronary stenting would be a rationale approach.

Regarding your blood pressure values, I recommend closely monitoring your BP several times daily for a couple of days up to a week (as it would yield the most reliable results about your BP values trends).

In case your BP values persist on abnormally high levels, then additional therapy is necessary such as any ACEIs (like Ramipril, Lisinopril, etc.), or ARBs (Olmesartan, Irbesartan, etc.) in case no contraindications exist.

At the end, I would like to assure you that high blood pressure values are almost always controllable with an optimal therapy.

So, nothing to worry about dear!

You need to discuss with your attending physician on the above mentioned opinions.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
thank you How hard should pains be before I go to ER?
doctor
Answered by Dr. Ilir Sharka (5 minutes later)
Brief Answer:
I could explain:

Detailed Answer:
Hi,

Chest pains lasting more than 10 min, frequent and not relieving by sub-lingual nitroglycerin, should be considered serious enough for seeking prompt medical attention.

In such case you need to immediately consult the nearest ER service for a new medical evaluation.

You should consider discussing with your attending cardiologist on the above mentioned additional tests.

Greetings!

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (2 days later)
y blood work says

Sodium level 127

Chloride level 92

Glucose random 117

aST 41

wBC 12.3

mPV 8.7

Lymphocytic 14.3

Eosinophils 1.0

Absolute neutrophil 9.18

Absolute monocycle 1.08
doctor
Answered by Dr. Ilir Sharka (11 hours later)
Brief Answer:
My answer as follows:

Detailed Answer:
Hello again!

Thank you for the additional information.

I carefully reviewed your blood lab tests and would explain that:

- Your blood count shows an elevated number of white blood cells, with normal ratios of neutrophiles and lymphocytes. These findings could be related to inflammation, but they do not show any viral or bacterial infection.

- Your sodium levels are low. I recommend repeating the electrolyte levels.
Low sodium levels, could be related to different symptoms like nausea, muscular cramps, fatigue. That is why they have given infusions of sodium to correct these low levels.

The other lab tests are normal.

These findings are not very specific for myocardial ischemia and they do not exclude this disorder.
I would recommend performing the other above mentioned tests to investigate for possible myocardial ischemia.

Hope to have been helpful!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ilir Sharka

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What do my lab test results indicate?

Brief Answer: My opinion as follows: Detailed Answer: Hello! Welcome and thank you for asking on HCM! I carefully read your question and would explain that morphine, nitro under tongue and patch are usually used in myocardial ischemia (acute coronary artery syndrome). Did you have any relief after receiving this therapy? Did they perform a resting ECG and cardiac enzymes at that moment? Could you please upload the ECG and lab tests reports for me to review? Stomach disorders like gastritis or gastro-esophageal reflux usually do not cause raises in blood pressure and are relieved by antiacids or PPIs (omeprazole, lansoprazole, etc.). Did you take any of these drugs, followed by relief of your symptoms? What are your coronary angiography reports? Your blood pressure values are above the normal ranges, and this is really concerning. You should discuss with your doctor on possible changes to your blood pressure therapy and performing some tests to exclude possible secondary causes of high blood pressure. I would be happy to review all your medical reports for a more specific professional opinion. Kind regards, Dr. Iliri