Cardiac CT for diastolic dysfunction shows some anomalies. Kindly explain.

Hello doctor,

I recently had a cardiac computed tomography (CT) scan. The report shows left circumference artery (LCx) - near the origin of the LCx or ramus. There appears to be an arterial communication with an outpouching of the left ventricular (LV) anterior to the left pulmonary veins. There is no coronary artery dilatation that one may expect in a coronary LV fistula. The appearances are odd and of uncertain clinical significance. I was diagnosed with grade 1 diastolic dysfunction. Please explain.

Hi doctor,

Thank you for the reply.

I had the scan after I was diagnosed with grade 1 diastolic dysfunction. I have been getting chest pressure and breathlessness. I have included both the whole CT scan and the echocardiogram (ECHO) report below. My clinical history includes the following:

• Chest pain.
• Several emergency department (ED) attendances.
• Being a non-smoker.
• Having a distant family history of ischemic heart disease IHD.
• Breathlessness with a normal cardiothoracic ratio in the x-ray.
• The lung pathology account for symptoms.

The following are the test results:

• CT coronary artery calcium scoring: The calcium score is zero.
• CT coronary angiogram: Systolic phase images 800 mcg SLGTN, 10 milligrams intravenous Metoprolol.
• RCA - dominant.
• Normal PDA.
• Normal LV branch - large arteries supplying the posterior of the LV.
• LMS - Normal.
• LAD - Normal.
• D1 - Normal.
• D2 - Normal.
• Ramus intermedius - small and normal.
• LCx - near the origin of the LCx/Ramus.

There does appear to be an arterial communication with an outpouching of the LV anterior to the left pulmonary veins. One may expect no coronary artery dilatation in a coronary- LV fistula. The appearances are odd and of uncertain clinical significance. The aortic valve is trileaflet and opens well. The visible portions of the aorta, lungs, pleural spaces, pulmonary arteries, pericardium, and bones are normal.

Summary:

• No flow-limiting coronary artery disease.
• LCx features as described above.
• Nondilated aortic root: Sinus of Valsalva 3.5 cm, sinotubular junction 2.4 cm.
• The ascending aorta was not imaged.
• Normal arch appearance, normal flow, and proximal descending aorta.
• The Tricuspid is a normally functioning aortic valve.
• The main pulmonary artery and pulmonary valve appear normal.
• Normal trans pulmonary Dopplers.
• Both AV valves appear morphologically normal with good leaflet excursion.
• No regurgitation was identified.
• Nondilated left atrium: minor axis 3.2 centimeters, left atrial volume 52 milliliters.
• There is evidence of mild diastolic dysfunction: E velocity 0.72, E DT 454 milliseconds, A velocity I, ratio 0.7, E/E prime (averaged) 7.58.
• No internal measurements or volumetric assessment of the left ventricle suboptimal images and off-axis parasternal view.
• The ventricle appears nondilated.
• There is good left ventricular function: VT 1 27.3 cm, ejection fraction (visual) 60%.
• No regional wall abnormality was identified.
• Normal longitudinal function: Lateral S wave 14 cm/sec, septal S wave 12 cm second, inferior S wave 11 cm second, anterior S wave 18 cm/sec.
• Nondilated, reactive IVC.
• Normal right heart appearance.
• There is good right ventricular systolic function: TAPSE 18 mm, lateral S wave 15 cm/sec.
• No flow was identified across the interatrial septum in the short axis and subcostal views.

Hi doctor,

Thank you for the reply.

I experience my symptoms both during rest and physical activity, but mainly when I lie flat. My blood pressure is normally around 136/63. I had ankle swelling only once last year. Two of my brothers have asthma. I wake up suddenly at night, feeling breathless. I am unable to sleep without a pillow. And exercise does not make my symptoms better.

I tried losing weight. I did a lipid profile test, and the results are as follows:

• Total cholesterol - 6.31.
• Non-HDL cholesterol - 5.22.
• HDL cholesterol - 1.09.
• Total cholesterol - HDL 5.79.
• Triglycerides - 5.64.

Do you think the abnormal results of the computed tomography (CT) scan just shot my diastolic dysfunction, or should I be more worried? My doctor says the results were normal, but I am concerned with finding LCx- Near the origin of the LCx/Ramus, there does appear to be an arterial communication with an outpouching of the LV anterior to the left pulmonary veins. One may expect no coronary artery dilatation in a coronary- LV fistula. The appearances are odd and of uncertain clinical significance. As I am not sure what it means?

Hi doctor,

Thank you for the reply.

I shall suggest my doctor to prescribe the medication you recommend as I am not sure, I can buy it over the counter.

Can I just ask if all the information I have given you rules out pulmonary hypertension?

Hi doctor, Thank you for the reply. My symptoms are mainly fatigue, slight breathlessness, and chest pressure, mainly when lying flat and sometimes when walking downstairs. I was very worried about PH, so I asked if these results ruled it out. Please explain more about your reply to my previous question (please see below). This statement simply means that an artery was found attached to the left part of your heart, which is unusual. In every individual, there's a different finding that is unique to that particular individual. This is common to every human being. Although you have this change, it is reported to be no problem. It does not affect your normal heart function. I hope you understand my explanation. Do I need to worry about it? Is it a heart defect or a growth? Could it be the cause of my diastolic dysfunction?

Hi doctor,

It is more of an odd feeling or pressure sensation than a pain. Also get palpitations and an odd feeling around my neck, mainly when I lie down.

Hi doctor,

Please see below for the replies to your questions.

To add to my symptoms, I also get dizzy and light-headed when standing up from sitting or lying down.

1. Have you ever suffered any trauma to the chest in the past? - No.
2. How severe are your palpitations? - It comes and goes, and sometimes it can get terrifying, but I am learning to cope with them.
3. Does it affect your daily activity? - Again, sometimes, it all depends on how bad it gets.
4. Have you ever been diagnosed with anxiety disorder? - I have recently been diagnosed with generalized anxiety disorder (GAD). I also have a history of an ulcer on the esophagus, and a hiatus hernia was found on my last endoscopy.

Thank you.

Hi doctor,

Thank you for your reply, So, do you think all my symptoms are anxiety rather than my heart?

Hi doctor,I have a further letter from my cardiologist and just wanted to share this with you for review. Once again, any further information or advise you can provide will be most helpful and I would be most grateful.

Hi doctor,

Thank you for the reply, Do you have any idea what causes the abnormality?Is it a birth defect or lifestyle issues?