Patient's Query
Hello doctor,
I recently had a cardiac computed tomography (CT) scan. The report shows the left circumflex 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.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understand your concern.
In case of next time, please always upload or give information on the complete result of an investigation. It helps to explain the investigation better. The report means simply that there is an anatomical deformity or changes, perhaps present in the left ventricular part of the heart. It is stated to be of no clinical significance, meaning it does not affect normal function.
Why did you go for this investigation?
Do you have any symptoms?
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
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 accounts 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 valve 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.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I have read the query and understand the concern.
Grade 1 diastolic dysfunction is a common finding in a large proportion of the healthy population and usually does not have clinical significance. Grade 2 and grade 3 diastolic dysfunction are considered clinically significant.
I would like to ask a few questions regarding chest pressure, chest pain, and breathlessness:
When are these symptoms experienced, at rest or during physical activity?
Is there a history of high blood pressure?
Is there any cough, swelling of the legs, or abdominal distension?
Is there any family history of asthma?
Is there sudden awakening at night with breathlessness, or difficulty sleeping without using a pillow?
Does physical exercise improve the symptoms?
Has weight reduction been attempted?
Are the results of the lipid profile test available?
Weight reduction can help improve symptoms and prevent the progression of diastolic dysfunction. If indicated based on lipid profile results, a low-dose statin (for example, Atorvastatin) may be beneficial.
I hope this is helpful.
Thank you.
Patient's Query
Hello doctor,
I experience symptoms both at rest and during physical activity, but they occur mainly when lying flat. My blood pressure is usually around 136/63 millimeters of mercury. I had ankle swelling only once last year. Two of my brothers have asthma. I wake up suddenly at night feeling breathless and am unable to sleep without using a pillow. Exercise does not improve my symptoms.
I have tried to lose weight. I also underwent a lipid profile test, and the results are as follows:
Total cholesterol: 6.31.
Non-high-density lipoprotein cholesterol: 5.22.
High-density lipoprotein cholesterol: 1.09.
Total cholesterol to high-density lipoprotein ratio: 5.79.
Triglycerides: 5.64.
Do you think the abnormal findings on the computed tomography scan only show diastolic dysfunction, or should there be more concern? My doctor mentioned that the results were normal, but I am worried about the finding described as the left circumflex artery near the origin of the left circumflex artery and ramus, with an apparent arterial communication and an outpouching of the left ventricle anterior to the left pulmonary veins. It was mentioned that one would expect no coronary artery dilatation in a coronary–left ventricular fistula and that the appearances are unusual and of uncertain clinical significance. I am not sure what this means.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I have read the query and understand the concern.
The cholesterol levels are elevated. It is advised to take the tablet Rosuvastatin 5 milligrams, one tablet once daily for two weeks, and then repeat the lipid profile test after completing the course of medication.
There is no need to worry about the diastolic dysfunction. Grade 1 diastolic dysfunction does not indicate a serious problem and does not affect normal heart function.
The finding mentioned in the report indicates that an artery is seen communicating with the left ventricle (LV), which is an unusual anatomical variation. Such variations can be seen in individuals and are often unique anatomical findings. In this case, the report states that the finding is of uncertain clinical significance and does not cause any functional impairment. It has been reported as not causing any problem and does not affect overall heart function.
I hope this is helpful.
Thank you.
Patient's Query
Hello doctor,
I shall suggest to my doctor to prescribe the medication you recommend, as I am not sure if I can buy it over the counter. Can I just ask if all the information I have given you rules out pulmonary hypertension?
Kindly advise.
Hello,
Welcome to icliniq.com.
I read your query and understand your concern.
Pulmonary hypertension (PH) has been ruled out. Pulmonary hypertension usually presents with a different set of symptoms. Reduced exercise tolerance, fainting episodes, and swelling of the ankles or legs are more commonly associated with pulmonary hypertension. The symptoms described do not suggest pulmonary hypertension. Pulmonary hypertension is also uncommon in individuals of this age group. There is no need to worry. Please remain calm.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
My symptoms mainly include fatigue, mild breathlessness, and chest pressure, particularly when lying flat and sometimes while walking downstairs. I was very worried about pulmonary hypertension, which is why I asked whether these results ruled it out.
Please explain further your response to my previous question, as mentioned below. The statement that an artery was found attached to the left part of the heart and that this is unusual was confusing to me. It was also mentioned that each individual can have unique anatomical findings and that such variations are common. Although this change has been reported as not causing any problem and not affecting normal heart function, I am still concerned.
Do I need to worry about this finding?
Is it a heart defect or a growth?
Could this be the cause of the diastolic dysfunction?
Kindly advise.
Hello,
Welcome to icliniq.com.
I read your query and understand your concern.
There is absolutely nothing to worry about. This is not a defect or an abnormality; rather, it is an anatomical variation seen in some individuals when compared to the rest of the population. It is not the cause of the diastolic dysfunction.
Diastolic dysfunction is a finding observed in more than half of the healthy population. The symptoms being experienced are not related to diastolic dysfunction. I sincerely understand the concern, but there is nothing in the test results that suggests this finding is a problem or requires intervention.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
It feels more like an unusual sensation or pressure rather than pain. I also experience palpitations and an odd sensation around my neck, mainly when I lie down.
Kindly advise.
Hello,
Welcome to icliniq.com.
I read your query and understand your concern.
Have you ever suffered any trauma to the chest in the past?
How severe are your palpitations?
Does it affect your daily activity?
Have you ever been diagnosed with an anxiety disorder?
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Please see the responses to the questions below. In addition to the previously mentioned symptoms, I also experience dizziness and light-headedness when standing up from a sitting or lying position.
Have you ever experienced any trauma to the chest in the past? No.
How severe are the palpitations? They come and go, and at times they can be frightening, but I am learning to cope with them.
Do the symptoms affect daily activities? Sometimes they do, depending on the severity.
Have you ever been diagnosed with an anxiety disorder? I was recently diagnosed with generalized anxiety disorder (GAD). I also have a history of an esophageal ulcer, and a hiatal hernia was identified during my last endoscopy.
Kindly advise.
Hello,
Welcome to icliniq.com.
I have read the query and understand the concern.
It was suspected that an anxiety disorder might be present, and the symptoms described are consistent with an anxiety disorder.
Are any medications currently being taken for anxiety? If the palpitations become difficult to tolerate, a low-dose beta blocker may be helpful. Bisoprolol 2.5 milligrams once daily can help reduce palpitations.
I hope this helps.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply,
So, do you think all my symptoms are anxiety rather than my heart?
Kindly advise.
Hello,
Welcome to icliniq.com.
I read your query and understand your concern.
Yes, that is exactly what it points to. There is no reason to think otherwise. Heart diseases do not present this way.
Why are you so worried about heart disease?
Do you have a family history of heart disease?
Do the palpitations make you think you can suffer a heart attack?
I hope this helps.
Thank you.
Patient's Query
Hello doctor,
I have received a further letter from my cardiologist and would like to share it with you for review. Once again, any additional information or advice that can be provided would be very helpful, and I would be most grateful.
Kindly advise.
Hello,.
Welcome to icliniq.
Welcome to icliniq.com.
I read your query and understand your concern.
I am pleased to hear from you, knowing you are in good spirits. Your cardiologist confirmed what I said earlier. They said abnormality is a coincidental finding. These kinds of findings are common in the healthy population. Also, for grade 1 diastolic dysfunction, exercise can help, although it is nothing to worry about. I advise you to live your normal life. Eat healthy, exercise, and always get sufficient rest. No need for panic.
I hope this helps you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply,
Kindly advise.
Hello,
Welcome to icliniq.com.
I have read the query and understand the concern.
The abnormality is often of unknown cause. The good news is that it does not pose any danger. In some cases, it may be related to genetic variations. This means that during heart development, there may have been a minor variation in formation. This finding helps rule out other significant heart diseases.
I hope this helps you.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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