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

Answered by
Dr. Isaac Gana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Nov 16, 2020

Hello doctor,

I recently had a cardiac CT scan. The report shows LCx - near the origin of the LCx/ramus. There appears to be an arterial communication with an outpouching of the 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.

#

Hello,

Welcome to icliniq.com.

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?

Thank you doctor,

I had the scan after I was diagnosed with grade 1 diastolic dysfunction. I have been getting chest pressue and breasthness.

I have included the full CT scan report below and also the report from my echo.

Clinical history: Chest pain. Several ED attendances. Non smoker. Distant family history of IHD. Breathlessness - normal CXR? Obstructive coronary disease? Lung pathology to account for symptoms.

CT coronary artery calcium scoring: The calcium score is zero.

CT coronary angiogram: systolic phase images. 800 mcg SLGTN, 10 mg IV 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, 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. There is no coronary artery dilatation that one may expect 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 all 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.

Ascending aorta not imaged.

Normal arch appearance normal flow and proximal descending aorta.

Tricuspid, normally functioning aortic valve.

Main pulmonary artery and pulmonary valve appear normal.

Normal trans pulmonary Dopplers.

Both AV valves appear morphologically normal with good leaflet excursion. No regurgitation identified.

Nondilated left atrium: minor axis 3.2 cm, left atrial volume 52 ml.

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 resuboptimal 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 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 identified across the interatrial septum in the short axis and subcostal views.

#

Hello,

Welcome back to icliniq.com.

Grade 1 diastolic dysfunction is a common finding in the majority of the healthy population. It has no significance.

Grade 2 and 3 diastolic dysfunction are considered significant.

Regards, your chest pressure /chest pain, and breathlessness. When do you experience these symptoms? At rest or during physical activity? Do you have a history of high blood pressure? Do you have any cough, leg swelling, or enlarged abdomen? Do you have a history of asthma in your family? Do you wake up suddenly at night or feel breathless? Or are you unable to sleep without a pillow? Does exercise better your symptoms?

Have you tried losing weight? Weight loss will help with your symptoms and prevent diastolic dysfunction from progressing. Do you have the result of the lipid profile test? I would love to prescribe a low dose statin. I believe it can be of help.

Thank you doctor,

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 my weight. I did a lipid profile test, and the results are:

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 CT scan's abnormal results just shot my diastolic dysfunction, or do you think I should 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. There is no coronary artery dilatation that one may expect in a coronary- LV fistula. The appearances are odd and of uncertain clinical significance. As I am not sure what it means?

#

Hello,

Welcome back to icliniq.com.

Your cholesterol levels are elevated. Take tablet Rosuvastatin 5 mg one tablet daily for two weeks and repeat the lipid profile test after finishing the medication.

No, you need not worry about the diastolic dysfunction. There is no problem at all.

Your concerning statement simply means that an artery was found attached to the left part of your heart, which is unusual. In every individual, there is 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 of no problem. It does not affect your normal heart function.

I hope you understand my explanation.

Thank you doctor,

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?

#

Hello,

Welcome back to icliniq.com.

You can cross-check with your doctor, although you can buy the drug over the counter. The basic function of the drug is to reduce the level of cholesterol.

Pulmonary hypertension (PH) is absolutely ruled out. PH presents differently. Inability to exercise, fainting, ankle or leg swelling are more common with PH.

Your symptoms do not point to pulmonary hypertension. PH hardly presents in young people of your age. Why did you think of pulmonary hypertension? Please be tension-free.


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