I am a 57 year old male, and I had episodes of shortness of breath and tachycardia, six months back. I take high doses of Statin and ACE inhibitors from ten years, and my lipid profile is excellent. EKG showed slight ST depression, an echocardiogram showed WMA (wall motion abnormalities), and the angiogram showed moderate coronary artery disease (CAD) in LAD, about 50% at first septal branch. LVEDP is 4 mmHg, no aortic pullback, and no mitral gradient. The diagnosis is nonobstructive coronary artery disease, and when I pressed for the etiology of symptoms, I was told it was due to a mild developmental disorder. After six months of weight loss, diet changes, exercise, etc., my symptoms have improved, but are still evident. How is LVEDP of 4 mmHg concordant with diastolic dysfunction? What else could be causing the symptoms, since CAD is nonhemodynamic?
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Thank you for the quick reply. EKG, echo and cardiopulmonary tests were done six months ago. My present weight is 230 lbs, down from 285 lbs. My LDL was 70, HDL was 57, non-HDL was 112, and TG 185. But, now my LDL is 35, HDL is 50, TG is 75, non-HDL is 51, and hs-CRP is 6. Unfortunately, I do not know LDL-P or ApoB. I added Ezetimibe 10 mg to 20 mg Crestor plus and stopped eating carbohydrates. I am still confused about how the LVEDP can be 4 mmHg, with diastolic dysfunction? Would not a non-compliant LV, typically cause preload to be higher rather than lower? And LVEF is 60 %. My cardiologist does not want to see me for another year and does not explain anything.
Welcome back to icliniq.com.
Your lipid profile test shows significant improvement, which is good.
I certainly do not know why he would not want to see you this year. Not to scare you, but a situation where you have diastolic dysfunction with a normal ejection fraction is known as heart failure with preserved ejection fraction (HFpEF).
This situation could be caused by obesity, ischemia, aging, etc. Your EKG result as of six months ago showed ST depression, which indicated ischemia. This could be the cause in your case.
There is a study, that shows the prevalence of diastolic dysfunction occurring for a longer time after an event of ischemia.
I sincerely hope you get better soon.
For further queries consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist
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