Patient's Query
Hello doctor,
I am a 57-year-old male who experienced episodes of shortness of breath and tachycardia six months ago. I have been taking high doses of statins and ACE inhibitors for ten years, and my lipid profile is excellent. An EKG showed slight ST depression, an echocardiogram revealed wall motion abnormalities (WMA), and an angiogram indicated moderate coronary artery disease (CAD) in the left anterior descending (LAD) artery, with approximately 50 percent blockage at the first septal branch. My left ventricular end-diastolic pressure (LVEDP) is 4 mmHg, with no aortic pullback and no mitral gradient. The diagnosis is non-obstructive coronary artery disease.
When I inquired about the etiology of my symptoms, I was told it was due to a mild developmental disorder. After six months of weight loss, dietary changes, and exercise, my symptoms have improved but are still present. How can an LVEDP of 4 mmHg be consistent with diastolic dysfunction? What else could be causing my symptoms, considering that the CAD is non-hemodynamic?
Please help.
Hello,
Welcome to icliniq.com.
Thank you for providing a detailed explanation. In my practice, normal left ventricular end-diastolic pressure (LVEDP) is considered to be between 4 and 12 mmHg. I would like to know when you last underwent any of these tests: EKG (electrocardiography), echocardiogram, and lipid profile tests. Is your current weight 229 pounds? These questions are important because non-obstructive coronary artery disease (CAD) can progress rapidly to cause cardiac events, as many physicians do not address it aggressively due to the absence of significant obstruction.
Symptoms often do not resolve immediately, especially if our body mass index (BMI) is currently 31, which categorizes you as stage 1 obesity. Therefore, I recommend that you repeat the EKG, echocardiogram, and lipid profile tests, as they may provide valuable insights.
Thanks and regards.
Patient's Query
Hello doctor,
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 mg/dL, HDL was 57 mg/dL, non-HDL was 112 mg/dL, and TG 185 mg?dl. But, now my LDL is 35 mg/dL, HDL is 50 mg/dL, TG is 75 mg/dL, non-HDL is 51 mg/dL, and hs-CRP is 6 mg/dL. 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.
Hello,
Welcome back to icliniq.com.
Your lipid profile test shows significant improvement, which is excellent. I am uncertain 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 condition could be caused by obesity, ischemia, aging, etc. Your EKG result from six months ago showed ST depression, which indicated ischemia and could be a contributing factor in your case.
There is a study that demonstrates the prevalence of diastolic dysfunction persisting for an extended period after an ischemic event. I recommend that you undergo a stress echocardiogram, as this will provide a clearer picture of your diastolic function. If the test results indicate traces of diastolic dysfunction, I suggest you approach your cardiologist and discuss the situation with him. It is important to conduct the test because six months is a considerable amount of time; there may no longer be traces of diastolic dysfunction, which would be good news.
I sincerely hope you feel better soon.
Thank you.
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Answered byDr. Isaac Gana
Medically reviewed byDr. K. Shobana
Same symptoms don't mean you have the same problem. Consult a doctor now!
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