Q. Is systemic hypertension the same as high BP?
Hi doctor,
I am a 45 year old male. My weight is 211 pounds and my height is 6 feet. My symptoms are breathlessness on exertion, neck constriction while walking, as well as on and off chest pain in the mornings that are unconnected with exertion. I am also suffering from severe sleep apnea. I had TMT positive 8 METs, 6.3 minutes and ST depression of 2.5 to 3 mm in inferolateral leads. I underwent coronary angiography last week. Fortunately, no significant blocks were found. Doctor said many small blocks are there, which do not restrict the flow of blood. The diagnoses are minor coronary atherosclerotic disease and systemic hypertension. The report says only minor plaques in LDA and LCX. Does this mean angiogram is negative, I mean normal? If so, are my symptoms non-cardiac in nature? Can I ignore further chest pains? Or where should I go to treat them? Am I right in thinking that this report means I am unlikely to have a heart attack at least in near future? What are the chances that these minor plaques may progress and become bigger or serious? How will I know if and when the blocks become bigger; since my stress test was already positive, false positive? Is systemic hypertension the same as high BP? My BP was only 130/80 mmHg at the hospital. My home BP machine often gives 150-160/90 mmHg. How did they diagnose systemic hypertension? Being a wonderful doctor I need your help again today.
Hi,
Welcome to icliniq.com.
I am really thankful for your kind comments. You have always been so nice and a health conscious person. I want to assure you do not worry as everything is going to be fine soon. I have thoroughly gone through your case and can well understand your genuine health concerns. Thanks for attaching the supporting documents (attachments removed to protect patient identity) for a thorough insight on the issue.
The Probable causes:
You had an unremarkable angiography. It was a very good and a bold decision to go for a timely angiography. I appreciate that you did as advised. Now at least we have got a direction to move on. Now I will reply every part of your query in the order. The report actually means that we do not need to go for angioplasty or stent placement or CABG (coronary artery bypass grafting - bypass operation) today. But it does not give any guarantee for future. You need to adapt a good lifestyle. Keep the hypertension in control. Take a good healthy diet. Do proper physical activity on a regular basis. You have to keep your lipids and cholesterol in limits too. This is the meaning of all what is written in your angiography report. If not controlled right now and not taken good care of, it may lead to enhanced and widespread coronary artery disease and may lead to blockage of vessels in the years to come. Yes, ignore the chest pains. They are nothing and will not pose any harm right away. You need to act upon my advice rather to remain healthy forever. There are least chances for a heart attack right now, but I have explained about the future consequences of the issue if not handled with care. These minor plaques may get definitely big problems if not dealt with care. Let me explain a little more about arteriosclerosis so that you may get better insight. Hypertension makes the arteries stiff and they cannot expand in case there is a need for some increased blood flow through them. No definite answer for future events as it will all depend on medical and personal care. Your blood pressure, lifestyle and diet will all be the main determinants. But if you feel unexplained weakness, tiredness, sleepiness even with a good sleep, restlessness, difficulty on exertion first and with passage of time difficulty in breathing even without exertion; it all means that, you have a bigger issue with the coronary arteries. Your stress test was not 100% false positive. It had some relevance and clinical significance. It is called early stage of coronary arteriosclerosis manifestations. Systemic hypertension is a word to differentiate it from other hypertension like portal hypertension. And, yes it means the same as you said the high blood pressure. Hypertension is one of the main causes of the coronary artery disease especially when there is no other major contributing factor. Also they have had monitored the blood pressures during the angiography and also during indoor stay in hospital.
Treatment plan:Mainstay of treatment is lifestyle modification as aforementioned.
Preventive measures:Keep away from smoking and alcohol.
Regarding follow up:For further information consult a cardiologist online.
Hi doctor, Thanks a lot for your detailed response as always! I learnt a lot with these exchanges. My main doubt is I am still trying to find answer for why am I still feeling breathless on exertion and fatigue? The blocks in arteries are only minor and they would not cause breathlessness. I had an ECG and echo today in a health camp in our neighborhood. Copy of echo report attached. It says concentric LVH, diastolic dysfunction and mild MR. Also it shows the size of something called Ao as 20 mm; it was 32 mm in last echo and normal range says 25 to 37 mm. Can any of this; may be diastolic dysfunction, be the cause for my breathlessness and fatigue? Is any of this a reason to worry? Also the ECG shows prolonged QTc of 499 ms. Somehow I feel that this is due to the tablet Dilzem, which I am taking. Earlier also when taking Dilzem the QTc went to 528 ms. Is my feeling right? Is there any problem in having a prolonged QTc like this? Should I stop that tablet? Please help in this too.
Hi,
Welcome back to icliniq.com.
Thanks for attaching the supporting documents (attachment removed to protect patient identity). Let me explain you the reason for your issues like shortness of breath, fatigue etc. They are all cardiac in nature. You have mild left ventricular hypertrophy (LVH). Your left sided valve between the left upper and lower heart chambers is not working optimally, mitral regurgitation (MR). What happens is when your heart relaxes to fill up with oxygenated blood from your lungs, it is not fully filled up in a proper way and also when it pushes blood into the aorta during systole the blood regurgitates back into the left atrium and back pressure builds up and is transmitted to your lungs and due to that there is sometimes fluid in the lungs. This causes shortness of breath in such patients like you. Also if there is narrowed atrium this also causes issues with proper pumping of blood. MR is due to the LVH. No, do not stop taking any drug prior to consulting your treating physician. Diltiazem is necessary for you to low your BP and to keep heart functioning normally. Ask your physician if you need some water pill, like HCTZ (Hydrochlorothiazide) or Furosemide or so to remove fluid from your lungs after checking the lungs thoroughly. Please revert in case of further queries.
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