Myocardial Ischemia and High Triglycerides: A Patient's Concerns

Myocardial hypoxia, triglycerides?

Dear Dr.
He,
I am born in 1984 and my body is not considered very overweight.
However, my triglyceride levels have consistently been high (I exercise regularly, but since I am active, I do not control my diet).
Below are my recent examination data:
Date Systolic/Diastolic Pressure Pulse Blood Sugar Triglycerides Total Cholesterol HDL LDL ECG
106.11.18 121/69 71 83 276 180 34 116
105.06.30 130/79 78 90 347 208 37 94 Left ventricular hypertrophy and conduction delay
103.08.01 120/72 62 96 136 184 - - Normal
101.08.20 137/70 77 85 339 191 37 97 Myocardial ischemia
100.11.12 136/78 61 81 276 200 38 107
My grandfather passed away at 83 due to myocardial obstruction, and my uncle experienced myocardial obstruction at 53 (fortunately, he was saved).
Therefore, I became aware of my triglyceride issue in 2014 and 2017.
I previously held the misconception that triglycerides were not important, and many of my other values were at critical levels.
Additionally, my ECG showed the aforementioned abnormalities, so I underwent ECG, exercise ECG, and echocardiography in 2014 and 2017.
During the exercise ECG, the technician mentioned that, based on his experience, I definitely had heart issues.
However, the doctor who performed the echocardiography and reviewed the exercise ECG results in 2014 advised me to control my triglycerides and weight, stating that I had no problems.
In 2017, I repeated the ECG, exercise ECG, and echocardiography, and the same technician made the same comment.
The doctor initially said there were indeed issues after reviewing my exercise ECG report, but after looking at the echocardiography report, he said that since I could run for 15 minutes, even if there were issues, he could only say that I had no problems, and prescribed medication to lower my triglycerides.
I initially thought everything was fine, but recently my father underwent a 256-slice CT scan and was shocked to find that all three coronary arteries were blocked: the right coronary artery and one of the left arteries were over 75% blocked, while the other was 25-50% blocked.
Seeing my father's results has raised many questions for me, and I would like to ask for your insights:
1.
Assuming my triglycerides have been above normal for 10 years, given my age and the recent ECG results indicating myocardial ischemia and left ventricular hypertrophy, have my coronary arteries already become obstructed?
2.
Is angina clinically very painful?
3.
Should I also undergo a CT scan? (I personally prefer to wait until I am 40.) In the meantime, should I consult a cardiologist for medication to prevent myocardial obstruction?
Thank you for your assistance, Dr.
He.

Dong, 30~39 year old female. Ask Date: 2018/02/28

Dr. He Dongjin reply Cardiology

Hello, I believe your bigger concern is whether there is a family history of coronary artery disease and if there is indeed a blockage.
No one can know for sure; no one has x-ray vision.
Theoretically, symptoms such as angina or shortness of breath may occur, but since you can run for 15 minutes, it seems to be okay.
Should you undergo a CT scan? It's up to you! If it's purely for peace of mind, and if you are already on medication for cholesterol management, it's best to remain calm and cooperate with your physician.
Changhua Hospital cares about your well-being.

Reply Date: 2018/02/28

More Info

Understanding myocardial ischemia and its relationship with elevated triglycerides is crucial, especially given your family history of cardiovascular disease. Your concerns are valid, and I will address each of your questions while providing additional context regarding the implications of high triglycerides and myocardial ischemia.

1. Coronary Artery Blockage: Given your history of elevated triglycerides and the presence of left ventricular hypertrophy (LVH) and myocardial ischemia on your electrocardiograms, there is a possibility that you may have some degree of coronary artery disease (CAD). High triglyceride levels, particularly when combined with other risk factors such as family history, can contribute to the development of atherosclerosis, which is the buildup of plaque in the arteries. This can lead to narrowing or blockage of the coronary arteries, potentially resulting in ischemia. While your exercise tolerance and echocardiogram results may suggest good cardiac function, it is essential to recognize that CAD can be present even in individuals who are asymptomatic or who can perform well on stress tests.

2. Chest Pain and Angina: The experience of angina, or chest pain due to myocardial ischemia, can vary significantly among individuals. Some may experience severe, crushing pain, while others may have more subtle symptoms, such as tightness or discomfort. It is also possible to experience "silent" ischemia, where individuals do not report any pain or discomfort despite having significant coronary artery blockage. Given your family history of heart disease, it is important to be vigilant about any symptoms you may experience, even if they seem mild.

3. CT Angiography: Considering your concerns and family history, a coronary CT angiography (CTA) could be a valuable diagnostic tool to assess the status of your coronary arteries. This non-invasive imaging technique can provide detailed information about the presence and extent of coronary artery disease. While you mentioned wanting to wait until you are 40, it may be prudent to discuss this option with your cardiologist sooner, especially given your elevated triglycerides and family history of heart disease.

In the meantime, it is advisable to take proactive steps to manage your triglyceride levels and overall cardiovascular health. Here are some recommendations:
- Dietary Changes: Focus on a heart-healthy diet that is low in saturated fats, trans fats, and refined sugars. Incorporate more fruits, vegetables, whole grains, and lean proteins into your meals. Omega-3 fatty acids, found in fish like salmon and in flaxseeds, can also help lower triglyceride levels.

- Regular Exercise: Continue your exercise regimen, aiming for at least 150 minutes of moderate-intensity aerobic activity per week. Exercise can help improve lipid profiles and overall cardiovascular health.

- Medication: If lifestyle changes alone do not adequately control your triglyceride levels, it may be necessary to consider medication. Statins, fibrates, or omega-3 fatty acid supplements are commonly prescribed to help manage high triglycerides.

- Regular Monitoring: Keep regular appointments with your healthcare provider to monitor your cardiovascular health, including blood pressure, lipid levels, and any symptoms you may experience.

In conclusion, while your current exercise capacity and echocardiogram results are reassuring, your elevated triglycerides and family history warrant a thorough evaluation of your cardiovascular health. Engaging with a cardiologist for further assessment and potential imaging studies will provide you with a clearer understanding of your heart health and help you take appropriate preventive measures.

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