Heart Issues: Key Questions About Your Cardiovascular Health

Cardiac issues

Hello Doctor, I would like to ask some questions.
After experiencing several episodes of palpitations, I visited a cardiologist last year for an electrocardiogram, echocardiogram, and exercise stress test.
The results indicated mild myocardial ischemia during the exercise stress test.
The echocardiogram showed mild mitral regurgitation (the doctor said it’s common and not a concern) and a left atrial and ventricular vessel narrowing of only 2 cm (the doctor said this needs to be addressed).
The goal is to improve it with medication to 3.7 cm.
I also had a health check-up at the end of last year, where my low-density lipoprotein (LDL) cholesterol was 111.
The cardiologist advised me to lower it further, so I was prescribed 5 mg of Rosuvastatin to take daily.
After a month, my LDL dropped to 89, but the doctor said to continue for three more months with the aim of reducing it below 70.
I understand the doctor’s intentions are for my benefit and that they are being careful.
I also have issues with autonomic nervous system dysregulation, which makes me anxious and uncomfortable whenever I feel unwell.
Here are my questions, and I appreciate your help:
1.
The night before last, just as I was about to fall asleep, I suddenly felt pain in the center of my chest (in the middle of both breasts, within a tolerable range).
My breathing was normal, and I did not experience palpitations or discomfort elsewhere, but I distinctly felt some pain in the center.
Since I was very tired and wanted to sleep, I endured it and fell asleep within about 5-10 minutes, and I slept until morning.
Could this be a heart issue? Is it a warning sign of something like a myocardial infarction? (I tend to overthink and feel anxious.)
2.
How can I improve the mild mitral regurgitation? Is it something I will have to live with for life? Will aging cause the heart to enlarge and lead to heart failure?
3.
Is it possible to improve the narrowing of the vessels?
4.
I usually have low blood pressure, with systolic readings between 85-110 and diastolic readings around 50-80.
I don’t typically feel severe discomfort, just occasional mild dizziness.
Besides drinking more water and exercising, how can I improve low blood pressure? The sublingual nitroglycerin, often referred to as a life-saving medication for heart attacks, is not suitable for people with low blood pressure, right? Taking it could risk fainting.
So, what should someone with low blood pressure do in case of a heart attack?
5.
I usually sleep around 1 AM and drink about 1500-2000 cc of water.
Since last year, I have been exercising 2-3 times a week with light aerobic activity.
My diet is generally normal, though I occasionally eat junk food.
I have quit smoking for almost a year and do not drink alcohol.
Do I need to undergo any further examinations or make lifestyle changes?
Thank you very much for your patience in answering my questions.
I really appreciate it.
Thank you!

Chen S, 30~39 year old female. Ask Date: 2018/04/20

Dr. He Dongjin reply Cardiology

Hello,
1.
Pain in the center of the chest without difficulty in breathing or palpitations, and no discomfort elsewhere, does not seem to indicate a heart problem.
It is more likely related to mild mitral valve regurgitation and autonomic nervous system dysregulation rather than a myocardial infarction, so there is no need to worry.
2.
If you have mitral valve regurgitation, it's best to coexist with it peacefully; it won't cause age-related cardiac hypertrophy leading to heart failure.
3.
Regarding vascular narrowing, to be honest, I do not understand the issue of a 2 cm narrowing in the left atrium and ventricle.
I cannot provide you with appropriate advice on that matter.
4.
That's correct; sublingual nitroglycerin is not suitable for individuals with low blood pressure.
Additionally, it is best to maintain your natural blood pressure as it is, and coexist peacefully without trying to improve it.
5.
If possible, going to bed a little earlier would be even better.
Changhua Hospital cares about you.

Reply Date: 2018/04/20

More Info

Understanding heart health is crucial, especially when you have experienced symptoms such as palpitations and chest discomfort. Based on your detailed description and the results of your previous tests, let's address your concerns systematically.

1. Chest Pain Before Sleep: The sudden chest pain you experienced before sleeping, especially if it was tolerable and not accompanied by shortness of breath or palpitations, is less likely to be indicative of a heart attack. It could be related to anxiety, muscle strain, or even gastrointestinal issues like acid reflux. However, it’s essential to monitor such symptoms. If they recur or worsen, a follow-up with your cardiologist is advisable to rule out any underlying cardiac issues.

2. Mitral Valve Regurgitation: Mild mitral valve regurgitation is common and often does not require treatment unless it becomes severe. Regular monitoring through echocardiograms can help assess any changes over time. As for concerns about aging and heart enlargement leading to heart failure, it’s important to maintain a healthy lifestyle, including a balanced diet and regular exercise, to mitigate these risks.

3. Vascular Narrowing: The narrowing of the left atrial and ventricular vessels you mentioned (2 cm) can potentially improve with lifestyle changes and medication. Statins, like the one you are taking, can help lower cholesterol levels and improve vascular health. Regular follow-ups with your healthcare provider will help track any changes in your condition.

4. Low Blood Pressure Management: Your blood pressure readings indicate that you have low blood pressure (hypotension). While this may not cause significant issues for you, it’s essential to stay hydrated and consider increasing your salt intake slightly, unless contraindicated by other health conditions. Regarding the use of sublingual nitroglycerin (often referred to as "emergency medication"), it is indeed not suitable for individuals with low blood pressure, as it can cause further drops in blood pressure. In case of a heart attack, it’s crucial to seek emergency medical help rather than self-medicate.

5. Lifestyle and Further Checks: Your current lifestyle, including regular exercise and a balanced diet, is commendable. However, consider reducing your intake of processed foods and increasing your consumption of fruits, vegetables, and whole grains. Since you have a history of anxiety, incorporating stress management techniques such as yoga or meditation may also be beneficial. Given your symptoms and medical history, it might be worthwhile to discuss with your doctor the possibility of additional tests, such as a Holter monitor for continuous heart rhythm monitoring or a stress test, to further evaluate your heart health.

In summary, while your symptoms and test results may seem concerning, many factors contribute to heart health. Regular monitoring, a healthy lifestyle, and open communication with your healthcare provider are key to managing your cardiovascular health effectively. If you have any new or worsening symptoms, do not hesitate to seek medical attention promptly.

Similar Q&A

Could It Be Heart Disease? Understanding Your Symptoms and Concerns

Hello, sometimes I experience chest pain. When I run or swim, I feel like I can't catch my breath. Sometimes when I'm sleeping, my heart beats suddenly become very loud, and I can hear them myself. Is this heart disease? However, I have been to the hospital for an exami...

Dr. Wang Yizhi reply Cardiology
Hello! If you have undergone a thorough examination of your heart at the hospital and it has been confirmed that there are no issues, you can at least be assured that your heart function is normal. However, to determine if there is any paroxysmal arrhythmia, further detailed exam...

Understanding Head Pressure, Heart Palpitations, and Cholesterol Issues

Hello Doctor, I would like to ask you a few questions: 1. I feel a constant pressure in my head throughout the day, and I can feel my heartbeat, which causes pain that seems to pulse with my heartbeat. Could this be related to high blood pressure? What impact does this have on m...

Dr. He Dongjin reply Cardiology
Hello, high cholesterol is not necessarily a bad thing. It can be categorized into so-called "good" cholesterol and "bad" cholesterol, as well as low-density lipoprotein (LDL). It is advisable to go to the hospital for further analysis; you can consult with a ...

Understanding Your Heart Health: Key Questions for Cardiovascular Concerns

Doctor, a few days ago I visited a cardiologist who did not prescribe any medication for me. He mentioned that there is a benign condition with my heart, but I forgot the cause. He said it wouldn't have any impact and that I can continue exercising. I would like to ask if th...

Dr. He Dongjin reply Cardiology
Hello, 1. Don't worry, the heart rate is not fast. 2. There is a benign condition of the heart, but I forgot the cause. It could be mitral valve prolapse. Since no medication has been prescribed, it indicates that there is no concern. There is no need to worry. Changhua Hosp...

Understanding Heart Issues: Causes, Treatment, and Genetic Concerns

Hello, doctor! I have some questions I would like to ask you! No one in my family has a history of heart disease, and I don’t either! However, about 4.5 years ago, I started working in a bar, which required me to drink alcohol daily. Over time, I gradually noticed some minor issu...

Dr. Lin Jixiong reply Cardiology
Hello: 1. It may be caused by autonomic nervous system dysfunction. 2. There are medications that can help control it; this is a constitutional issue that can be improved through self-regulation of diet and lifestyle, but it is unlikely to be completely cured. 3. This type of con...