Heart Health: Navigating Hypertension and Cardiac Concerns

Cardiac examination results indicate myocardial ischemia. There is atheromatous arteriosclerosis, but the coronary artery calcium score is between 0 and 10?

Hello, Doctor.
I have a history of hypertension for about 7-8 years.
I have been experiencing chest pain (at rest), so my cardiologist arranged for me to undergo an exercise electrocardiogram.
During the test, my heart rate was normal at 120 bpm, but I became short of breath when it reached 140 bpm.
I then underwent a nuclear medicine test, which indicated severe myocardial ischemia.
The cardiologist believes I have cardiovascular blockage and recommended that I undergo a cardiac catheterization as soon as possible (all tests were conducted at Hospital A).
Due to my fear, I opted for non-invasive tests at Hospital B, where a chest X-ray showed atherosclerosis, and at Hospital C, a 256-slice coronary CT scan showed a calcium score of 0 with no significant coronary artery disease stenosis.

I would like to ask:
1.
The results from Hospital C seem to be completely different from the first two results.
How can I further confirm my heart condition?
2.
I take my antihypertensive medication very regularly.
Previously, my blood pressure was around 140/90.
After the tests mentioned above, I have also started taking anticoagulants (Lixiana and Berkey) and have made dietary changes.
Recently, I noticed that my blood pressure has dropped a bit too low, around 90/50.
Is this a normal phenomenon?
3.
With long-term, regular use of antihypertensive medication and stable blood pressure, is it still possible to have a myocardial infarction? (I actually want to ask if a patient at Hospital A who took antihypertensive medication regularly later had a myocardial infarction, could it be that the condition changed and went undetected? Should I consider changing doctors?) Thank you.

Ms. Yang, 50~59 year old female. Ask Date: 2021/05/21

Dr. He Dongjin reply Cardiology

Hello, C - The results of the coronary CT angiography are most accurate - no significant stenosis means there is nothing to worry about.
The accuracy of nuclear medicine tests is lower than that of CT scans.
Risk factors include not only hypertension, and we are human, not machines; one can develop diseases even without risk factors, and conversely, those with risk factors can also experience myocardial infarction.
Stable blood pressure does not eliminate the possibility of a heart attack.
Doctors are not omniscient; without performing a cardiac catheterization or CT scan, it is impossible to know the condition of the blood vessels inside or to understand the changes in vascular stenosis over time.
There is no need to change doctors; everything is fine.
Just manage your three highs (hypertension, hyperglycemia, and hyperlipidemia) and exercise regularly.
Take care, and Changhua Hospital is concerned about you.

Reply Date: 2021/05/21

More Info

Navigating heart health, particularly in the context of hypertension and cardiac concerns, can be quite complex and often requires a thorough understanding of various diagnostic tests and their implications. Based on your situation, let's address your questions systematically.

1. Discrepancy in Test Results: It is not uncommon for different diagnostic tests to yield varying results. The myocardial perfusion scan indicating severe myocardial ischemia suggests that there may be significant issues with blood flow to the heart muscle, potentially due to coronary artery disease (CAD). In contrast, the coronary CT angiography showing a calcium score of zero and no significant stenosis suggests that there may not be significant atherosclerotic plaque present in your coronary arteries at this time. This discrepancy could be due to several factors, including the possibility of microvascular disease, which may not be detected by standard imaging techniques. To further clarify your heart condition, you might consider discussing with your cardiologist the option of a coronary angiogram, which is an invasive procedure that provides a direct view of the coronary arteries and can help confirm or rule out significant blockages.

2. Blood Pressure Fluctuations: It is important to monitor your blood pressure regularly, especially after making changes to your medication regimen. A blood pressure reading of 90/50 mmHg can be considered low, particularly if you are experiencing symptoms such as dizziness or fainting. This could be a result of the anticoagulants you are taking, as they can sometimes lead to lower blood pressure. It is crucial to communicate these changes to your healthcare provider, as they may need to adjust your medications or provide guidance on managing your blood pressure effectively.

3. Risk of Myocardial Infarction: Even with well-controlled hypertension, there is still a risk of myocardial infarction (heart attack), particularly if there are other risk factors present, such as high cholesterol, smoking, or a family history of heart disease. The fact that a patient on antihypertensive medication experienced a heart attack does not necessarily mean that the medication was ineffective; rather, it could indicate that other underlying issues were present that were not adequately addressed. Regular follow-ups with your healthcare provider are essential to monitor your heart health and adjust your treatment plan as necessary. If you feel uncertain about your current treatment or if your symptoms persist, seeking a second opinion from another cardiologist could provide additional insights and reassurance.

In summary, managing heart health, especially with a history of hypertension, requires a comprehensive approach that includes regular monitoring, lifestyle modifications, and possibly further diagnostic testing. It is essential to maintain open communication with your healthcare providers and to advocate for your health by seeking additional opinions or tests when necessary. Remember, your health is paramount, and understanding your condition is a critical step in ensuring effective management and prevention of potential complications.

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