Myocardial Hypoxia: Key Insights from Cardiac Evaluations

Q: Myocardial Hypoxia: Key Insights from Cardiac Evaluations

Please exercise regularly, avoid consuming overly greasy foods, and monitor your cholesterol levels regularly.

Myocardial hypoxia

Hello Doctor, in June, my fasting blood glucose was 132, total cholesterol was 230, low-density lipoprotein (LDL) was 129, and triglycerides were 452.
I am currently taking medication for blood glucose and lipid reduction.
Recently, I experienced chest tightness, palpitations, shortness of breath, and chest pain with stabbing sensations.
I have undergone the following tests: 1.
Echocardiogram, 2.
Stress test on a stationary bike, and 3.
24-hour Holter monitor.
The 24-hour Holter monitor indicated myocardial ischemia, but the doctor mentioned that the previous exercise electrocardiogram did not show any issues, so I shouldn't worry.
Is that correct? Could you please review my case and let me know if there are any concerns? Additionally, is a sinus rhythm with a rate of 54-131/min and a mean of 75/min considered normal? The report also mentioned intermittent wandering atrial pacemakers and intermittent T wave inversions.
What do these findings mean? Thank you.
The sequence of my examination dates is as follows:
6/20 Echocardiogram (including single and dual views)
□ Abnormal septal motion
Echo window □ good ■ fair ■ poor
Tape No: IVSt: 7 mm (6-12)
LVEDD: mm (36-52)
EF: 60% (49-76)
LVPWt: 7 mm (5-11)
LVESD: mm (20-36)
SV: 38 cc (32-95)
LAD: 25 mm (18-38)
LVEDV: 63 cc (46-138)
ASAO: mm (23-37)
Ao Root: 25 mm (23-37)
LVESV: 25 cc (10-54)
RAD: 33 mm (18-38)
Clinical Impression: Diabetes Mellitus, tachycardia
ASSESSMENT:
1.
Heart size: ■ normal; □ dilatation of; □ thickening of; □ LV mass index gm/㎡; □ LA volume index mL/㎡; □ RA volume index mL/㎡
2.
Pericardial effusion: ■ nil; □ small (<100ml); □ moderate (100-300ml); □ large (300ml); □ tamponade
3.
LV systolic function: ■ good; □ fair; □ borderline; □ slightly impaired; □ poor;
4.
LV diastolic function: ■ normal; □ impaired relaxation; □ pseudonormal; □ restrictive; □ reversible restrictive; □ fixed restrictive
5.
Valvular lesion: ■ yes; □ no; MS □ trivial; □ mild; □ moderate; □ severe;
(Vmax: m/s; PG max; mmHg; PG mean: mmHg)
(Amv(Doppler): cm²; Amv(2D): cm²)
MR □ trivial; □ mild; □ moderate; □ severe;
AS □ trivial; □ mild; □ moderate; □ severe;
(Vav: m/s; Vlvot: m/s; Alvot:; Aav:)
AR □ trivial; □ mild; □ moderate; □ severe;
TS □ trivial; □ mild; □ moderate; □ severe;
(Vmax: m/s)
TR ■ trivial; □ mild; □ moderate; □ severe;
(Vmax: m/s: PG: 16 mmHg, RVSP: 19 mmHg)
PS □ trivial; □ mild; □ moderate; □ severe;
(Vmax: m/s: PG: mmHg)
PR □ trivial; □ mild; □ moderate; □ severe;
6.
Congenital: ■ Nil; □ ASD; □ VSD; □ PDA; □ T/F; □ others;
7.
Asynergy: ■ Nil; □ hypokinesis; □ akinesis of segments; □ dyskinesis of segments
8.
RV systolic function: ■ normal; □ impaired; IVC 13 mm
9.
Additional findings
IMPRESSION: Trivial TR, PG: 16 mmHg, estimated RVSP about 19 mmHg.
No chamber dilation.
No regional wall motion abnormality.
Good LV systolic function with EF of 60%.
7/12 Stress Test Findings: Machine interpretation: The patient exercised according to the BRUCE protocol for 5:33 minutes, achieving a maximum MET level of 7.00.
The resting heart rate of 110 bpm rose to a maximum heart rate of 153 bpm, which represents 87% of the maximal, age-predicted heart rate.
The resting blood pressure of 122/94 mmHg rose to a maximum blood pressure of 172/94 mmHg.
The exercise test was stopped due to the target heart rate being achieved.

Interpretation -- Conclusions -- Negative.
7/21 24-hour Holter Monitor Findings: Machine interpretation:
COMMENTS:
1.
Sinus rhythm with a rate of 54-131/min and a mean of 75/min.

2.
There were intermittent wandering atrial pacemakers.

3.
No atrial premature contractions (APCs).

4.
One ventricular premature contraction (VPC).

5.
No pauses.

6.
There were intermittent T wave inversions.

7.
No entries of symptoms were made in the patient diary.

Note: Three Channels (MV5, MV1, Lead III).

Impression: Physician confirmed report:
COMMENTS:
1.
Sinus rhythm with a rate of 54-131/min and a mean of 75/min.

2.
There were intermittent wandering atrial pacemakers.

3.
No APCs.

4.
One VPC.

5.
No pauses.

6.
There were intermittent T wave inversions.

7.
No entries of symptoms were made in the patient diary.

Note: Three Channels (MV5, MV1, Lead III).

Xiao Ping, 40~49 year old female. Ask Date: 2023/08/04

Dr. Wu Xueming reply Cardiology

Please exercise regularly, avoid consuming overly greasy foods, and monitor your cholesterol levels regularly.

Reply Date: 2023/08/04

More Info

Understanding myocardial hypoxia is crucial for assessing cardiac health, especially in patients with risk factors for coronary artery disease (CAD). Based on the evaluations you've undergone, including echocardiograms, stress tests, and 24-hour Holter monitoring, several key insights can be drawn regarding your condition.

Myocardial Hypoxia and Its Implications
Myocardial hypoxia refers to a deficiency of oxygen in the heart muscle, which can lead to ischemia and potentially result in angina or myocardial infarction if not addressed. The presence of hypoxia is often evaluated through various cardiac imaging techniques, such as myocardial perfusion scans, which assess blood flow to the heart muscle during stress and at rest.

In your case, the 24-hour Holter monitor indicated intermittent T wave inversions and wandering atrial pacemakers. T wave inversions can suggest underlying ischemia or other cardiac conditions, while wandering atrial pacemakers indicate variability in the heart's electrical conduction system, which may not be inherently problematic but warrants monitoring.

Risk Factors and Their Role
Your reported risk factors include diabetes mellitus (DM), dyslipidemia, and a history of chest tightness and palpitations. These factors significantly increase the risk of developing CAD and experiencing myocardial ischemia. The elevated blood sugar and lipid levels you've mentioned (e.g., total cholesterol at 230 mg/dL and triglycerides at 452 mg/dL) are concerning and should be managed through lifestyle changes and medication as prescribed by your healthcare provider.

Cardiac Evaluations
1. Echocardiogram: Your echocardiogram results indicated good left ventricular (LV) systolic function with an ejection fraction (EF) of 60%. This is a positive sign, as it suggests that your heart is pumping effectively despite the presence of other symptoms. However, the mention of abnormal septal motion could indicate regional wall motion abnormalities, which may be related to ischemia.

2. Exercise Stress Test: The results from your exercise stress test showed that you reached 87% of your age-predicted maximum heart rate, which is a good effort. The test was interpreted as negative for significant ischemia, suggesting that your heart can handle stress without major issues at this time.

3. 24-Hour Holter Monitoring: The findings of sinus rhythm with a rate ranging from 54 to 131 beats per minute, along with intermittent T wave inversions, need careful interpretation. While the mean heart rate of 75 bpm is within a normal range, the variability and presence of T wave inversions could indicate episodes of myocardial stress or ischemia, particularly if correlated with your symptoms of chest pain and palpitations.

Recommendations and Follow-Up
Given your history and the results of your evaluations, it is essential to maintain regular follow-ups with your cardiologist. Here are some recommendations:
- Medication Adherence: Continue taking your prescribed medications for blood sugar and lipid management. Regular monitoring of your blood glucose and lipid levels is crucial.

- Lifestyle Modifications: Implement dietary changes to manage cholesterol and triglyceride levels. A heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins can significantly impact your cardiovascular health.

- Regular Monitoring: Keep up with routine cardiac evaluations, including echocardiograms and stress tests, as advised by your healthcare provider. This will help track any changes in your cardiac function or the development of ischemia.

- Symptom Awareness: Be vigilant about any new or worsening symptoms, such as increased chest pain, shortness of breath, or palpitations. Report these to your doctor promptly.

- Consideration for Further Testing: If symptoms persist or worsen, discuss with your cardiologist the potential need for further testing, such as coronary angiography, to evaluate for significant blockages in the coronary arteries.

In conclusion, while your current evaluations suggest that you are managing your condition relatively well, ongoing monitoring and proactive management of your risk factors are essential to prevent the progression of coronary artery disease and maintain heart health. Always consult with your healthcare provider for personalized advice and treatment options.

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