Post-Heart Examination Care: Key Considerations and Next Steps

I would like to inquire about the follow-up precautions after various heart examinations?

Description of Symptoms: On June 14, 2022, approximately a year and a half ago, while climbing Keelung Mountain, I experienced a sudden onset of fatigue during the final steep segment.
I stopped, but my heart continued to beat strongly for about ten minutes without slowing down.
After that, I paid close attention to my exertion while hiking, and this phenomenon did not recur.
On August 23, 2023, about six months ago, I contracted COVID-19, after which I found myself easily short of breath.
It was also around this time that I coughed so much that I developed a right inguinal hernia.
On December 1, 2023, about two months ago, I underwent hernia surgery at the hospital.
The routine pre-operative examination report included:
Electrocardiogram Report: NORMAL SINUS RHYTHM
Radiology Report: Chest X-ray (1 view PA) - Normal mediastinum and heart size.
- Tortuosity and atherosclerosis of the thoracic aorta.
- Prominent bronchovascular lung markings.
- Both costo-phrenic angles clear.
- Degenerative thoracolumbar spondylosis with scoliosis.

Upon reviewing the chest X-ray report, I wanted to further investigate my heart and lungs.
On January 10, 2024, I visited another hospital's cardiology department for evaluation, where I underwent three tests:
Electrocardiogram Report: Diagnosis: Normal sinus rhythm, Old anteroseptal wall myocardial infarction, Abnormal ECG.
This part showed significant discrepancies compared to the previous hospital's report.

Echocardiogram (including single and dual-sided Doppler color flow imaging) Report:
- Echo machine: Philips Epiq7
- Patient source: OPD
- Atrium and Aortic Root: AO (mm) = 39, LA (mm) = 40
- Left Ventricle: IVS (mm) = 11, PW (mm) = 9, EDD (mm) = 48, ESD (mm) = 29, EDV (ml) = 110, ESV (ml) = 32, LV mass (g) = 174, LVEF: by M-mode measurement: 71%, LV Wall motion: Normal wall motion
- Right Ventricle: TAPSE = 19mm, Right ventricle wall motion: Normal
- Diastolic function: Mitral inflow E/A: 0.77/0.9 (E/A ratio = 0.9), Septal e: 0.06cm/s; Lateral e: 0.09cm/s; Septal E/e: 12.9; Lateral E/e: 8.6;
- Valve lesions: MS: nil; MR: Mild; AS: nil; AR: Trivial; TS: nil; TR: Trivial; Vmax = 2.21m/s = 20mmHg; PS: nil; PR: nil;
- Other findings: IVC diameter: mm with sniff collapse > 50%, Intracardiac vegetation: No; Pericardial effusion: None, Intracardiac thrombus: No, Congenital lesions: None.

Conclusion:
1.
Dilatation of LA, Ao; normal wall thickness
2.
Normal LV systolic function with normal wall motion
3.
Normal RV systolic function with normal wall motion
4.
Grade 1 diastolic dysfunction
5.
Mild MR, Trivial AR, Trivial TR
Stress Myocardial Perfusion Tomography Report:
The Tl-201 myocardial perfusion SPECT study was performed with dipyridamole pharmacologic stress.
Intravenous dipyridamole was administered at a rate of 0.142 mg/kg/min for 4 minutes.
The administered dose was 7.5 ml (5mg/ml).
No significant discomfort was noted during dipyridamole stress.
The Tl-201 myocardial perfusion SPECT study performed 5 minutes after intravenous injection of 2mCi Tl-201 and 4 hours later revealed mild reduced uptake of radioactivity in the inferolateral segment of the LV during the stress study.
There was redistribution in that segment in the delayed study.
The EKG-gated functional study showed: Stress LVEF = 74%, Rest LVEF = 64%.

Impression: - Suspected myocardial ischemia at the inferolateral segment of the LV.

At this point, I would like to consult on the best course of action moving forward! For example, what tests should I undergo, what medications or dietary changes should I consider, or even what surgeries might be necessary? Is my shortness of breath due to inadequate lung ventilation, or is it related to cardiovascular narrowing? The reports indicate suspected myocardial ischemia in the inferolateral segment of the LV; can the symptoms of myocardial ischemia be reversed? Would aerobic exercise help improve my condition?

Mr. Wu, 60~69 year old female. Ask Date: 2024/01/18

Dr. Wu Xueming reply Cardiology

It is recommended to moderately adjust your exercise routine, such as brisk walking or jogging for thirty minutes three times a week.
If symptoms do not improve, please consult with a physician in the outpatient clinic to discuss further treatment options.

Reply Date: 2024/01/18

More Info

After undergoing a comprehensive heart examination, it is crucial to understand the implications of your results and the necessary steps for post-examination care. Given your history of symptoms such as chest tightness, shortness of breath following COVID-19, and the findings from your recent tests, there are several key considerations and next steps to take.

Understanding Your Test Results
1. Myocardial Ischemia: The results from your myocardial perfusion scan indicate suspected ischemia in the inferolateral segment of the left ventricle. This suggests that there may be reduced blood flow to this area, which can lead to chest pain or discomfort, especially during physical exertion.

2. Echocardiogram Findings: Your echocardiogram shows normal left ventricular systolic function with a left ventricular ejection fraction (LVEF) of 71%, which is within normal limits. However, the presence of mild mitral regurgitation and trivial aortic regurgitation indicates that there may be some degree of valve dysfunction, although it is not severe.

3. Diastolic Dysfunction: The report mentions grade 1 diastolic dysfunction, which means that your heart may have some difficulty relaxing and filling with blood. This can contribute to symptoms of shortness of breath, especially during exertion.

4. Atherosclerosis: The chest X-ray indicated tortuosity and atherosclerosis of the thoracic aorta, which is a risk factor for cardiovascular events.

Key Considerations for Post-Examination Care
1. Follow-Up with a Cardiologist: It is essential to schedule a follow-up appointment with your cardiologist to discuss your results in detail. They may recommend further diagnostic tests, such as a coronary angiogram, to assess the severity of any coronary artery disease (CAD) and to determine the best course of action.

2. Lifestyle Modifications: Implementing lifestyle changes can significantly impact your cardiovascular health. This includes:
- Diet: Adopt a heart-healthy diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit saturated fats, trans fats, sodium, and added sugars.

- Exercise: Engage in regular physical activity. Aim for at least 150 minutes of moderate aerobic exercise per week, such as brisk walking or cycling. However, consult your doctor before starting any new exercise regimen, especially given your history of symptoms.

- Weight Management: Maintaining a healthy weight can reduce the strain on your heart and improve overall cardiovascular health.

3. Medication Management: Depending on your cardiologist's recommendations, you may need to start or adjust medications to manage blood pressure, cholesterol levels, or other risk factors. It is crucial to adhere to prescribed medications and discuss any side effects with your healthcare provider.

4. Monitoring Symptoms: Keep a close watch on any symptoms you experience, such as chest pain, shortness of breath, or palpitations. Documenting these occurrences can provide valuable information for your healthcare team.

5. Managing Comorbidities: Given your history of hypertension and potential sleep apnea, it is vital to manage these conditions effectively. If you have not already, consider using a CPAP machine for sleep apnea, as this can improve your overall cardiovascular health and reduce daytime fatigue.

6. Stress Management: Chronic stress can negatively impact heart health. Consider incorporating stress-reducing techniques such as mindfulness, yoga, or meditation into your daily routine.

Conclusion
In summary, your heart examination results indicate some areas of concern, particularly regarding myocardial ischemia and diastolic dysfunction. It is essential to work closely with your cardiologist to develop a comprehensive care plan that includes lifestyle modifications, potential medications, and ongoing monitoring of your heart health. By taking proactive steps, you can significantly improve your cardiovascular health and overall well-being. Always prioritize open communication with your healthcare providers to ensure that you receive the best possible care tailored to your individual needs.

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