Seeking Treatment Advice for Suspected Myocardial Ischemia

Q: Seeking Treatment Advice for Suspected Myocardial Ischemia

Hello： For a 15-year-old male, the likelihood of having coronary artery disease is relatively low. <br>It is recommended to discuss further with your clinician whether additional tests should be arranged to clarify the condition. <br>Sincerely, Dr. <br>Lin Chi-Hsiung, Taoyuan Hos

Inquire about treatment recommendations for myocardial hypoxia?

Hello Doctor: Recently, I have been experiencing frequent chest tightness and chest pain, so I visited a nearby cardiology clinic (not the original medical institution for my diagnosis).
Today, I underwent a stress echocardiogram as arranged by the cardiology department.
Medical history: Moderate pulmonary valve insufficiency, mild mitral valve prolapse with regurgitation, mild tricuspid valve prolapse with regurgitation, and mild hypertension suspected to be related to kidney issues (monitored for several months, with systolic blood pressure often abnormal, exceeding 140-180 mmHg in over 80% of readings).
Therefore, I have been taking medications prescribed by a nephrologist and antihypertensive medications: Carvedilol 25 mg/day (once in the morning and once in the evening) and Amlodipine 2.5 mg/day (once in the morning).
After completing the stress echocardiogram, the physician indicated that there was one instance of suspected myocardial ischemia detected at 7 minutes and 4 seconds during the test, which was noted at that time and at the conclusion of the examination.
My blood pressure at the end was 191/81 mmHg, and my heart rate was 156 bpm.
Current status and family history: I am currently 15 years old, a student, and I believe I have no exam or other stress.
I do not smoke, chew betel nut, or use drugs.
My grandparents have issues with hypertension; my grandmother has undergone coronary artery surgery, and my maternal grandparents both have heart enlargement and hypertension issues.
After discussing with my mother, we suspect there may be a problem with coronary artery disease.
I would like to ask the doctor for any advice you can provide.

Ttt Avas, 10~19 year old female. Ask Date: 2011/04/12

Dr. Lin Jixiong reply Cardiology

Hello: For a 15-year-old male, the likelihood of having coronary artery disease is relatively low.
It is recommended to discuss further with your clinician whether additional tests should be arranged to clarify the condition.
Sincerely, Dr.
Lin Chi-Hsiung, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2011/04/12

More Info

Based on your recent medical history and the results of your exercise electrocardiogram (ECG), it appears that you are experiencing symptoms that may be indicative of myocardial ischemia. Your report of chest tightness and pain, along with the findings from the exercise ECG, which detected a potential episode of myocardial ischemia, warrants further evaluation and management.

Understanding Your Condition
Myocardial ischemia occurs when blood flow to the heart muscle is reduced, preventing it from receiving enough oxygen. This can happen due to various factors, including coronary artery disease (CAD), which is often caused by atherosclerosis (the buildup of plaque in the arteries). Given your family history of hypertension and heart disease, along with your symptoms, it is essential to take these findings seriously.

Recommendations for Further Evaluation
1. Consult a Cardiologist: Given your symptoms and the findings from your exercise ECG, it is crucial to follow up with a cardiologist. They can provide a comprehensive evaluation, including a detailed review of your symptoms, medical history, and family history of heart disease.

2. Additional Diagnostic Testing: Your cardiologist may recommend further tests to assess your heart's condition more accurately. These could include:
- Coronary Angiography: This is an invasive procedure that allows doctors to visualize the coronary arteries and identify any blockages or narrowing.

- Stress Testing: Another form of stress testing, such as a nuclear stress test or echocardiogram, may be performed to assess how well your heart functions under stress.

- Cardiac MRI or CT Scan: These imaging techniques can provide detailed information about the heart's structure and function.

3. Management of Risk Factors: Since you have a history of hypertension, it is essential to manage your blood pressure effectively. Continue taking your prescribed medications, and ensure regular follow-ups with your nephrologist to monitor your kidney function and blood pressure. Lifestyle modifications, such as a heart-healthy diet, regular physical activity, and avoiding tobacco, are also crucial.

4. Monitoring Symptoms: Keep a diary of your symptoms, noting when they occur, their duration, and any associated activities. This information can be valuable for your healthcare provider in determining the best course of action.

5. Family History Consideration: Given your family history of heart disease, it may be beneficial to discuss genetic counseling or screening for hereditary conditions that could predispose you to cardiovascular issues.

Conclusion
Your symptoms and the findings from your exercise ECG suggest that you may be at risk for myocardial ischemia, and it is essential to take proactive steps in managing your heart health. Engaging with a cardiologist for further evaluation and potential diagnostic testing is crucial. Additionally, managing your blood pressure and adopting a heart-healthy lifestyle can significantly impact your overall cardiovascular health. Remember, early detection and intervention are key to preventing more severe complications in the future.

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