Should I See a Cardiologist? Heart Health Concerns

Should I see a cardiologist?

Dear Dr.
Zhong,
I would like to ask you a question.
I am 165 cm tall and weigh 73 kg.
Last year, I was diagnosed with hyperlipidemia and hyperglycemia.
After taking lipid-lowering medication for three months, I stopped for two months, and my cholesterol and triglycerides were around 280.
My fasting blood sugar ranged from 99 to 150, and my postprandial blood sugar was between 91 and 245 (I underwent an oral glucose tolerance test, with a fasting level of 113 and all other time points above 220).
I have now resumed taking lipid-lowering medication (one pill daily) and antidiabetic medication (twice daily, half a pill each time).
I have severe fatty liver (diagnosed last August), but when I recently asked my doctor if I should have follow-up tests, he said it was unnecessary.
Is that correct?
I rely on medication for my menstrual cycle (I had brain surgery a year and a half ago, and my estrogen levels are currently very low).
My blood pressure is approximately 90-110/65-75.
In recent months, I have frequently experienced numbness in my hands and swelling in my lower legs (around the lower tibia and ankles), which sometimes leaves indentations when pressed.
The swelling is not daily.
I have reduced urine output during activity but produce a lot of urine when lying down (over 200 ml every half hour to two hours).
I often feel dizzy, have a tight neck, and experience persistent belching throughout the day.
After exercising (I only do gymnastics or march in place for 20 minutes), my heart rate exceeds 130 beats per minute, and I experience severe coughing afterward.

There have been instances where I suddenly felt like I was suffocating while sleeping, and last week, while watching TV, I experienced a sudden pain in my heart for about a minute.
Moving my body and taking deep breaths intensified the pain.
My resting heart rate is usually between 88 and 96 beats per minute.
I started experiencing palpitations about two years ago (feeling like my heart stopped for 1-2 beats).
At that time, an electrocardiogram showed normal results (the doctor said it was just a coincidence that it didn't capture an episode), so the doctor prescribed Inderal for me to take half a pill when I feel uncomfortable.
I took it for a week, and I still occasionally experience palpitations, sometimes feeling a strong and irregular heartbeat for about a minute.
I rarely drink coffee.
I am unsure if these issues indicate a heart problem or if there is another underlying issue.
Additionally, do I need to undergo a carotid ultrasound to check for vascular obstruction? Is this covered by health insurance?
I appreciate your time in explaining this, and I look forward to your response.
Thank you!
May I kindly request that you reply directly to my email and not post it online? Thank you!

snoopy, 20~29 year old female. Ask Date: 2002/06/02

Dr. Zhong Yuxun reply Cardiology

Dear Ms.
Snoopy,
Your letter indicates that your situation is quite complex.
At 23 years old, with a height of 165 cm and a weight of 73 kg, you are clearly overweight.
Being overweight can lead to numerous issues, including hyperlipidemia, hyperglycemia, and fatty liver, which you seem to be experiencing.
Additionally, excess weight can increase the burden on your heart.

From your correspondence, it is evident that you have symptoms of arrhythmia and chest pain, indicating potential cardiac issues.
It is crucial that you consult a cardiologist for examination and treatment as soon as possible, and to adjust your medication (including Inderal).
Given your history of brain tumor surgery and irregular menstruation, it is advisable to follow up with an experienced endocrinologist to investigate any connections between your weight and these conditions.

You should also consult a nutritionist to find ways to reduce your weight, which is essential for improving your complex health issues.
Your cholesterol level of 280 mg is too high and should be lowered promptly through dietary changes, weight management, and medication.

A carotid ultrasound is typically determined by a neurologist based on your condition, as per health insurance regulations.
The swelling in your lower extremities and decreased urine output may be related to your overweight status or heart disease.
Given the variety of your health concerns, it is recommended that you seek care at a medical center (such as our hospital) for more comprehensive management.

Reply Date: 2002/06/02

More Info

Based on the information you've provided, it seems that you are experiencing a range of symptoms and health concerns that warrant a thorough evaluation by a cardiologist. Given your history of high blood sugar and high cholesterol, along with the recent symptoms of numbness in your hands, lower extremity swelling, dizziness, and episodes of chest pain, it is crucial to seek specialized medical advice.

Understanding Your Symptoms
1. High Blood Sugar and Cholesterol: Your blood sugar levels indicate a potential issue with glucose metabolism, which could suggest prediabetes or diabetes. High cholesterol levels can lead to atherosclerosis, increasing the risk of coronary artery disease (CAD). Both conditions are significant risk factors for cardiovascular disease.

2. Fatty Liver Disease: The presence of severe fatty liver disease can also be associated with metabolic syndrome, which includes obesity, hypertension, dyslipidemia, and insulin resistance. This condition can further complicate your cardiovascular health.

3. Neurological Symptoms: The numbness in your hands and swelling in your lower extremities could be related to vascular issues or nerve compression. These symptoms, especially when combined with dizziness and episodes of feeling faint, should be evaluated to rule out any serious underlying conditions.

4. Cardiac Symptoms: The episodes of chest pain, palpitations, and irregular heartbeats are concerning. While you have had a normal resting ECG in the past, the presence of symptoms like palpitations and chest pain during exertion or at rest should be taken seriously.
5. Breathing Issues: The sensation of shortness of breath or feeling like you are choking while sleeping could indicate sleep apnea or other respiratory issues, which can also affect heart health.

Recommendations
Given the complexity of your symptoms and medical history, here are some recommendations:
1. Consult a Cardiologist: It is essential to see a cardiologist for a comprehensive evaluation. They may recommend further testing, such as a stress test, echocardiogram, or even a Holter monitor to assess your heart rhythm over a longer period.
2. Neck Ultrasound: A carotid ultrasound can be beneficial to check for any blockages in the carotid arteries, especially given your risk factors. This test is often covered by health insurance if deemed medically necessary.

3. Regular Monitoring: Keep a close watch on your blood sugar and cholesterol levels. Regular follow-ups with your primary care physician and endocrinologist are crucial for managing these conditions effectively.

4. Lifestyle Modifications: Focus on a heart-healthy diet, regular physical activity, and weight management. Reducing stress and avoiding smoking and excessive alcohol can also help improve your overall health.

5. Medication Review: Discuss with your doctor the medications you are currently taking for blood sugar and cholesterol management. Ensure that they are appropriate for your condition and that you are taking them as prescribed.

6. Mental Health Support: Given the anxiety and fear surrounding your health, consider speaking with a mental health professional. Anxiety can exacerbate physical symptoms, and addressing it may help improve your overall well-being.

Conclusion
Your symptoms and medical history suggest that you should definitely see a cardiologist. They can provide a thorough assessment and determine if there are any underlying heart conditions that need to be addressed. Additionally, managing your blood sugar and cholesterol levels, along with lifestyle changes, will be crucial in reducing your risk of cardiovascular events. Don't hesitate to seek help; your health is paramount.

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