Is It Typical Angina? Myocardial Ischemia Risks

Is it typical angina? Is it very likely that I have myocardial ischemia?

Dr.
He: Hello, I am a 57-year-old male, weighing approximately 66 kg and standing 166 cm tall.
I experience significant discomfort and even pain in my chest after brisk walking for a few minutes or climbing more than five flights of stairs.
Resting alleviates the discomfort.
Sometimes, I feel uncomfortable for a few seconds when standing up from a seated position.
I have periodontal disease and tend to worry a lot, which makes me easily anxious.
I only walk 2 to 3 times a week for 20 to 30 minutes each time and do not engage in other forms of exercise.
Last year, I underwent a health check-up, and the report indicated abnormal Q waves on my resting electrocardiogram.
In May of this year, I visited a cardiologist, and the examination results showed cholesterol levels at 204 mg/dL, triglycerides at 63 mg/dL, HDL at 66 mg/dL, and LDL at 128 mg/dL.
The echocardiogram report indicated the following: Anatomy AO root: 16, LA: 30, LVS: 8, LVEDD: 40, LVPW: 8, LVESD: 27, RA: normal, RV: normal, LVEF M-mode: 61%, Mitral Valve structure MR: mild, Tricuspid valve TR: mild.
The exercise electrocardiogram report had the primary diagnosis of mitral valve disorders, secondary diagnosis 1: chest pain, secondary diagnosis 2: dyspnea and respiratory abnormalities.
The reason for the examination was to deny major systemic disease, but abnormalities in the ECG were noted during the physical check-up.
I was informed of valvular heart disease in 2014.
I also have knee osteoarthritis, which prevents me from running.
The examination report indicated inadequate heart rate response and inconclusive results.
The doctor mentioned that I have mitral valve prolapse but did not explain further and scheduled me for a myocardial perfusion scan.
Later, I found out that this examination involves radiation, and I am hesitant to proceed.
I would like to ask you: 1.
Is my condition indicative of typical angina? Is it likely that I am experiencing myocardial ischemia? 2.
Both the 256-slice cardiac CT and the myocardial perfusion scan involve high radiation exposure.
If further examination is necessary, are there alternative methods that can avoid these two types of tests? 3.
If these two tests cannot be avoided, which one should I undergo? Thank you for your response.

Chen Ming, 50~59 year old female. Ask Date: 2015/07/16

Dr. He Dongjin reply Cardiology

Hello, your condition resembles typical angina.
There is a possibility of myocardial ischemia.
I recommend further evaluation with a myocardial perfusion scan.
Yes, it does involve radiation; however, the radioactive material will be eliminated from your body and should not have significant effects.
It seems you should undergo a myocardial perfusion scan.
The radiation dose from a 256-slice cardiac CT scan is relatively higher.
Changhua Hospital is concerned about your health.

Reply Date: 2015/07/16

More Info

Hello, thank you for your questions. Based on the information you've provided, let's address your concerns regarding typical angina, myocardial ischemia risks, and the diagnostic procedures available.

1. Is Your Condition Typical Angina?
From your description, it appears that you are experiencing symptoms consistent with angina, particularly when engaging in physical activities such as brisk walking or climbing stairs. Typical angina is characterized by chest discomfort or pain that occurs with exertion and is relieved by rest. The fact that you experience discomfort that improves with rest suggests that your symptoms may indeed be angina-related. Additionally, your history of abnormal ECG findings, elevated cholesterol levels, and the presence of mitral valve prolapse further contribute to your cardiovascular risk profile. Given these factors, it is reasonable to suspect that you may be at risk for myocardial ischemia, which occurs when the heart muscle does not receive enough blood due to narrowed or blocked coronary arteries.

2. Radiation Exposure from Imaging Studies
You expressed concerns about the radiation exposure associated with myocardial perfusion scans and cardiac CT scans. It is true that both procedures involve some level of radiation; however, the benefits of these tests often outweigh the risks, especially when they are used to diagnose potentially life-threatening conditions like coronary artery disease (CAD). If you are apprehensive about radiation, you might consider discussing alternative non-invasive tests with your cardiologist. Options such as a cardiac MRI or echocardiogram can provide valuable information about heart function and structure without the use of ionizing radiation. However, the choice of test will depend on your specific clinical situation and the information your doctor needs to make an accurate diagnosis.

3. Which Test Should You Consider?
If your cardiologist recommends a myocardial perfusion scan, it is likely because they believe it will provide important insights into your heart's blood flow and function. If you are still concerned about radiation, discuss this openly with your doctor. They can explain the rationale behind the recommendation and help you weigh the risks and benefits. If you ultimately decide to proceed with the scan, rest assured that the radiation dose is typically low and is considered safe for diagnostic purposes. If you are looking for alternatives, a cardiac MRI may be a suitable option, as it provides detailed images of the heart without radiation exposure.

In summary, your symptoms suggest a possibility of typical angina and myocardial ischemia, warranting further investigation. While radiation exposure is a valid concern, the diagnostic benefits of tests like myocardial perfusion scans often justify their use. Discuss your options thoroughly with your cardiologist to determine the best course of action for your health. Regular follow-ups and lifestyle modifications, such as increased physical activity and dietary changes, can also play a crucial role in managing your cardiovascular health. Thank you for reaching out, and I hope this information helps you make informed decisions regarding your health.

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