Hello and welcome to the forum.
I am interpreting your post as having essentially two questions so I will try to answer them both:
First, as far as whether or not coronary artery disease (CAD) is genetic, the answer is yes and no. As with many (if not most) medical conditions, CAD certainly has genetic components. However, this does not mean that a person with a family history of CAD will develop CAD and the same goes for those without a family history of CAD. Genetics is one piece of the puzzle. The known CAD risk factors, such as high cholesterol, elevated blood pressure, diabetes, tobacco use, etc are as important if not more so than the family history. Thus, while you can not pick your parents, you can adopt a healthy lifestyle and preventive measures are clearly proven to reduce the incidence of CAD, heart attacks, etc even in those with a family history.
Second, as far as your symptoms are concerned, among all the tests you describe, the only one that was “abnormal” was your tilt table test. You seemed to have done well on your stress test and I suspect that your echo was normal as well (hard to know what to make of the septal hypokinesis—it is likely nothing). Thus, on the basis of the information provided, it sounds like you have a tendency to become what is referred to as “vasovagal.” Although this is a benign condition and not inherently life threatening (unless you faint while driving, etc), it can certainly be frustrating for some patients. The general approach to patients with vasovagal symptoms is focused upon lifestyle modification and avoidance of certain medications or other known “triggers”. Avoidance of dehydration by increasing fluid (and sometimes salt) intake may be helpful as well.
I should also emphasize, however, that extreme shortness of breath can not be explained by a tendency to have vasovagal syncope. If you tend to have anxiety or panic attacks, your symptoms are consistent with this (and perhaps you have been getting worked up over your family history, your brother’s condition, etc). However, if you are not an anxious person, I would encourage you to continue to be evaluated for your shortness of breath.
All the best,
Dr. Rich
I also must mention that my cardiologist said everything was ok and that I was young enough that my heart could handle this.