I'm a 43 yr old woman with a history of exercise related chest pain for the last year or so, I also tend to have sinus tachycardia and a low exercise tolerance due to heart rate maxing out quickly. I have had PVCs for many years, but don't get them much any more. I've had a history of pericarditis and pleurosy but haven't had problems with that for many years either. I am asthmatic, take synthroid for hypothyroid (blood levels stable now), and have an undifferentiated connective tissue disease with high ANA and lupus like symptoms but scleroderma like antibody pattern (thus not specified). My father died after a massive heart attack at age 45. Heart disease runs in his family and my mother's family. Although everybody else in my family requires high blood pressure medicine, I've been the lucky one, mine is usually low (occasionally it has been elevated for no apparent reason, but it always goes back down to its normal low within days). My cholesteral ratio is great, my total cholesteral is only 144 -0 155, my bad cholesteral is low, my good cholesteral is high, triglycerides are low. I am not diabetic. I do not smoke, and have only rarely smoked throughout my life. Besides the family history, I am about 50 pounds overweight, have a difficult time getting regular exercise due to asthma and joint pain, have a very high stress life, and have a high homocysteine level. About 14 months ago I had a normal cardiolite exercise stress test which reproduced PVCs but nothing else, and an echo that indicated mild atrial enlargement due to mild mitral regurgitation, also trace or mild regurgitation from other valves; I was told this was within normal limits, that most people have mild regurgitation, and the diagnosis of mitral valve prolapse I got in the 80s following an echo was probably not accurate since the technology today is better. EKGs throughout that indicated sinus tachycardia and PVCs according to the computer printout (docs just tell you they are fine). I had an EKG recently prior to PT and the computer printout (Repeated 3 times on the same machine) said "consider anterior wall infarction" "possible AV node block" and "idioventricular rhythm" and "possible atrial fibrillation." I went back to cardiologist and he looked at the new strip and said he didn't see anything too bad and in light of normal tests one year ago he didn't see any reason to repeat any tests; they did NOT repeat the EKG because they said insurance wouldn't pay to have it done again. However, when he looked down and realized my dad died at such a young age he said although he felt the chest pain was related to the connective tissue disease and fibromyagia, to be sure they might need to do a cardiac cathertization, but he hated to do that on a young woman. So as a test he started me on IMDUR ER ( an extended release form on nitroglycerin ) to be taken daily and also NITROQUICK SL ( the short acting sublingual form of nitr ) to be used when chest pain occurs. If these drugs help then he will consider the cath.
The drugs do seem to help, I have had less chest pain since taking them. Because I have had the flu and a severe flare up of the connective tissue disease, I have not had as much exercise as I usually get, and I only really get the pain with exercise, so the "test" might not be as accurate at this point since I haven't been able to do my normal activities. However, at first even things like stair climbing or doing laundry at the laundrymat would bring pain, which the nitroquick helped, now that I've been on the Imdur longer most of the time I don't need the sublingual form. Also, I have Reynaulds Phenomenon and my feet nor fingers have been turning blue since using the nitroglycerin. I am scared he will want to do the cath test since there is some improvement.
Here are my questions:
1. Would one of those new ultra fast CT heart scans I've been reading about be appropriate to rule out the need for a catheterization? I have read that especially in young woman, they can be used as a noninvasive way to virtually eliminate unnecessary caths.
2. Is it possible that the nitroglycerin is responsible for improving the Reynauld's phenomenon or is that likely to be just a coincidence?
3. Since the chest pain has been reduced so much with the nitro, and the only side effect has been a lowering of my blood pressure that has not bothered me, why not just keep using the medicine and forego further tests unless more symptoms occur?
4. How does elevated homocysteine levels fit into the risk assessment? Are they more/less important than cholesteral ratios (I have read both viewpoints depending on which camp is talking)?
Thank you very much for taking your time to answer these questions. I am sorry it is long, but I have tried to post for several months, so I wanted it to be thorough. This is a great service and I really appreciate it.
Dee