Confused

[ndf]

Age:  35
Sex:  Male
Weight:  134Kg
Height:  1.95cm
Diagnosed Conditions:  Hypothyroid (mild), Type 2 Diabetes
Medications:  Indapamide 1.5mg, Simvastatin 40mg, Metformin 1000mg, Levothyroxine 75mcg
Familial Conditons:  Aschaemic Heart Disease, Hypothyroidism, Diabetes.

Rheumatic fever at age 10 (1987) suffering from endocarditis and arthritic knees, ankles, wrists and elbows, recovery took 3 months.

At age 14 (1991) diagnosed with Tricuspid Valve leaf out of sync, 1 leaf opening and closing after other 2,  resulting in orthostatic hypotension and loss of vision for around 10-15 seconds per episode.  Advised by cardiologist that unless symptoms became disabling I should leave alone and see if I "grow out of it" and perhaps in adult life may require attention as and when.

Echocardiogram tests performed in 2007 showed no regurgitation and normal ECG, despite minor pain on exertion, GNT discontinued due to headache associated with use, activity levels reduced to compensate.

Now aged 35 I am experiencing palpitations and shortness of breathe at rest which is exacerbated during rest from exertion, very mild chest pain (similar to tooth ache) upon exertion rising to collarbone and left shoulder.

Admitted to hospital ( 2 days ago) for 24 hours observation following mild tachycardia (135bpm) and very high blood pressure (180/120) at GP appointment.

During observation ECG normal, pulse rate did not go below 115, BP lowest 140/102, negative for MI protein.  

Treadmill stress test duration 4 mins 55 seconds (average I'm told is 11 mins) BP highest at test 220/165, Pulse 165, Lowest 195/145, Pulse 130, ECG throughout normal, although when I took a peak there were some pauses between beats wider than others, similar to what I've researched to be arrhythmia.

Consultant recommends Angiogram to determine cause of pain.

Is it normal for tricuspid valve behavior to change or has something been missed on a previous Echo ?
Anything else I should be asking to be done ?

Thanks

[CCFHeartMD19]

Hi ndf,

Thanks for the extensive description of your condition. Despite the description, I must caution you that it is hard for anyone to give you an accurate assessment of the situation without meeting you in person.
Tricuspid valve is a valve on the right side of the heart and tricuspid regurgitation generally arises as a result of valvular heart disease from the left side.
Rheumatic endocarditis are notorious for affecting the left sided heart valves and as a result may result in tricuspid valve regurgitation.
Although your symptoms are atypical but persistent and it is reasonable to get concerned about problems with coronary arteries.
Given your persistent symptoms, it is okay to proceed with coronary angiography.
The only thing that I can recommend is consideration of a 48 hour holter monitor which may sometimes help detect abnormal rhythms that are transient but responsible for chest symptoms like yours.

Hope that helps

[ndf]

Should have said usual BP is 120/75 and Pulse 75