Risks for CAD

[LisaGS]

My risk factors for CAD are:
1. overweight ( ht 5'4" wt 180)
2. exercise only once per week
3. elevated cholesterol
4. HTN (new)
5. strong family history (father extensive CAD CABG x 5 at age 60, maternal grandmother extensive heart hx in 40s and 50s death at age 61 from MI

I am a 37 year old female.  HTN started approximately 2 months ago.  PCP tried 3 meds.  Toprol XL appears to be working.  BP runs 130-140/80-95 on Toprol.

Recent labwork by PCP: LDL 141; HDL 73; Triglycerides 92.  Previous to this Total Chol 200-250 and HDL 70s at healthfairs.

PCP ordered renal u/s due to HTN and age. U/s normal, except for luminal irregularities of the abdominal aorta.

PCP ordered nuclear stress test, which I did on this past week.  I was able to achieve the heart rate required by the test without difficulty, and then continued to go.  No problems.  Results are due this week.

Scheduled to see cardiologist in April.  Cardiologist wants labwork to include hs CRP and homocysteine, due to family hx.

My questions are:
1.  Do the luminal irregularities in the abdominal aorta mean that the stress test will most likely reveal CAD?
2. If the nuclear stress test is normal, are there other cardiac causes for concern in regards to the HTN at a young age that should be investigated?
3.  What role does homocysteine have as a predictor of CAD?


Thanks for your help!

[CCF-M.D.-MJM]

Hello Lisa,

It is good that you are addressing the issue before they become a problem.  You may be able to prevent or delay the onset of cardiovascular disease

1. Do the luminal irregularities in the abdominal aorta mean that the stress test will most likely reveal CAD?

Not necessarily.  If they said aortic atheroma, that is suggestive of an arterial process.  Luminal irregularities are a non specific finding.


2. If the nuclear stress test is normal, are there other cardiac causes for concern in regards to the HTN at a young age that should be investigated?

By far the most common cause of hypertension in your age group is essential hypertension, meaning we don’t know what is causing it.  Renal u/s is the simplest and the most common test ordered.  If there are no other symptoms like headaches, weight changes, heart failure, etc, the work up often ends there.

The first line therapy is usually a diuretic.  Toprol tends to make people feel tired.  Did you try a diuretic?

3. What role does homocysteine have as a predictor of CAD?

There is a subgroup that has premature CAD with elevated homcysteine.  Folic acid decreases homocysteine levels. If it is elevated, a folic acid supplement is started.  There is no data that decreasing homocysteine decreases your risk of cad, but this is what is usually done.


I am a huge believer in lifestyle modification.  Your next steps are changing your diet and increase your aerobic exercise to improve your cardiovascular fitness.  

I hope this helps.  Good luck and thanks for posting.

[Fran71]

Hi all,
the doctor mentioned that Toprol can make feel people tired. For about 2 weeks I've been taking Inderal daily for tachycardia and PVCs. I'm only taking 20 mg a day but it's making me feel very tired and strange. I even hear a buzz in my ears all the time...I guess this is normal but I was wondering if all types of beta blockers cause this. If they do, do we get used to the side effect with time?

So far it's working great for my PVCs so I wouldn't want to stop taking it! My cardio said I can try splitting it into 2 doses of 10 mg daily and see if I feel better.

Thanks so much

Fran

[PED]

Al,

Seems like you have quite a few fun filled things going on.  As such I've noticed you have done quite a bit of research.

Here is a question for you on angina, based on your experience.

I'm 35, took a trip to the ER in early December.  At that time my chest pain was dead center, and was a pressure/squeeze.  I've been having shooting pains in my arms, chest, jaw, and even face since November.  The time I took the trip to the ER the pain was different, dead center squeeze.  It has happened 2x since, and not nearly to that pain level.  Both times understressful situations.

All tests were normal, including a Nuclear ECG stress.

Since that time I've gone through a battery of GI tests with limited results (yes, some Gerd).

Here is my deal, I can exercise, and I feel so much better when exercising.  My shooting pains are reduced if not elminated.  I never, ever have had any crushing or anginal type pains during exercise.  I can go 85% of my HR for over an hour with not a problem.

One time you mentioned something similar, but that your angina would come back later.  Here is the thing, I don't know what I'm feeling.  The pains are shooting if they come back.

But now I get the shooting pains, some nausea, GI distress, all the time.  It's like I have every symptom of a MI, other than the MI.  

I know a cath is the gold standard, and a 64 slice CT is damn close.

But, I also understand why a cardiologist would not order either.  I can exercise, and excercise for a good long time at high HR's without any problems, I mean, not a problem.

I'm trying to chalk it up to anxiety.

I'm kind of looking for your experience since you said you blew tests away but did have blockages bad enough to stent.

What does your Angina "Feel like".  Is it a pressure/squeeze?

Or is is shooting?  My pains are shooting in nature 99% of the time.  Arms, chest, face, jaw etc.

Thanks.

[PED]

Thanks Al.  Good insight.

So here is my dilemma.

I get the shooting pains in my arms, neck, jaw, and even on the tip of my jaw regularly lately.  The shooting pains, not a one lasts longer than 5 seconds.

I have not had the center chest tightness in over a month.

You mentioned you would get the chest pressure/choking feeling along with the other symptoms.

Most of the time I get the other symptoms, at rest, and very rarely during exercise.  But I don't get the shooting pains and the tightness in my chest at the same time.  That is, it doesn't start from the chest and move out.  It's like one minute I have some shooting pains in my left arm, right arm, then it moves to my jaw, or tip of my jaw.  Then a shooting pain in the outer chest region.

I've also got severe GI stuff going on, indigestion.  All of the "signs" of a heart attack.  But this has been going on for months now with no angina.

Anyways, guess I'm not really looking for advice (as I will likely talk to my doc again soon) as much as a comparison.

I don't need to take anything for the pains to go away, they are shooting in nature 99% of the time.

With a wife and two young kids, and frankly a real want to get back to "living my life" I'm grasping a bit here.

With your pains, did/do they generally start in the chest and move outward?

Thanks.

[Fran71]

Thanks Ped for your input. Sorry, I just saw it. I'm now taking 10 mg Inderal in the morning and 10 at night and I feel much better. Now I have a bad cold and I guess I was developing it when I felt so tired, so maybe Inderal was not totally to blame....

Thanks again

Fran