Please Help: Need Test Results explained

[RonShake]

My 61 yr old mom is Type 2 diabetic (20 yrs), Left stent, Angina, Hypertension,CKD Stage 3, Edema, had a CT Scan & Stress Test and the findings were: The heart is enlarged, Cardiomegaly. There is toruosity and calification of the thoracic aorta.
Stress Test: Non Specific ST-T wave abnormalities, Relatively small area of mild reversible antero-lateral ischemia, mild inferior wall ischemia. Wall thickening was normal in all segments. EJ left ventricular 56%. Her BNP is 2,800 and all EKG's come back "normal".

The cardiologists feel there is no need to be "alarmed" but she continues to have chest,abdominal pain and classic angina like symptoms even upon rest and was advised of Cardiac Cath but kidneys might be furher damaged. Appreciate all help in breaking this down.

[BrokenPen]

I guess it won’t be useful to describe the meaning of the numbers, as it might confuse you more, and I guess you are only interested in getting a simple meaning of the conclusion. I will try to make it as simple as possible.

Elevated LV end systolic and diastolic pressure simply means that the blood pressure inside the Left Ventricle is high in both systole and diastole. This condition is found in hypertensive patient, and with your mother known condition, it was expected.

Pulmonary capillary wedge pressure is a method used to measure indirectly the blood pressure in Left Atrium. A normal pressure should not exceed 12 mmHg. The results showed a pressure of 21 mmHg, which obviously indicate some kind of obstruction in the Left atrium. The commonest cause is Mitral Valve stenosis (tightening). An echocardiography would be more helpful to help in the diagnosis of cause of the raised pressure.

Single Vessel coronary artery disease. The heart is supplied by 3 main vessels. The term “disease” in this context means there’s some degree of obstruction in one of the vessels supplying the heart. In this case, an artery named “Left Circumflex Artery”, a branch of Left Coronary artery is partially occluded. The LCA supplies mainly the posterolateral part of the left ventricle. The left ventricle is the part of the heart that sends blood to different parts of the body. If a part of this ventricle becomes deficit, it will affect the distribution of blood throughout the body.

A coronary artery can be occluded to 75% without causing any symptom. However, this one is occluded by 80%, which means it starts to be symptomatic.

The term Diastolic Heart Failure would be rather hard to explain here, but in short, it means that the left ventricle can not be filled to its maximum.

The last note before the conclusion means no dye can be used due to the bad kidney condition.

I know it was long but I tried my best to summarize it. I hope this will help you and that your mom will improve soon.

[RonShake]

A CARDIAC CATH was recently done (without angioplasty),can you please explain in a way that I can understand what exactly is going on:

Hemodynamics:
Pressures Right Arium (a/v/m) 18mmHg 12mmHg 10mmHg
Right Ventricle (s/d/edp) 45, 7, 11
Pulmonary Artery (s/d/m) 44, 19, 31
Pulmonary Cap Wedge (a/v/m)            21
Left Ventricle (s/d/edp) 217mmHg, 25mmHg
Aorta (s/d/m) 183, 70, 115

Cardiac Output: Fick 4.10 L/min, Thermodilution: 5.80 L/min
Oxygen Saturation: Pulmonary Artery (main) 64%

Left Anterior Descending Artery: Discrete stenosis of proximal LAD artery in 50% obstruction of the vessel

Left Circumflex Artery: mid LCS artery in 80% obstruction of vessel, distal vessel was small, distal flow antegrade.

No LV gram for increased creatinine

CONCLUSIONS:
1. Elevated LV end diastolic pressure, systolic pressure
2. Elevated pressures at pulmonary capillary wedge
3. Single Vessel coronary artery disease
4. Obstructive disease in the left circumflex artery.
5. Diastolic heart failure

RECOMMENDATIONS: Treat with medical therapy

[Dr J Singh]

Hi,

I think I’ll go with the cardiologist’s word. Inspite of the multiple problems your mom has got, her Left ventricular ejection fraction is reasonably good. The walls of the ventricles are not thinned out. Hence, I don’t think you need to worry much.

I sincerely hope that helps. Take care and keep me posted Kind Regards.