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fullness in neck

  :  Dear docs,
  :   Thank you for this forum.  I 've had cardiac symptoms the last few
  : months but have been checked out by a cardiologist (with echo and stress(
  : and been told I'm OK. I have a few questions please:
  : 1. Lately I've felt a fullness in my neck (both sides) a book I read said
  : this was a sign of right sided heart failure. When I asked the doctor he
  : said it looked normal with 3 cm of water. My echo measured my right side
  : larger than an echo did 5 months ago but still in the normal range. Would
  : an echo rule out right sided failure despite this feeling in my neck.
  : 2. If one had CAD what would the treatment be?
  : 3. I am 34 and have no family history of CAD, no hypertension or diabetes,
  : 150 chol, 90 ldl but only 33 Hdl. What level risk do I have? When I work
  : on the phone,I sometimes feel a pain in my chest for a hour or two could
  : that be angina?  I don't know what to do? Thank you.  Will
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Avatar universal

Dear Will,
1. An echocardiogram, yes, will rule out right heart failure, even if you have a fullness in your neck.  Not only can the fullness in your neck be something completely unrelated to your heart, it certainly is not related to any increased pressure since the echo showed a normal right heart and the pressure as assessed by your neck veins was normal.  The jugular venous pressure is assessed in various positions, the more supine the patient, the higher the cm that are considered normal.  Therefore 3cm would not be "normal" for a patient who is standing and it would be for the patient sitting at 45degrees.  Keep in mind this is one of the most insensitive tests one can perform on a physical exam and is probably not contributory at all unless it is markedly abnormal or if there is no way to get an echocardiogram (the best way to assess right sided pressures.)
2.The treatment of CAD, once the diagnosis is established, is dependent on the extent of the disease, which vessels and which branches are involved, whether or not the heart muscle has been effected, and even whether or not the patient has comorbidities such as diabetes.  Also significant in determining the treatment of CAD is the patients symptoms and his/her quality of life.  Basically Will, there is not enough time in the day for me to cover all the possible CAD treatment options.
3.Firstly, no I doubt that your pains are "angina" as they are atypical, however I do hope that you are making your physician aware of any new symptoms you might have.  Secondly, your risk profile is low (no family history, excellent LDL level) but not "nil" because your HDL is low (if you smoke then your risk is greater than I am implying here since cigarrettes are a major risk factor for CAD.)  The testosterone is not doing any damage to your heart specifically, however it may be slightly increasing your risk of developing coronary artery disease by the time you are 50 or 60, this is a little controversial.  The most important thing you can do Will, in order to keep your heart healthy, is that you not smoke, that you maintain an ideal body weight by eating right and exercising daily (40minutes of aerobic conditioning a day, and that you keep regular check ups with your doctors.
I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.

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