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possible diastolic dysfunction

Hi,
I hope someone can help me with understanding the results of a cardiac CT scan.  First a little history, I am a 51 yr old female; I had to have a hysterectomy at the age of 42 due to multiple complicated cycts of the ovaries; I have hypothyroidism, type 2 diabetes, COPD emphezema and am considered medically obese.  Two years ago I had an echo but the results were noted as inclusive as it stated they were unable to obtain a clear image.  My Dr. ordered the cardiac CT to ensure that my breathing issues were not impacting my heart.  It's not one event that puzzles me but the culmination of multipe events.  I was average weight 110-115 (I'm 5 feet tall) up until 6 years ago when I started to rapidly gain weight - I went from 112 to 172 in 1 1/2 years.  Despite multiple pleas from me my Dr. had only run thyroid tests after all the weight gain only to find out my thyroid level was 89!
Last Tuesday I had sudden and severe sharp chest pain; I couldn't take a deep breath.  Because I had known the results of my CT scan I didn't think it was a heart attack so I didn't go to the ER.  The first episode lasted about 20 mins and a second one later that night about 40 mins.  I was thinking possibly gall bladder so I went to my Dr on Thursday.  She ordered a sonogram which showed: normal pancreas; gall bladder; spleen; mildly complicated cyst on my right kidney measuring 3.5 cm and a complicated cyst with calcification at one edge and a single septation on my left kidney measuring 1 cm.  Calcifications were noed in the liver consistent with old inflammorty disease.  With the way my Dr spoke to me after these results, it seemed that she doesn't believe I had ever had the level of pain I complained of.
I have been trying to lose the weight ever since I was diagnosed with hypothyroidsm and of course developed high BP due to the weight, and now type 2 diabetes.  I was put on metformin about 2 months ago and it seems not long after I began to lose weight (nothing has changed as I've always been a concientious eater since diabetes does run in my family -on Dad's side); I have lost 20 pounds in the last 2 months and am down to 152 (yes I know still too high) however, my BP med was cut in half (I was taking 150 mg Avapro); I have been taking niacin and fish oil for 2 yrs which has done a wonderful job of controlling my cholesterol which is within normal ranges for about the same period of time.  What is strange is my lower # still seems a bit high - today at the Dr. it was 112/90.
About 3 weeks ago I had what is being called an allergic reaction to a med I had been taking for about 2 weeks - wellbutrin to stop smoking.  The rash started in a small place, intensified into more like weeping welts and then spread everywhere except my face.  I still have the rash 3 weeks later but it is much better as if it may be going away.
The CT summary noted that no coronary artery disease was seen and the estimated likelihood of a flow-limiting lesion is < 1%. The CT showed and I quote "great arteries - both aorta and pumonaries"; pericardium - normal; normal RV systolic function; LV Mass 48 gms; aortic, mitral, tricuspid & pulmonary value normal; LV wall thickness normal & all 4 chambers of normal size; ejection fraction of 71%. Ok here is the confusing part - immediately following the EF is the notation 'possible diastolic dysfunction is suggested. Consider echo'.  My Dr. never mentioned this to me, it wasn't until I read my report that I saw it. Should I be concerned? Should I call my Dr. and ask why she didn't mention this? My Dad had a history of severe angina (he had 2 heart attacks and 2 strokes the second of which killed him but and thank God that was at the age of 83).
Some other things the CT showed: no pericardial effusion; there are small mediatinal and hilar nodes without adenopathy/mass; mild to moderate esophageal reflux; a moderate sized hiatal hernia, mild to moderate COPD emphysema and small airway disease suggestive of asthma or bronchitis; linear and nodular abnormality within the left upper lobe advise further characterization of the lung parenchyma; spondylosis thoracic spine noted;
I haven't had any other events of chest pain since last week, however, I always feel exhausted and just not right. The bloodwork she ran shows my diabetes is well controlled (fasting was down to 97 woohooo); creatine kinase 20 - low (normal 29-143); urine analysis showed trace blood, trace protein; leukocte esterace 1+ (normal is negative); WBC 10-20 (normal < or = 5) squamous epithelial cells 10-20 (normal < or =5) bacteria - moderate; hyaline cast 0-5; WB cell count 17.8 (normal 3.8-10.8); hemoglobin 15.6 (normal 11.7-15.5); menatocrit 47.6 (normal 35-45); RDW 15.2 (normal 11-15); absolute neutrophils 12,104 (normal 1500-7800); absolute lymphocytes 4,664 (normal 850-3900); My Dr. put me on an antibiotic as she stated all of the above reflects a minor infection somewhere in my body - probably urinary.
I am totally baffled by the possible diastolic dysfunction and with my history for reason of hysterectomy am wondering if all of the above could possibly be some type of autoimmune disease?
Sorry for the length, but no one single thing above concerns me but the combination of everything that has me concerned
4 Responses
367994 tn?1304957193
You may have conditions concomitant issues so it may be difficult to be specific regarding diastolic dysfunction.  I don't read anything in you post that suggests that malady.

Suspected Diastolic dysfunction usually is the result of an individual having signs and symptoms of heart failure and preserved systolic functionality (EF 55 to 75%).  If the DD is not successfully treated it will eventually cause heart failure!  An explanation is the DD occurs when the left ventricle does not properly relax, and as a result the filling capacity is reduced.  The same fraction (EF) remains, but the same fraction pumped is a fraction of reduced capacity and decreased cardiac output (amount of blood pumped at minute intervals).  Also, with DD the left chamber walls are thickened (become rigid and inflexable) and capacity (chamber size is reduced) that reduces filling capacity.

Additionally, "Diastolic dysfunction may not manifest itself except in physiologic extremes if systolic function is preserved. The patient may be completely asymptomatic at rest. However, they are exquisitely sensitive to increases in heart rate, and sudden bouts of tachycardia (which can be caused simply by physiological responses to exertion, fever, or dehydration, or by pathological tachyarrhythmias such as atrial fibrillation with rapid ventricular response) may result in flash pulmonary edema".  Your post doesn't indicate those symptoms, and making a DD is not revealed in anything you have posted?
Avatar universal
Thank you for your responce. The reason I asked is because possible diastolic dysfunction was noted in my CT results based on a EF of 71.  About a week after the test I had severe chest pain (I hadn't seen a copy of the results but my Dr had stated they were excellant) so I grin a beared the pain.  It was very difficult to take a deep breath due to the level of pain.  Prior to that I had occassional chest tightness and pain but it was always mild to moderate.  It does happen more frequently with exertion but I had contributed that to the COPD.  I guess the most frustrating part is that my Dr never mentioned this to me nor did she advise me to have an echo as recommended in the CT results.  After the episode with my thyroid I've learned to request a copy of all test results and to read them for myself.  If you were me would you pursue this with your Dr and request the echo or maybe I should see a cardiologist?
Thank you again for your responce.
367994 tn?1304957193
You are welcome, and thanks for your reply.  If you have any further questions feel free to post.  Take care
212161 tn?1537898045
i myself would get a echo
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