shortness of breath, fatigue and chest pains

[bac4107]

I have been having shortness of breath, chest pain and fatigue.  I also have an abdominal aortic aneurysm (4.8cm at widest point.  A recent ekg states "abnormal"  right ventrical hyptrophy, QT= 480 QTc=481.  I also  had an echo with indicated marked aortic valvular calcification.  Then I had a stress test which led my cardiologist to perform a left heart cath.  No Block were seen and only mild regurg of the mitral, aortic and tri valves.  While attempting to gather past records from previous Dr.'s my husband noticed under previous medical history on one of the reports "Pulmonary Hypertension 30-40mmHg".  My sister passed away from PPH about 7 years ago at the age of 50. But we believe it was caused by the use of diet pills. My questions are 1.  What does marked aortic valvular calcification mean? 2. Is this jus the normarl aging process and of little and no concern? 3.  Is it correct to assume that the report was wrong regarding PH and I can ignore it.  Thank you for any clarification you can provide.

[Jonathan D. Rich, MD]

I am disappointed by the response you received from your cardiologist.  Unfortunately, I believe you will need a second opinion.  It is unacceptable, in my opinion, to not provide someone who is having shortness of breath, etc with a diagnosis.  At the very least, further testing would seem warranted to me if the diagnosis is not readily apparent.  But to wish you luck and leave the room is not ok in my opinion.

Be careful when you seek a 2nd opinion and try to find someone who comes recommended. You should also make sure you have a good primary care physician as he/she can be very helpful facilitating referrals and with other testing.  If by chance you are in the chicago area, I would be happy to see you.

Best,

Dr. Rich

[bac4107]

Sir,
Thank you for responding to my questions.  I followed up with a cardiologist who performed a left heart cath.  He said no heart blocks were found.  I attemted to discuss with him what I should do next regarding my symtoms.  His response was "It's not your heart, and we will do a repeat ultra-sound of the abdomen in 6 months to evaluate the AAA". He then left the room.  I am uncertain whether I sould do anything else or wait 6 months and see if the shortness of breath, fatigue and chest pain worsen. Any recommendation would be greatly appreciated.

[Jonathan D. Rich, MD]

Hello and welcome to the forum:

1. I am not too worried about the aortic calcification.  As you correctly suggested, this is likely a manifestation of aging (and possibly previously elevated cholesterol or blood pressure, etc).  But if the valve is not severely tight (or leaky), there is not a lot you need to worry about.  You should, of course, continue to live a healthy lifestyle to prevent progression.

2. Regarding the "PH", I do not think you can (nor can I), make anything of this report of "PH 30-40 mmHg).  I assume this was from an echo and this is notoriously unreliable (only a right heart catheterization can make the diagnosis of PH).. However, more intriguing to me, is the ECG report suggesting right ventricular hypertrophy.  RVH can be seen in PH (though it can also be seen in other instances).  I think it would be more than reasonable to see a cardiologist to discuss this.  This is not to make you nervous but rather to ensure that no stone goes unturned. Plus, the fact is that you are having symptoms. To me, this is the biggest reason to be evaluated so that a correct diagnosis can be made and therapy started to make you feel better.

Hope this helps.  Wishing you the best.

Dr. Rich