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I Am 50 Years Old / Male. I Have A
Question: I am 50 years old / male. I have a history of atypical chest pain on & off for last few years. I also suffer from sleep apnea and some neurological issue which causes some (slight) gait imbalance.
In March 2020, I had chest pain with palpitations one night, following which I had an angiogram (some ECG changes and Trop T somewhat elevated and diagnosed as NSTEMI). Angio showed 60% block in RCA with minor blocks in LAD and a myocardial bridge in mid-LAD. It was felt that none of these were very critical (i.e. they could not have caused my NSTEMI) and I am on medicine - Ciplar, Clopitab, Flavidon).
I now feel fatigued easily, and have exercise intolerence i.e. I find it difficult to undergo any effort - even normal things like bending and stretching make me a bit out of breath and uncomfortable. I also feel lightheaded at times and chest pain even unrelated to exertion. All these symptoms have been there even before the NSTEMI, but seem to be more now, particularly the exercise intolerance. Also feel very sleepy and fatigued.
An earlier angio in 2015 showed only minor blocks in mid-LAD and distal-LCX (none in RCA).
A CT angio in 2018 showed minor blocks as above (none in RCA) and a superficial myocardial bridge (MB) of 6cm length . Also showed LV wall hypertrophy.
TMT test done in 2015 came positive.
A recent ECG taken last week (after chest pain that day) looks similar to the previous one just after the NSTEMI.
A holter (
I have not been able to follow up with my cardiologist physically due to the current pandemic situation.
I have attached the following reports -
- ECGs of 9/3/20 (just after the NSTEMI), 12/3/20 & 25/07/20 (taken locally)
- Echo - 5/10/19 (no echo taken after that)
- Angio report of 9/3/20
- Discharge summary of 10/3/20
My questions:
1. I feel concerned about the gradually worsening effort intolerence and fatigue. Other symptoms - chest pain on and off (sometimes with palpitations), lightheadedness, sleepiness, some breathlessness on exertion. Also sometimes pain around calf (leg). However the cardiologist says the existing lesion in the artery is minor and will not cause such symptoms. What may cause these symptoms then? Will the MB play a role in this.
2. The CT angio done just over a year ago (and regular angio of 2015) did not show any block in RCA, but current one shows 60% block in RCA. Is it common to get a new block in such a short time. Also block found in LCX in earlier angio is not present in current one.
3. How can we find out an objective measure of how much blood flow limitation exists due the above blocks / MB. How does the CT angio grade the MB as 'superficial' without measuring its depth. Could the MB cause a blood flow limitation and thereby cause my symptoms?
Thank you.
In March 2020, I had chest pain with palpitations one night, following which I had an angiogram (some ECG changes and Trop T somewhat elevated and diagnosed as NSTEMI). Angio showed 60% block in RCA with minor blocks in LAD and a myocardial bridge in mid-LAD. It was felt that none of these were very critical (i.e. they could not have caused my NSTEMI) and I am on medicine - Ciplar, Clopitab, Flavidon).
I now feel fatigued easily, and have exercise intolerence i.e. I find it difficult to undergo any effort - even normal things like bending and stretching make me a bit out of breath and uncomfortable. I also feel lightheaded at times and chest pain even unrelated to exertion. All these symptoms have been there even before the NSTEMI, but seem to be more now, particularly the exercise intolerance. Also feel very sleepy and fatigued.
An earlier angio in 2015 showed only minor blocks in mid-LAD and distal-LCX (none in RCA).
A CT angio in 2018 showed minor blocks as above (none in RCA) and a superficial myocardial bridge (MB) of 6cm length . Also showed LV wall hypertrophy.
TMT test done in 2015 came positive.
A recent ECG taken last week (after chest pain that day) looks similar to the previous one just after the NSTEMI.
A holter (
I have not been able to follow up with my cardiologist physically due to the current pandemic situation.
I have attached the following reports -
- ECGs of 9/3/20 (just after the NSTEMI), 12/3/20 & 25/07/20 (taken locally)
- Echo - 5/10/19 (no echo taken after that)
- Angio report of 9/3/20
- Discharge summary of 10/3/20
My questions:
1. I feel concerned about the gradually worsening effort intolerence and fatigue. Other symptoms - chest pain on and off (sometimes with palpitations), lightheadedness, sleepiness, some breathlessness on exertion. Also sometimes pain around calf (leg). However the cardiologist says the existing lesion in the artery is minor and will not cause such symptoms. What may cause these symptoms then? Will the MB play a role in this.
2. The CT angio done just over a year ago (and regular angio of 2015) did not show any block in RCA, but current one shows 60% block in RCA. Is it common to get a new block in such a short time. Also block found in LCX in earlier angio is not present in current one.
3. How can we find out an objective measure of how much blood flow limitation exists due the above blocks / MB. How does the CT angio grade the MB as 'superficial' without measuring its depth. Could the MB cause a blood flow limitation and thereby cause my symptoms?
Thank you.
I am 50 years old / male. I have a history of atypical chest pain on & off for last few years. I also suffer from sleep apnea and some neurological issue which causes some (slight) gait imbalance.
In March 2020, I had chest pain with palpitations one night, following which I had an angiogram (some ECG changes and Trop T somewhat elevated and diagnosed as NSTEMI). Angio showed 60% block in RCA with minor blocks in LAD and a myocardial bridge in mid-LAD. It was felt that none of these were very critical (i.e. they could not have caused my NSTEMI) and I am on medicine - Ciplar, Clopitab, Flavidon).
I now feel fatigued easily, and have exercise intolerence i.e. I find it difficult to undergo any effort - even normal things like bending and stretching make me a bit out of breath and uncomfortable. I also feel lightheaded at times and chest pain even unrelated to exertion. All these symptoms have been there even before the NSTEMI, but seem to be more now, particularly the exercise intolerance. Also feel very sleepy and fatigued.
An earlier angio in 2015 showed only minor blocks in mid-LAD and distal-LCX (none in RCA).
A CT angio in 2018 showed minor blocks as above (none in RCA) and a superficial myocardial bridge (MB) of 6cm length . Also showed LV wall hypertrophy.
TMT test done in 2015 came positive.
A recent ECG taken last week (after chest pain that day) looks similar to the previous one just after the NSTEMI.
A holter (
I have not been able to follow up with my cardiologist physically due to the current pandemic situation.
I have attached the following reports -
- ECGs of 9/3/20 (just after the NSTEMI), 12/3/20 & 25/07/20 (taken locally)
- Echo - 5/10/19 (no echo taken after that)
- Angio report of 9/3/20
- Discharge summary of 10/3/20
My questions:
1. I feel concerned about the gradually worsening effort intolerence and fatigue. Other symptoms - chest pain on and off (sometimes with palpitations), lightheadedness, sleepiness, some breathlessness on exertion. Also sometimes pain around calf (leg). However the cardiologist says the existing lesion in the artery is minor and will not cause such symptoms. What may cause these symptoms then? Will the MB play a role in this.
2. The CT angio done just over a year ago (and regular angio of 2015) did not show any block in RCA, but current one shows 60% block in RCA. Is it common to get a new block in such a short time. Also block found in LCX in earlier angio is not present in current one.
3. How can we find out an objective measure of how much blood flow limitation exists due the above blocks / MB. How does the CT angio grade the MB as 'superficial' without measuring its depth. Could the MB cause a blood flow limitation and thereby cause my symptoms?
Thank you.
In March 2020, I had chest pain with palpitations one night, following which I had an angiogram (some ECG changes and Trop T somewhat elevated and diagnosed as NSTEMI). Angio showed 60% block in RCA with minor blocks in LAD and a myocardial bridge in mid-LAD. It was felt that none of these were very critical (i.e. they could not have caused my NSTEMI) and I am on medicine - Ciplar, Clopitab, Flavidon).
I now feel fatigued easily, and have exercise intolerence i.e. I find it difficult to undergo any effort - even normal things like bending and stretching make me a bit out of breath and uncomfortable. I also feel lightheaded at times and chest pain even unrelated to exertion. All these symptoms have been there even before the NSTEMI, but seem to be more now, particularly the exercise intolerance. Also feel very sleepy and fatigued.
An earlier angio in 2015 showed only minor blocks in mid-LAD and distal-LCX (none in RCA).
A CT angio in 2018 showed minor blocks as above (none in RCA) and a superficial myocardial bridge (MB) of 6cm length . Also showed LV wall hypertrophy.
TMT test done in 2015 came positive.
A recent ECG taken last week (after chest pain that day) looks similar to the previous one just after the NSTEMI.
A holter (
I have not been able to follow up with my cardiologist physically due to the current pandemic situation.
I have attached the following reports -
- ECGs of 9/3/20 (just after the NSTEMI), 12/3/20 & 25/07/20 (taken locally)
- Echo - 5/10/19 (no echo taken after that)
- Angio report of 9/3/20
- Discharge summary of 10/3/20
My questions:
1. I feel concerned about the gradually worsening effort intolerence and fatigue. Other symptoms - chest pain on and off (sometimes with palpitations), lightheadedness, sleepiness, some breathlessness on exertion. Also sometimes pain around calf (leg). However the cardiologist says the existing lesion in the artery is minor and will not cause such symptoms. What may cause these symptoms then? Will the MB play a role in this.
2. The CT angio done just over a year ago (and regular angio of 2015) did not show any block in RCA, but current one shows 60% block in RCA. Is it common to get a new block in such a short time. Also block found in LCX in earlier angio is not present in current one.
3. How can we find out an objective measure of how much blood flow limitation exists due the above blocks / MB. How does the CT angio grade the MB as 'superficial' without measuring its depth. Could the MB cause a blood flow limitation and thereby cause my symptoms?
Thank you.
Brief Answer:
Please refer to the detailed answer below
Detailed Answer:
Hello
After going through the medical courses for you I can understand your concern for your health and I would like to elaborate your queries in the following manner
1. Yes myocardial Bridge can be important cause of your symptoms in your case.
2. CT angio has less sensitivity as compared to routine conventional angiography and can under or over estimate the lesions. Lesions upto 60% cannot develop in such a short while.
3. Myocardial bridge develop when a coronary artery pierce and go through the muscle instead of going via the surface. Now every time your heart muscles contract it cuts of the supply of blood via that blood vessel making the area of heart supplied by that vessel deprived of blood supply Thereby causing symptoms of chest discomfort or breathlessness.
However I would like to suggest you to kindly get an echocardiogram first to rule out any newly developed reduction in ejection fraction or any new significant mitral regurgitation.
Kind Regards
Please refer to the detailed answer below
Detailed Answer:
Hello
After going through the medical courses for you I can understand your concern for your health and I would like to elaborate your queries in the following manner
1. Yes myocardial Bridge can be important cause of your symptoms in your case.
2. CT angio has less sensitivity as compared to routine conventional angiography and can under or over estimate the lesions. Lesions upto 60% cannot develop in such a short while.
3. Myocardial bridge develop when a coronary artery pierce and go through the muscle instead of going via the surface. Now every time your heart muscles contract it cuts of the supply of blood via that blood vessel making the area of heart supplied by that vessel deprived of blood supply Thereby causing symptoms of chest discomfort or breathlessness.
However I would like to suggest you to kindly get an echocardiogram first to rule out any newly developed reduction in ejection fraction or any new significant mitral regurgitation.
Kind Regards
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
Please refer to the detailed answer below
Detailed Answer:
Hello
After going through the medical courses for you I can understand your concern for your health and I would like to elaborate your queries in the following manner
1. Yes myocardial Bridge can be important cause of your symptoms in your case.
2. CT angio has less sensitivity as compared to routine conventional angiography and can under or over estimate the lesions. Lesions upto 60% cannot develop in such a short while.
3. Myocardial bridge develop when a coronary artery pierce and go through the muscle instead of going via the surface. Now every time your heart muscles contract it cuts of the supply of blood via that blood vessel making the area of heart supplied by that vessel deprived of blood supply Thereby causing symptoms of chest discomfort or breathlessness.
However I would like to suggest you to kindly get an echocardiogram first to rule out any newly developed reduction in ejection fraction or any new significant mitral regurgitation.
Kind Regards
Please refer to the detailed answer below
Detailed Answer:
Hello
After going through the medical courses for you I can understand your concern for your health and I would like to elaborate your queries in the following manner
1. Yes myocardial Bridge can be important cause of your symptoms in your case.
2. CT angio has less sensitivity as compared to routine conventional angiography and can under or over estimate the lesions. Lesions upto 60% cannot develop in such a short while.
3. Myocardial bridge develop when a coronary artery pierce and go through the muscle instead of going via the surface. Now every time your heart muscles contract it cuts of the supply of blood via that blood vessel making the area of heart supplied by that vessel deprived of blood supply Thereby causing symptoms of chest discomfort or breathlessness.
However I would like to suggest you to kindly get an echocardiogram first to rule out any newly developed reduction in ejection fraction or any new significant mitral regurgitation.
Kind Regards
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your prompt response. I shall try and get an echo done. Meanwhile, I have the following queries:
1. Is there any procedure to find out whether the MB is actually causing limitation in blood supply - I think this was not done during the angio i.e. there was nothing in the report like say, The MB causes 25% reduction in blood supply (for example.)
2. If the Mb is found to actually cause such limitation, what is the cure for this? Medical / surgical?
3. Can the Mb cause a heart attack?
Thank you
1. Is there any procedure to find out whether the MB is actually causing limitation in blood supply - I think this was not done during the angio i.e. there was nothing in the report like say, The MB causes 25% reduction in blood supply (for example.)
2. If the Mb is found to actually cause such limitation, what is the cure for this? Medical / surgical?
3. Can the Mb cause a heart attack?
Thank you
Thank you for your prompt response. I shall try and get an echo done. Meanwhile, I have the following queries:
1. Is there any procedure to find out whether the MB is actually causing limitation in blood supply - I think this was not done during the angio i.e. there was nothing in the report like say, The MB causes 25% reduction in blood supply (for example.)
2. If the Mb is found to actually cause such limitation, what is the cure for this? Medical / surgical?
3. Can the Mb cause a heart attack?
Thank you
1. Is there any procedure to find out whether the MB is actually causing limitation in blood supply - I think this was not done during the angio i.e. there was nothing in the report like say, The MB causes 25% reduction in blood supply (for example.)
2. If the Mb is found to actually cause such limitation, what is the cure for this? Medical / surgical?
3. Can the Mb cause a heart attack?
Thank you
Brief Answer:
Please refer to the detailed answer below
Detailed Answer:
Hello again
1.In majority of the case if MB has been detected by angiogram, then there are high possibilities that the blood flow will be hampered with heart contractions. However to document it one can go for Myocardial perfusion imaging (Stress MPI) after having a talk with the treating cardiologist.
2. Usually medical treatment is enough in most of the cases for symptomatic relief. Surgical options include Bypass, myotomy or sometimes coronary stenting.
3. Yes, recent studies have found that MB can be associated with complications like heart attack, cardiac arrhythmias etc.
Kind Regards
Please refer to the detailed answer below
Detailed Answer:
Hello again
1.In majority of the case if MB has been detected by angiogram, then there are high possibilities that the blood flow will be hampered with heart contractions. However to document it one can go for Myocardial perfusion imaging (Stress MPI) after having a talk with the treating cardiologist.
2. Usually medical treatment is enough in most of the cases for symptomatic relief. Surgical options include Bypass, myotomy or sometimes coronary stenting.
3. Yes, recent studies have found that MB can be associated with complications like heart attack, cardiac arrhythmias etc.
Kind Regards
Above answer was peer-reviewed by :
Dr. Kampana
Brief Answer:
Please refer to the detailed answer below
Detailed Answer:
Hello again
1.In majority of the case if MB has been detected by angiogram, then there are high possibilities that the blood flow will be hampered with heart contractions. However to document it one can go for Myocardial perfusion imaging (Stress MPI) after having a talk with the treating cardiologist.
2. Usually medical treatment is enough in most of the cases for symptomatic relief. Surgical options include Bypass, myotomy or sometimes coronary stenting.
3. Yes, recent studies have found that MB can be associated with complications like heart attack, cardiac arrhythmias etc.
Kind Regards
Please refer to the detailed answer below
Detailed Answer:
Hello again
1.In majority of the case if MB has been detected by angiogram, then there are high possibilities that the blood flow will be hampered with heart contractions. However to document it one can go for Myocardial perfusion imaging (Stress MPI) after having a talk with the treating cardiologist.
2. Usually medical treatment is enough in most of the cases for symptomatic relief. Surgical options include Bypass, myotomy or sometimes coronary stenting.
3. Yes, recent studies have found that MB can be associated with complications like heart attack, cardiac arrhythmias etc.
Kind Regards
Above answer was peer-reviewed by :
Dr. Kampana
Dear Doctor
Thank you for your clear reply. I hope you will help me further by clarifying these doubts:
1. Are the medicines I am already taking (Ciplar, Clopitab, Flavidon) suitable for the MB also? Because I am still having the symptoms.
2. Is the MB or the 60% block in RCA (both of them minor as per the cardiologist) more likely to have caused the NSTEMI I had? I would like to know, because I am still having symptoms and of course am worried about having an MI again. And I guess that the block in the RCA would be easier to treat.
3. Is there any doctor / hospital you can suggest in South XXXXXXX (Chennai / Bangalore) that are known specially for treating MBs?
4. Since the MB must have been there form birth, but is causing symptoms now in middle age - will the symptoms worsen as the years go by?
Thank you for your patience with my queries.
Thank you for your clear reply. I hope you will help me further by clarifying these doubts:
1. Are the medicines I am already taking (Ciplar, Clopitab, Flavidon) suitable for the MB also? Because I am still having the symptoms.
2. Is the MB or the 60% block in RCA (both of them minor as per the cardiologist) more likely to have caused the NSTEMI I had? I would like to know, because I am still having symptoms and of course am worried about having an MI again. And I guess that the block in the RCA would be easier to treat.
3. Is there any doctor / hospital you can suggest in South XXXXXXX (Chennai / Bangalore) that are known specially for treating MBs?
4. Since the MB must have been there form birth, but is causing symptoms now in middle age - will the symptoms worsen as the years go by?
Thank you for your patience with my queries.
Dear Doctor
Thank you for your clear reply. I hope you will help me further by clarifying these doubts:
1. Are the medicines I am already taking (Ciplar, Clopitab, Flavidon) suitable for the MB also? Because I am still having the symptoms.
2. Is the MB or the 60% block in RCA (both of them minor as per the cardiologist) more likely to have caused the NSTEMI I had? I would like to know, because I am still having symptoms and of course am worried about having an MI again. And I guess that the block in the RCA would be easier to treat.
3. Is there any doctor / hospital you can suggest in South XXXXXXX (Chennai / Bangalore) that are known specially for treating MBs?
4. Since the MB must have been there form birth, but is causing symptoms now in middle age - will the symptoms worsen as the years go by?
Thank you for your patience with my queries.
Thank you for your clear reply. I hope you will help me further by clarifying these doubts:
1. Are the medicines I am already taking (Ciplar, Clopitab, Flavidon) suitable for the MB also? Because I am still having the symptoms.
2. Is the MB or the 60% block in RCA (both of them minor as per the cardiologist) more likely to have caused the NSTEMI I had? I would like to know, because I am still having symptoms and of course am worried about having an MI again. And I guess that the block in the RCA would be easier to treat.
3. Is there any doctor / hospital you can suggest in South XXXXXXX (Chennai / Bangalore) that are known specially for treating MBs?
4. Since the MB must have been there form birth, but is causing symptoms now in middle age - will the symptoms worsen as the years go by?
Thank you for your patience with my queries.
Brief Answer:
hello again
Detailed Answer:
1. Yes, the medicines are alright.
2. It's difficult to say whether the culprit was MB or the lesion in RCA.
3. You can visit XXXXXXX Hrudayalaya or Jayadeva Institute.
4. Usually it has no correlation with advancing age.
Kind Regards
hello again
Detailed Answer:
1. Yes, the medicines are alright.
2. It's difficult to say whether the culprit was MB or the lesion in RCA.
3. You can visit XXXXXXX Hrudayalaya or Jayadeva Institute.
4. Usually it has no correlation with advancing age.
Kind Regards
Above answer was peer-reviewed by :
Dr. Kampana
Brief Answer:
hello again
Detailed Answer:
1. Yes, the medicines are alright.
2. It's difficult to say whether the culprit was MB or the lesion in RCA.
3. You can visit XXXXXXX Hrudayalaya or Jayadeva Institute.
4. Usually it has no correlation with advancing age.
Kind Regards
hello again
Detailed Answer:
1. Yes, the medicines are alright.
2. It's difficult to say whether the culprit was MB or the lesion in RCA.
3. You can visit XXXXXXX Hrudayalaya or Jayadeva Institute.
4. Usually it has no correlation with advancing age.
Kind Regards
Above answer was peer-reviewed by :
Dr. Kampana
Thank you, Doctor. My last question:
As suggested I have taken Echo and attached report. Also last night I again experienced chest and neck pain for about 5-10 minutes. I have also taken one more ECG and attached the report.(File name XXXXXXX 1 Aug report) Can you please tell me if ECG shows any new changes?
EF in Echo seems to be OK. It is 70% (last time 82%). Are the other parameters in Echo OK?
Thank you.
As suggested I have taken Echo and attached report. Also last night I again experienced chest and neck pain for about 5-10 minutes. I have also taken one more ECG and attached the report.(File name XXXXXXX 1 Aug report) Can you please tell me if ECG shows any new changes?
EF in Echo seems to be OK. It is 70% (last time 82%). Are the other parameters in Echo OK?
Thank you.
Thank you, Doctor. My last question:
As suggested I have taken Echo and attached report. Also last night I again experienced chest and neck pain for about 5-10 minutes. I have also taken one more ECG and attached the report.(File name XXXXXXX 1 Aug report) Can you please tell me if ECG shows any new changes?
EF in Echo seems to be OK. It is 70% (last time 82%). Are the other parameters in Echo OK?
Thank you.
As suggested I have taken Echo and attached report. Also last night I again experienced chest and neck pain for about 5-10 minutes. I have also taken one more ECG and attached the report.(File name XXXXXXX 1 Aug report) Can you please tell me if ECG shows any new changes?
EF in Echo seems to be OK. It is 70% (last time 82%). Are the other parameters in Echo OK?
Thank you.
Brief Answer:
Hello again
Detailed Answer:
1. No there are no significant new changes.
2. In echo any percentage of LVEF above 55% is considered normal. It hardly matters whether it is 70% or 82%, atleast in your your context.
Kind Regards
Hello again
Detailed Answer:
1. No there are no significant new changes.
2. In echo any percentage of LVEF above 55% is considered normal. It hardly matters whether it is 70% or 82%, atleast in your your context.
Kind Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
Hello again
Detailed Answer:
1. No there are no significant new changes.
2. In echo any percentage of LVEF above 55% is considered normal. It hardly matters whether it is 70% or 82%, atleast in your your context.
Kind Regards
Hello again
Detailed Answer:
1. No there are no significant new changes.
2. In echo any percentage of LVEF above 55% is considered normal. It hardly matters whether it is 70% or 82%, atleast in your your context.
Kind Regards
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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