Dear Mr XXXXXXX
Thanks for writing in.
I am a qualified and certified cardiologist. I read your mail with diligence.
I am commenting on your echo report in capital letters before coming to other question.
M-Line measurement
Mitral valve DE 490 mm, EF slope 100mm, EPSS 7.6 NORMAL

AORTIC valve Aortic root 31.4 mm valve opening 17 mm WITHIN NORMAL LIMITS

Left atrium Diameter 36.5 HIGHER NORMAL

Left ventricle IVS ED=8.5mm, ES=15.3mm EDV=118.8ml, IVPW ED=9.3mm ES=16.1mm ESV=34.2ml NORMAL CAVITY BUT LEFT VENTRICULAR WALLS
THICKENED, HYPERTROPHY OF LEFT VENTRICLE
DUE TO HYPERTENSION
LVID D=50.1mm S=29.7mm NORMAL

Ejection fraction 71% NORMAL

shortening fraction= 40^

Right ventricle ID 34.8mm HIGHER SIDE ARE YOU A SMOKER?

Dimensional imaging:

Mitral valve normal, aortic valve normal, pulmonary valve normal, tricuspid valve normal, right ventricle normal, right atrium normal, inter ventricular septum intact, interatrial septum intact, intracardiac clot/ vegetation/myxoma none, left atrium normal, left ventricle-LV mass=181gms, pericardium nofluid seen . no regional wall motion abnormality seen LV MASS INCREASED UNLESS YOU ARE OBESE
OR HAVE LARGE FRAME YOUR HEIGHT/WEIGHT?

colour flow mapping No MR/TR/AR/PR NORMAL

Doppler study NORMAL

mitral flow: E=1.12 A=0.83

Aortic flow=1.38

Pulmonary flow= 1.23

Tricuspid flow: E=0.93 A=0.80

summary of finding and echocardiographic diagnosis

normal LV size and contractility

normal LV systolic function LVEF=71%

no diastolic dysfunction present

no MR/TR/AR/PR seen

No LA/LV clot

No regional wall motion abnormality seen. AGREED WITH DOPPLER REPORT

i am having shifting pain in chest what may be the reason, whether it is due to gas or something else, what other test which i should undertake, please advice

130/94 BP ON AN AVERAGE MEANS MILDLY INCREASED; ECHO CONFIRMS. I SUGGEST YOU SEE YOUR DOCTOR WHO AFTER PRESCRIBING SUITABLE MEDICINES TO CONTROL BLOOD PRESSURE WILL DO AN EKG AND POSSIBLY A STRESS TEST. YOU NEED LIPID PROFILE & FASTING BLOOD SUGAR SO AS TO FIND OUT ABOUT HEART DISEASE AS CAUSE OF PAIN AND OTHER COMMON RISK FACTORS. NOR YOU HAVE MENTIONED ABOUT SMOKING, YOUR HEIGHT AND WEIGHT NEITHER ABOUT YOUR LIFE STYLE WITH REGARDS TO EXERCISE. THESE ARE FACTORS WHICH HAVE TO BE LOOKED INTO. IN INDIA AT AGE 34 ONE CAN NOT EXCLUDE HEART DISEASE AS A CAUSE OF CHEST PAIN, ALL THIS IS NECESSARY TO EXCLUDE WITH CERTAINTY THE MOST IMPORTANT CAUSE. GOOD LUCK.
With best wishes.
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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Dear Sir,
Thanks for writing back. My apologies for missing on your data in the first instance. Your final diagnosis is Metabolic Syndrome with no definite evidence of heart disease. Good thing is with risk factors like obesity, lack of exercise and dyslipidemia there is much scope for complete recovery. Still the advise stands. We from XXXXXXX can not prescribe medicines but certainly urge you continue to take blood pressure drug in the dose appropriate to control your BP (It should never exceed 140/90). I am sure your doctor will prescribe a statin to control your dyslipimia. You need to undergo a stress test irrespective of EKG findings (unless it shows a recent ischemic insult) that can differentiate chest pain due to non cardiac from cardiac causes. I suggest any good hospital (Apollo or Nizam Institute Hyderabad to name two) for initial management. If heart as a cause of chest pain is excluded we can think of other causes like Gastro Esophageal Reflux Disease (GERD) that is second possibility and we will treat that only after heart as cause is excluded (That is not a serious situation and can be tackled comfortably) Please do not worry about gas. Once blood pressure is under control it will either take care of itself or OTC tablet gassex an ayurvedic medicine can help.

You have to remember that two things you have to be aiming at reduce your weight depending upon being vegetarian or nonvegetarian status you can obtain chart of 1600 calories low cholesterol diet and aim for doing exercise (if your TMT is normal) 5 KM/Hour brisk walk for 40 minutes daily (do not worry if your speed is slow) that will go long way to help you with your symptoms.

The most important role is played by stress (tension) in causing Hypertension (increased BP). I have borrowed from internet translation of a Yogic Exercise which will go long way you to relieve from it and may be we can stop drugs for high BP altogether.

Please do this yogic exercise for ten minutes twice a day. Western medical literature writes about the progressive muscular relaxation which is used for non pharmacological treatment of blood pressure. This has opposite effect to heavy isometric exercise. Additionally, this is a great stress buster. It is called Savasana: corpse pose if literally translated (original text is in ancient Sanskrit books but here net is of great help and literal English translation conveys the accurate steps)

No yoga session is complete without the final pose – Savasana. The body needs this time to understand the new information it has received through practicing yoga. Even though Savasana is a resting pose, it’s not the same a sleeping! You should stay present and aware during the five to ten minute duration of final relaxation.
used help of WWW.WWWW.WW for translation (without permission as it is a translation of freely available text in Sanskrit and Hindi)
Instructions:

1. Come to lie down on the back.

2. Let the feet fall out to either side.

3. Bring the arms alongside the body, but slightly separated from the body, and turn the palms to face upwards.

4. Relax the whole body, including the face. Let the body feel heavy.

5. Let the breath occur naturally.

6. To come out, first begin to the deepen the breath. Then move the fingers and toes, awakening the body.

7. Bring the knees into the chest and roll over to one side, keep the eyes closed.

8. Slowly bring yourself back up into a sitting position.

Here are some ideas on ways to use props during savasana to make this pose more comfortable and relaxing. Progressive muscle relaxation it produces even help patients of high blood pressure. So, I picked up not exactly the worst case scenerio form the net.


In Allahabad where you reside there is a medical college with cardiology department you can get stress done there and medicines prescribed, that would be my suggestion

If there is any further query I will be most happy to answer asap. It is a pleasure interacting with you.
With Best Wishes.

Dr Anil Grover,
Cardiologist & Internist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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Dear Mr XXXXXXX

Thank you for sending me the report. With a slight limitation of taking actual reading of waveform of normal EKG and exercise test by a semi cardiologist at face value my interpretation is a little differrent.
1. I agree you do not have no resting EKG changes.
2. From a thirty four year old with overweight hypertensive person, I would have expected much more tolerance almost double the amount of exercise you performed in techinical terms not 4.7 METS but ABOVE 9 METS. As you did not develop chest pain or shortness of breath I believe one or both reasons for this exercise limitation to be true.
1. As you had achieved target heart rate may be anxiety and test was terminated.
and/or
2. You are not acclimitized of performing exercise or bluntly speaking your life style is sedantary.
One thing I agree with the amount of exercise you did and the fact you did not have chest pain or shortness of breath so the cause of your Chest pain (as asked in your original question) is not heart. So we are left with 2 risk factors of coronary artery disease for which you are advised to take treatment (Consult a cardiologist with reports, in India the degree which a cardiologist has to achieve to be legally called as cardiology is DM cardiology, I am sure there would be some in in private sector in Allahabad, while in Cardiology department of Medical college there ought to be someone otherwise I suggest a trip to SGPGI Lucknow where there are at least 6 qualified cardiologists- Diploma in Cardiology is no degree). Coming back to risk factors modifiable ones are:
1. Overweight and sedantary life style (your ideal weight should be below 78 KG maximum- that is more than 20% above the weight for your height as recommended to prevent cardiac disease-, and circumference around waist should be less than 100 cm and less than circumference around hip called waist/hip ratio). We are concerned with next 50 years of cardiac health so as I had suggested in my last mail we know TMT you can start exercise programme. Gastric problems winill take care of itself. No harm in taking some antacids available over the counter one and three hours after meals. Keep yourself upright for at least 2 hours specially after dinner (do not lie down immediately after meals for that promotes GERD and that appears to be the cause of chest pain).
2. Abnormally high bad cholesterol and components on your lipid profile. You need a statin and monitoring of liver function test and lipids periodically under supervision.

And if there is family history of heart disease you ought to be more conscious.

If you have any more question I will be happy to answer.
With Best Wishes.
Dr Anil Grover,
Cardiologist & Internist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)http://www/ WWW.WWWW.WW

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