Brief Answer:
Cardiac ischemia is quite impossible.

Detailed Answer:
Hello!

Thank you for asking on HCM!

I understand your concern and would explain that it is quite impossible that your clear coronary artery view could have changed over a one year period.

Your relapsed chest pains are not of any cardiac origin at all.

So, you should relax and don't worry about it!

The only issue to be considered in your clinical situation would be your blood pressure. I would recommend you to closely monitor your blood pressure values for at least a couple of days (several times during the day) and re-discuss with your doctor the registered values for concluding if any antihypertensive therapy is necessary.

In addition complete blood count, fasting glucose and thyroid, renal, liver function tests should be done to assure that no secondary disorders are responsible for your high blood pressure.

You should know that, pregnancy may be sometimes a substantial trigger for a longstanding and even lifelong hypertension. Also diabetes as well.

Meanwhile (as you cannot continue Crestor because of breastfeeding) I would strongly encourage you to perform a lot of physical activity, modify your diet (preferably recommended Mediterranean diet) and try to relieve your anxiety.

Please let me know about your blood pressure monitoring results and additional lab tests for a direct review.

In case of any further uncertainties, please do not hesitate to ask me again!

Best wishes,

Dr. Iliri

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Brief Answer:
Every thing seems to be OK.

Detailed Answer:
Dear XXXXXXX

I carefully reviewed your uploaded ECG and lab tests.

I am glad to confirm you that there is nothing dangerous from your test results.

Your ECG is within normal ranges for a postpartum woman (remember that in pregnancy there are spatial changes i cardiac orientation and position, due to the increased intra-abdominal volume and elevated diaphragm). Your ECG is OK (no rhythm and conductance disturbances, no specific repolarization abnormalities, just a reflection of a slight change in heart position (which is quite a normal thing in pregnancy).

Your lab tests are within the normal ranges.

So you have nothing to worry about.

I can assure you that!

Hope to have been helpful!

Kind regards,

Dr. Iliri

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Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again XXXXXXX

I would exclude any cardiac disorders related to your symptoms.

Other causes to consider as possibly related to this symptomatology would be:


- a musculo-skeletal pain. Is your chest pain modulated by respiration or body movements? This would be indicative of a musculo-skeletal pain (just a little inflammation).

-gastro-esophageal reflux or esophageal spasms. Where is your pain located: on the left, on the right or in the middle of the chest? Where does it irradiate?
Have you tried taking an antiacid during the pain? If this helped reduce the pain, it would be indicative of one of these disorders.

-a cholecystitis. Do you have fever? Is your pain located on the right of the chest? This could indicate a gall bladder disorder (stones, inflammation, etc.).

-anxiety could also mimic all this clinical scenario.

I recommend consulting with your attending physician for a careful physical exam and some tests to determine the nature of your chest pain:

-chest X ray study
-abdominal ultrasound
-lab blood tests (complete blood count, PCR, sedimentation rate, kidney and liver function tests, blood electrolytes).

A fibrogastroscopy may be needed if suspicions of possible gastro-esophageal reflux are raised.

If all the above tests result normal, you should consider anxiety as the main cause of your chest pain.

Hope you will find this answer helpful!

Greetings!

Dr. Iliri

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Brief Answer:
Opinion as follows:

Detailed Answer:
Hi again, dear XXXXXXX

As I explained you before, it is quite impossible that your pain be explained with any cardiac ischemia.

Based on your symptomatology and already performed tests (especially coronary angiography) coronary disorder issue is excluded.

Coming to this point, I would recommend investigating other extracardiac potential causes of your recent complaints. You need to discuss with your attending physician (PCP or internist) on the alternatives I mentioned above and try a careful diagnostic work up to arrive to the right etiology of chest pain.

Regarding your blood lipid profile, it seems that dyslipidemia is present (increased LDL, total cholesterol, and triglycerides, decreased HDL cholesterol).

Rosuvastatin or any other statin would not be appropriate in such circumstances, as long as breastfeeding is present (risk for excretion with milk).

The only preventive management measures would be a strictly diet poor in lipids (saturated fats) and rich in fibers, daily physically active life-style, avoid all close smoking contacts.

Statins could be suitable alternatives in case there is no more breastfeeding or any other contraindications.

And remember to frequently check your blood pressure values until there is no trend for hypertension.

I remain at your disposal for any further question in case there are further uncertainties.

Kind regards,

Dr. Iliri

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