Brief Answer:
My answer as follows:

Detailed Answer:
Dear Mr. XXXXXXX

I passed carefully through all your uploaded medical tests and would like to conclude that you are actually suffering from ischemic cardiomyopathy, which is a consequence of all previously experienced cardiac muscle damage, due to cardiac ischemia.

These conclusions are supported in an excellent evidence by the cardiac MRI report. It shows chronic changes in the inferior, inferio-septal and inferio-lateral walls, but fortunately the rest of the cardiac muscle does not show any evidence of acute cardiac ischemia.

In addition, your systolic cardiac function is slightly imparied (LVEF around 47%).

The above findings coupled with results of Holter monitoring may conclude on the probability of a possible complex ventricular arrhythmia as a reason of your fainting.

Nevertheless, these complex ventricular arrhythmia could only be hypothesized, because the Holter monitoring revealed only extrasystolic ventricular ectopy. But what is more suggestive of the arrhythmogenic propensity is QTc interval prolongation (which is an optimal environment where life-threatening cardiac arrhythmia may occur).

Another possible alternative of fainting is of course arterial hypotension, due to the abrupt and not escalating anti-hypertensive dose increase. This could be simply confirmed if someone measured your blood pressure during those unpleasant moments.

First of all it is necessary to review again your anti-hypertensive daily schema and if those episodes of fainting or syncope reoccur, to undergo a more prolonged ECG monitoring such as loop recorder.

In addition, I would also recommend performing some blood lab tests including
- complete blood count for anemia,
- thyroid hormone levels for thyroid dysfunction,
- blood electrolytes for possible imbalance.

Hope to have been helpful to you!

I remain at your disposal for any other questions, whenever you need!

Kind regards,

Dr. Iliri

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Brief Answer:
I would ecplain as follows:

Detailed Answer:
Hello again!

Regarding your last questions I would explain as follows:

1) Cardiac MRI has shown it clearly that those myocardial defects correspond to previous infarcted areas and that no current acute myocardial ischemia is present.

This is a very reliable test and has definitely excluded the possibility of new myocardial damages. In addition, conclusions regarding myocardial kinetics abnormality (previous MI location corresponding to LCX territory) are quite concordant between cardiac MRI and cardiac ECHO.

Furthermore, if a new cardiac ischemia event would have occurred, a significant clinical symptomatology would be evident.

2) I would not go in favor of calibration errors of those utilized medical devices (it would be quite impossible with the current technology), but rather conclude on the different inherent measurement accuracy offered by cardiac ECHO and cardiac MRI.

It is true that cardiac ECHO suffers from inter-observer and even intra- observer variability (when the test is repeated in different times by the same examiner it may yield some slight variations).

BUT, cardiac MRI is very accurate and quite superior when compared to cardiac MRI in estimating cardiac function (including LVEF) and several other cardiac performance indexes as well. At the end, 47% to 50% is not any big difference and the clinical judgment based on those values is the same.

3) To definitely answer the third question is necessary to perform all the above mentioned medical tests (including an accurate and prolonged cardiac rhythm investigation for excluding any already undetected life-threatening cardiac arrhythmia).

Meanwhile, you may follows a normal healthy life (avoid any possible coronary risk factors like smoking, control high blood pressure, avoid fatty and spicy foods profile, control your body weight, etc.) but it is advisable to avoid very strenuous physical exertions like competing sports.

You may have a normal sexual life (without any limitation) as your overall clinical conditions are quite satisfactory.

Hope to have clarified your uncertainties!

I remain at your disposal in case of any further question.

Regards,

Dr. Iliri

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