Brief Answer:
I would explain as follows:

Detailed Answer:

Hello,

Welcome on HCM!

I reviewed your uploaded TMT report and would like to explain that the stress test result concludes a suspicion (?!) for exercise inducible ischemia.

TMT in your conditions would be a reliable diagnostic and prognostic tool if you have an intermediate pretest probability (based on age, gender and symptoms).

In other terms, if you haven't a history of at least atypical/probable angina pectoris or nonanginal chest pain, facing your actual age of 45 yrs (between 40-49); also if you have not any well known coronary artery risk factors (like hypertension, smoking history, a glucose metabolism disorder or diabetes, dyslipidemia, heredity for coronary artery disease) then your TMT conclusions couldn't be sufficiently reliable.

But if you have a history of suspicious chest pain and have any of the above mentioned coronary artery risk factors, then this TMT conclusions should prompt for further diagnostic work up.

In such case other imagine tests would be necessary for investigation possible cardiac ischemia, such as cardiac stress echo (using for example dobutamine, etc).

One rationale screening test for coronary artery disease in patients with intermediate pretest probability would be coronary angio CT, which could estimate the future risk for coronary events (by measuring overall coronary calcium burden); and also detecting possible coronary lesions.

So, to conclude and make it clear and easy for you, I would explain that everything depends on your clinical symptomatology and presence of coronary risk factors:

(1) If you are free of any suggestive symptomatology or risk factors, then nothing to worry to much for the moment. Just repeat a new stress test (TMT) after 6-12 months and continue a healthy life-style and diet.

(2) If you have experienced chest pain, or there is presence of coronary risk factors, it is necessary to further explore your coronary artery status by performing additional tests like cardiac stress echo or coronary angio CT.

You need to discuss with your attending cardiologist on the above mentioned issues.

In case of further uncertainties do not hesitate to ask me!

Wishing you the best for the New Year,

Kind regards,

Dr. Iliri

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Brief Answer:
My opinion:

Detailed Answer:
Hi again,

I carefully reviewed your lab tests results and I would explain as follows:

- You have a normal cholesterol level, but an abnormally low HDL-cholesterol (which his considered “good” cholesterol), also abnormally high triglycerides level; so you have dyslipidemia,

- You are a smoker (no mater you are using 3, 5 or 15 cigarettes/day; the harming effects are always present),

- You have a glycosylated hemoglobin (HbA1c) 5.7%, so greater than 5.6%. HbA1c level between 5.7 – 6.4% indicate increased risk of diabetes,

- You have a low vitamin D level, so probably you are over-weighed (over-weighed people frequently have low vit D level),

- You have an atypical pain (right hand), which could not be caused by uric acid of 6.8 mg/dl (which in fact in near upper normal borderline)

So, you have presence of coronary artery risk factors and atypical symptomatology. In such case, it is advisable to continue with the above recommended screening tests, like:

- cardiac stress ECHO,
- coronary angio CT
- or nuclear cardiac stress test (CARDIOLITE)

whichever is available in you reference (attending) medical center. In that way, it will be possible to give a more reliable conclusion on your coronary artery status and if a real cardiac ischemia is present.

Hope to have been clear in my explanations, nevertheless do not hesitate to discuss with me if you need further opinion.

Regards,

Dr. Iliri

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Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

Here are the answer to your questions:

1. Your total cholesterol is OK but your fractionated blood lipid profile is dis favorable. As I explained before you have high triglycerides and low HDL-cholesterol, so you have dyslipidemia.

2. A lot of physical activity and diet modifications (diabetic diet, reduce of sugar intake, reduce of saturated fat contained in fatty animal foods and increase in omega 3 rich food, such as fish oil,olive oil, nuts, plenty of vegetables,etc.) would help reduce your triglycerides and glycosylated hemoglobin.

3. A relation between muscle cramps and vitamine D deficiency could exist, if your plasma levels of calcium and phosphates result abnormal.

You need to be tested for these electrolytes (calcium, phosphorus) and parathyroid hormone plasma levels first, to come into a possible conclusion regarding this issue.

Nevertheless, you need to take vitamin D supplements in order to achieve vitamin D levels at least 30ng/ml.

X ray studies of your bones (mainly in the limbs) and bone densitometry would help examine better your bones and the possible changes due to osteoporosis.

4. Regarding sexual activity, I would explain that as long as during your stress test you have achieved a maximal theoretical heart rate and demonstrated good effort tolerance, there is no limitations to your sexual activity. You should know that for a satisfactory sexual performance, it is sufficient to achieve 4MEDs, which is not such a big physical effort.

Please let me know how things are going on.

You can ask me directly at any time for any other uncertainties at the link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Wishing all the best,

Dr. Iliri

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