Brief Answer:
I would explain as follows:

Detailed Answer:

Hello xxxxxx!

Welcome and thank you for asking on HCM!

I understand your concern and would like to explain that when judging on a possible cardiac ischemia disorder, it is necessary to consider all the aspects of clinical history; clinical symptomatology being one of the most important clues.

Do you ever have experienced episodes of chest pain or shortness of breathing?

Or any other complains, like heartburn, dizziness, etc?

As you have an impaired glucose metabolism (you are taking Metformin) an atypical clinical symptomatology for cardiac ischemia or even absence of symptoms at all (silent ischemia) may happen.

Fortunately your cardiac ultrasound doesn't reveal any evidence of myocardium damages. There is only mild concentric LV hypertrophy suggestive of a long standing hypertension.

Coming to this point, where multiple coronary risk factors are present (diabetes or glucose intolerance, hypertension, dyslipidemia, etc) and consequently the future 10 years risk for coronary events is not negligible, it is important to further investigate for possible presence of intra-coronary lesions.

A single exercise stress test would not be specific sufficiently (no pain or its equivalents are present, no clear evidence of the degree of ST depression) to confirm coronary disease in women of your age.

Not rarely a positive stress test for cardiac ischemia in women concludes with a normal coronary angiography, which is considered as X syndrome.

But to be more careful, as you have major coronary risk factors further cardiac imagine tests would be beneficial to discriminate cardiac ischemia.

- pharmacological stress cardiac Echo (dobutamine echo),
- provocative stress radionuclide tast (CARDIOLITE).
- coronary angio-CT

would be helpful clearly make evidences of cardiac ischemia and better stratify the future risk for coronary event.

I recommend you to discuss with your attending doctor about the above mentioned opportunities.

If these tests (any one of them) results positive, then it would be rationale to proceed with coronary angiography.

Hope to have been helpful to you!

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

Best regards,

Dr. Iliri

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Brief Answer:
My opinion:

Detailed Answer:

Hi again, dear XXXXXXX

Absence of specific clinical symptomatology is a promising outcome. So, you haven't any obvious exertional of resting chest angina.

But, as you have multiple coronary risk factors (mentioned above), it is recommended you check your future risk for coronary events, and also for the presence of actual signs of intra-coronary lesions.

It is sufficient to perform one of the above recommended tests, the most suitable for both reasons (prediction and actual diagnosis) would be a coronary angio CT.

I strongly advise you to properly control your actual coronary risk factors (hypertension, diabetes, dyslipidemia, etc) by following the underlying therapy, life-style modulation and a healthy diet, as in such way you would minimize the future risk for major cardiac and cerebrovascular events.

Kind regards,

Dr. Iliri

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