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Question:

My condition and history are complicated and high risk. Can you advise me how to proceed? 

I am a 67-year-old obese woman. My biological father and brother died of heart disease in their 60's. My mother died of congestive heart failure at 86. My mother's family also has a hereditary history of high blood pressure and high cholesterol, despite diet and exercise. As such, I have been on a statin, high blood pressure medication and baby aspirin for a number of years. The previous mentioned areas are under control. I eat a good diet and I have lost 60 pounds.

Unfortunately, during the past two years, I have been slowly losing the use of my legs and I can no longer walk without the use of a walker. I can only walk short distances before my legs give way. This eliminates most exercise, so my weight loss has stopped. I have been to many doctors and have had many tests, but no one has yet determined what is wrong with me.

I see a cardiologist yearly and have a stress test [now, a nuclear stress test]. He simply tells me that things are the same, but he does not define what the same is. In the past few months, I have developed constant chests pains while sitting and shortness of breath while moving. My doctor seems to dismiss these symptoms. I did not have them before I lost the weight. I want him to perform a catheterization on me as I cannot believe that I don't have heart problems. I realize that this is a risky procedure, but I would prefer warding off a stroke. Your thoughts?

submitted by Rose from Reisterstown, Maryland on 2/8/2014

Answer:

Deborah Meyers, MDby Texas Heart Institute cardiologist, Deborah E. Meyers, MD  

Rose,
I wanted to get back to you on your rather complicated situation. It is clear that you are very worried and are feeling very alone in your current situation. Let me summarize a bit. 

You are 67 and have a strong family history of heart disease and heart failure. You seem to have a number of risk factors for these problems yourself including family history, obesity, hypertension and elevated cholesterol . You and your doctor both agree that you are on good medications. You have even achieved a good weight loss. But despite this you now have developed new symptoms. You cannot walk- this may or not be related to your other problems. You have constant  chest pain and shortness of breath which seems to be increasing or of relatively recent onset, despite the medications and the weight loss.

Your stress test showed no changes. You feel that your doctor has dismissed your symptoms and your concerns. 

I am of the opinion that you may need to consider a few different options: Option 1) meet with your current doctor and tell him or her that you are worried  and that your symptoms are worsening despite the reassuring tests. Ask what your options are for further diagnosis of your symptoms.  Whether or not you choose  to have this conversation depends on your level of comfort with the doctor, and your level of comfort having a slightly confronting conversation at a time where you are not feeling the best. Your concern is not something you need to apologize for in any case.  Option 2) obtain copies of your test results and get a second opinion from another doctor that may be more open to addressing your symptoms afresh. 

We doctors are here to help you.  You have to be comfortable that you are being taken seriously and that your concerns are being addressed. Like in any relationship, things can go awry. Your job right now is to look after yourself the best that you can. 

Lastly, cardiac catheterization is a diagnostic test and the risk of stroke is small.  This test could potentially help define blockages in the arteries that may be missed on a standard stress test. I don't know what your weight is but at some centers with expertise,  diagnostic angiography can be done via the artery in your wrist and for very obese individuals this can be an easier approach. To further  clarify: This test will not "ward off a stroke" but can serve to  define any arterial disease and can measure pressures in the heart which can be helpful in defining reasons for your shortness of breath.  

I wish you all the best,   

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Updated February 2014
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Texas Heart Institute Heart Information Center
Through this community outreach program, staff members of the Texas Heart Institute (THI) provide educational information related to the prevention, diagnosis, and treatment of cardiovascular disease. It is not the intention of THI to provide specific medical advice, but rather to provide users with information to better understand their health and their diagnosed disorders. Specific medical advice will not be provided and THI urges you to visit a qualified physician for diagnosis and for answers to your questions.
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