Umberto (Gary) Fontana, MD

The short answer is probably. The likelihood of coronary artery disease depends on your age and risk factors and when the pains occur and the quality of the pain. Classic heart pain is a supply and demand problem and made worse with activity and relieved with rest. It is a pressure or fullness. It is usually not sharp or burning. Angina or heart pain is potentially life threatening. There are other conditions like esophageal spasm, reflux, peptic ulcer disease, hypertension, aneurysms all can cause chest pain that may also need treatment.

Potassium and magnesium have some anti arrhythmic properties. Avoidance of stimulants such as caffeine is helpful in some patients. There is a comprehensive review of supplements used in traditionally Eastern medicine (Biomed Research International 4/2017) which documents the published literature on compounds like Beriberine, Ginkgolide, Omega 3 FA, Resveratrol and there is documented suppression of arrhythmias. There are also the potential for pro arrhythmias i.e. potential for causing worsening (sometimes fatal). The products commercially available are of different potencies depending on the manufacturer. When Cardioligists titrate traditional anti arrhythmic, medicines we will check drug levels and EKGs, initially on a daily basis. I would discourage the use of these products unless they are produced by a reputable, preferably American based company and with proper medical supervision (i.e EKG and rhythm monitoring). Hope that was helpful!

As a rule, the heart fills about 1/2 the total lung space (cardiothoracic ratio is normally 0.5). Magnification can alter this measurement. It is a rough estimate but if there is a suspicion for an enlarged heart (hypertension, heart failure, etc) an echocardiogram accurately assesses the heart dimensions. Hope that helped!

Atrial arrhythmias May be exacerbated by electrolyte abnormalities such as hypokalemia and hypomagnesemia. It is reasonable to supplement with Mg and K unless you have kidney disease.

“Heart disease” is a risk factor for severity of Covid illness. However, it was unclear whether congenital heart disease was or not. In a retrospective study published is the Journal of the American College of Cardiology in 12/2020, 1044 patients who had various forms of congenital heart disease and contracted Covid. The study concluded that patients who were the most symptomatic (shortness of breath and exercise intolerance) and those that had cyanosis (shunting of blood from the right side to the left because of high pulmonary pressures) had the highest mortality of 2.3%. This is in comparison to an overall US mortality of about 0.7%. Hope this was helpful!

SVT can be triggered by exercise, stress and lack of sleep. It is conceivable that people who are claustrophobic might be under higher stress triggering SVT. Other triggers stimulants, alcohol, meds (thyroid meds, bronchodilators, etc). Hope this was helpful!

There are a number of potential causes for that constellation of symptoms in a young person. In addition to a thorough history and physical exam, a panel of lab work (CBC, BMP and see rate), an echocardiogram and stress test may be part of the work up.

Pectus excavatum is a congenital malformation of the breast bone more common in males and can appear more severe during the adolescent growth spurt. It can cause chest pain, shortness of breath, exercise intolerance and palpitations. It can be associated with connective tissue diseases like Marfan’s and Ehlers Danlos. It can make one self conscious about one’s appearance. It can be surgically corrected. If that would something you would like to discuss, would have your PCP refer you to a thoracic or cardiothoracic surgeon. I hope this helps!

Stabbing chest pain is usually related to arrhythmias (Afib, PVCs, PACs), musculoskeletal pains or pain from inflammation of the sac around the heart or lungs (pericarditis, pleurisy). Rarely, it is related to lack of blood flow. With your history, it is likely related to a rhythm issue. Your cardiologist may want you to wear a monitor if symptoms are significant or frequent. Hope this was helpful!

Myocarditis is as the name implies inflammation of the heart muscle. It is caused by viruses, toxins, chemo drugs, and auto immune diseases (lupus, Rheumatoid Arthritis). It is marked by heart failure symptoms, arrhythmias, chest pain and sudden cardiac death. Diagnosis is made by echocardiogram, MRI, elevated heart muscle enzymes (troponin) and invasively by biopsy. Outcomes are related to the severity of symptoms (heart failure), presence of arrhythmias, need for mechanical support (left ventricular assist devices, etc). Most patients are treated with heart failure medications (beta blockers, ACE inhibitors) and make a full recovery. Follow up echocardiograms are performed in 1 month, 6 months and a year to document recovery. Hope this was helpful!

After a heart attack there is a healing process that ensues. I assume you had a heart cath and balloon and stent to open up the artery. Return of blood flow reduces the damage ultimately but temporarily the showering down stream of blood clot and inflammatory molecules can cause “stunning” of muscle cells and cause reversible dysfunction. Certain medications reduce the likelihood of “negative remodeling” or a healing process that puts strain on the surrounding undamaged muscle. These include beta blockers, ACE inhibitors and statins. Modest exercise and a heart healthy diet rich in anti oxidants is also advisable. Hope this helps!

An EKG is reflective of a steady state. Unless you have had a heart attack you may have a normal EKG at rest. Provocative test like a treadmill stress increase the sensitivity of picking up a blockage but a treadmill stress test is only 70% sensitive (30% are missed). A stress nuclear or stress echocardiogram improves the sensitivity to 80-90%. Hope this helps!

Actually a low heart could be a good thing! High vagal tone is seen in marathon runners and cyclists because of aerobic conditioning. Their resting heart rates can be in the 30’s and 40’s! If you are not a marathoner a low heart rate could be a result of medications for high BP (beta blockers, calcium channel blockers and Clonidine) or indicative of a failing natural pacemaker of the heart , the sinus nose. This so called “sick sinus syndrome “ can cause fatigue, shortness of breath, dizziness and syncope (passing out) and may require a pacemaker. Hope this helps!

The goal of revascularization is to relieve all ischemic symptoms (angina). If you are having similar symptoms to pre balloon/stent, it could be due to trapping of a side branch, distal spasm or distal embolization. You need to discuss these symptoms with your cardiologist. There are benign causes as well such as so called “stretch pain” but this is transient. Hope this was helpful!