George James, M.D.

Thank you for the question. A carotid Doppler is a simple non invasive test that uses ultrasound technology to evaluate, in your case, the vascular structure of the carotid artery (which is the artery that carries blood to your brain). The test will give you the following information: A) size and diameter for the vessel; B) if there is evidence of narrowing due to plaque or evidence of tears in the layers of the artery or thickness of the muscular walls that can lead to narrowing (called fibromuscular dysplasia). These are the main purposes of a carotid Doppler study.
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In any person who does not have hypertension, it is normal for the blood pressure to rise DURING any exercise. However, if one has been diagnosed to have HYPERTENSION, it would be prudent to have ones blood pressure response during exercise be evaluated. Your physician can perform a routine treadmill exercise stress test and monitor your BP response during AND after exercise. One can have a ACCELERATED or higher than normal rise in their blood pressure DURING exercise, which would indicate inadequately controlled hypertension. The blood pressure is usually 10-15 points LOWER, after one exercises.

Anxiety can give a person a sensation of palpitations primarily due to an increase in the heart rate. Occasionally, it can cause a “slipped beat“ or PVC. However, the converse is also true. One MAY have an underlying problem with the electrical system of the heart, causing the heart to beat faster (regular or irregular), which in effect will give the person a sensation of anxiety. A classic case of “chicken V’s egg." A simple app two hours would be to have a heart monitor applied for a period of time, which would allow your cardiologist to determine cause or effect!
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The answer is normal clothing. If you have any metal on your chest it will be removed prior to a CTA (such a jewelry) primarily so as not to cause any artifact. Plenty of water and hydration before the study as they will use IV contrast during the CT angiogram. Other precautions: One should not be allergic to IODINATED CONTRAST and the kidney function should be normal prior to any contrast exposure.
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Hyperthyroidism is associated with a higher incidence of arrhythmias. The commonest is a higher than normal resting heart rate (simply referred to as sinus tachycardia). However, it can also cause other atrial arrhythmias such as atrial fibrillation. A very high heart rate of left untreated could lead to what we refer to as a tachycardia mediated cardiomyopathy (progressive weakening of the heart muscle leading to a decline in the heart function), which is very often reversible when identified and treated properly.
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That is a very broad question. The short answer is, there are MANY a number of cardiovascular conditions that are genetically passed on to siblings and run in families, BUT NOT ALL cardiac conditions are “hereditary.“ One would have to very specific of the diagnosis in question for a cardiologist to answer the question about genetic predisposition.
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It is not normal for a 40-year-old otherwise healthy individual to have an audible heart murmur. There are certain conditions that can cause a physiological murmur which may be normal in an adult (more so heard in conditions like severe anemia/hyper-thyroid states/pregnancy to name a few). I would recommend you see a good clinical cardiologist and undergo a physical evaluation and this MAY lead to an echocardiogram.

By "normal echo," you must mean that her ejection fraction as reported is normal and that no significant valvular heart disease was noted on the echocardiogram. Shortness of breath can be either due to her heart, her lungs, or a combination of both.

If we are to assume that she has no issues with her lungs, a "normal ejection fraction" does not rule out heart related causes of shortness of breath. One of the often missed or under recognized but very common causes of shortness of breath is what is referred to as diastolic dysfunction. Putting it simply, how "complaint" is the heart or how "stiff" has the heart become over time. As we age and with other risk factors, the heart becomes less complaint and it is the commonest cause of shortness of breath and cause of heart failure what we now refer to as Heart Failure With Preserved Ejection Fraction (HFPEF).

Secondly, severe coronary artery disease can often present just as shortness of breath with exertion in the presence of normal ejection fraction (although over time the ejection fraction will slowly decline).