Dear Dr. Roach: I am 26 years old, 6 feet, 3 inches tall and weigh 290 pounds. About two years ago, I had chest pain and palpitations. I saw a cardiologist, who performed an echocardiogram. It showed mild LVH and mild pulmonary hypertension. I had multiple EKGs, and my doctor says I have a clean bill of health. Are any of the symptoms I have dangerous, or am I overreacting?
Dear J.A.: Chest pain and palpitations are common concerns that occasionally represent serious heart disease, but often donít. Itís estimated that the average person has 500 or so abnormal heartbeats a day, and these can be felt as palpitations. Chest pain should raise the concern for angina caused by heart blockages, but that would be extremely unusual in a 26-year-old.
The concern I have in hearing about your echo results is that they could represent obstructive sleep apnea. Left ventricular hypertrophy (LVH) is the heartís response to chronic stress, especially to elevated blood pressure, which is common in sleep apnea. Pulmonary hypertension has many causes, but in someone very overweight (your body mass index, BMI, is 36.2, where ďobeseĒ is defined as over 30), I have to be concerned about chronic low oxygen to the lungs. There are many people with sleep apnea who arenít diagnosed. I would recommend a sleep study. Certainly I recommend careful checking of your blood pressure, and weight loss.
Dear Dr. Roach: I am an 85-year-old woman living in a nursing facility. A little before my arrival here, I began experiencing night sweats. I have seen my doctor regarding this, and he said he cannot help me. I feel weak when I wake in the morning, and I need to constantly change the towels I put under myself. This is a big concern.
Dear A.M.: I take night sweats seriously. Tuberculosis is the classic cause of night sweats, which is of immense concern in a nursing facility, where most people are tested for TB yearly. But other chronic infections, high thyroid levels and even blood and marrow diseases like lymphoma can show up with night sweats. Most of the time, a chest X-ray and blood tests, along with a careful exam, can make the diagnosis. Other times, itís harder to find. More often, it goes away as mysteriously as it came. But it is worth another look.
Dear Dr. Roach: In December of last year, I had a stent placed in one of my heart arteries.
The doctor called it the LAD. Is that the main heart artery?
Dear R.T.: Two heart arteries branch off from the first part of the aorta. Those two arteries are the right coronary artery and the left main coronary artery.
The left main artery then divides into two other arteries: the LAD ó left anterior descending ó and the circumflex. These arteries supply the left side of the heart with blood. The main pumping chamber is on the left side of the heart.
The left main coronary artery and the left anterior descending arteries are the two most important heart arteries. Actually, all the heart arteries are important.
Email questions to ToYourGoodHealth@med.cornell.edu.