Hi doctor, I am a 45 year old male. My weight is 96 kg and my height is 184 cm. My symptoms are breathlessness on exertion, neck constriction while walking, as well as on and off chest pain in the mornings that are unconnected with exertion. I am also suffering from severe sleep apnea. I had TMT positive 8 METs, 6.3 minutes and ST depression of 2.5 to 3 mm in inferolateral leads. I underwent coronary angiography last week. Fortunately, no significant blocks were found. Doctor said many small blocks are there, which do not restrict the flow of blood. The diagnoses are minor coronary atherosclerotic disease and systemic hypertension. The report says only minor plaques in LDA and LCX. Does this mean angiogram is negative, I mean normal? If so, are my symptoms non-cardiac in nature? Can I ignore further chest pains? Or where should I go to treat them? Am I right in thinking that this report means I am unlikely to have a heart attack at least in near future? What are the chances that these minor plaques may progress and become bigger or serious? How will I know if and when the blocks become bigger; since my stress test was already positive, false positive? Is systemic hypertension the same as high BP? My BP was only 130/80 at the hospital. My home BP machine often gives 150-160/90. How did they diagnose systemic hypertension? Being a wonderful doctor I need your help again today.
Hi. I am really thankful for your kind comments. You have always been so nice and a health conscious person. I want to assure you do not worry as everything is going to be fine soon. I have thoroughly gone through your case and can well understand your genuine health concerns. Thanks for attaching the supporting documents (attachments removed to protect patient identity) for a thorough insight on the issue. You had an unremarkable angiography. It was a very good and a bold decision to go for a timely angiography. I appreciate that you did as advised. Now at least we have got a direction to move on. Now I will reply every part of your query in the order.  The report actually means that we do not need to go for angioplasty or stent placement or CABG (coronary artery bypass grafting - bypass operation) today. But it does not give any guarantee for future. You need to adapt a good lifestyle. Keep the hypertension in control. Take a good healthy diet. Do proper physical activity on a regular basis. You have to keep your lipids and cholesterol in limits too. This is the meaning of all what is written in your angiography report. If not controlled right now and not taken good care of, it may lead to enhanced and widespread coronary artery disease and may lead to blockage of vessels in the years to come.  Yes, ignore the chest pains. They are nothing and will not pose any harm right away. You need to act upon my advice rather to remain healthy forever. There are least chances for a heart attack right now, but I have explained about the future consequences of the issue if not handled with care. These minor plaques may get definitely big problems if not dealt with care. Let me explain a little more about arteriosclerosis so that you may get better insight. Hypertension makes the arteries stiff and they cannot expand in case there is a need for some increased blood flow through them.  No definite answer for future events as it will all depend on medical and personal care. Your blood pressure, lifestyle and diet will all be the main determinants. But if you feel unexplained weakness, tiredness, sleepiness even with a good sleep, restlessness, difficulty on exertion first and with passage of time difficulty in breathing even without exertion; it all means that, you have a bigger issue with the coronary arteries. Your stress test was not 100% false positive. It had some relevance and clinical significance. It is called early stage of coronary arteriosclerosis manifestations.  Systemic hypertension is a word to differentiate it from other hypertension like portal hypertension. And, yes it means the same as you said the high blood pressure. Hypertension is one of the main causes of the coronary artery disease especially when there is no other major contributing factor. Also they have had monitored the blood pressures during the angiography and also during indoor stay in hospital. Mainstay of treatment is lifestyle modification as aforementioned. Keep away from smoking and alcohol. For further information consult a cardiologist online.--->