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?
Dr. Roach says: Chest pain and palpitations — such as pounding, racing or fluttering heart — are common concerns that occasionally represent serious heart disease but often don’t. It’s 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 heart’s 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 “obese” 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 aren’t diagnosed. I would recommend a sleep study. Certainly I recommend careful checking of your blood pressure, and weight loss.
From a blood test, how can I tell if I am an insulin-dependent Type 2 diabetic? For instance, what would my insulin or glucose readings have to be? Secondly, at what point would I have to start taking medications?
Dr. Roach says: Diabetes is diagnosed with any of the following: hemoglobin A1c of 6.5 percent or higher; fasting blood sugar of 126 or higher; blood sugar during a glucose tolerance test of 200 or greater at two hours; or random glucose of 200 or greater in someone with classic symptoms. In Type 1 diabetes, insulin levels are very low, while in Type 2 they are normal or high.
Not everybody with diabetes needs medication. Many people with Type 2 diabetes can be well-controlled just with dietary modification and often weight loss, and almost everybody with diabetes can improve with a better diet. Medications usually are given if the A1c is much greater than 7 percent and if diet, exercise and weight loss efforts have been so far inadequate.
In addition, medication often can be stopped with better control through lifestyle. Insulin-dependent Type 2 means just that — insulin is being used, along with lifestyle and often non-insulin medications.
Except in very rare instances, everyone with Type 1 diabetes needs insulin.
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