Brief Answer:
I would explain as follows:

Detailed Answer:
Hello Connie!

Welcome on HCM!

I passed carefully through your medical history and would like to explain that it is necessary to perform a differential diagnosis of your chest pain.

First of all, it is necessary to delineate the real nature of your chest pain (whether its is influenced by positional changes, breathing, coughing, etc.)

If the pain is influenced by the above conditions, then it is less likely to be cardiac ischemia related. In such case, another alternative should be sought.

Also, it is necessary to investigate the age of the bifascicular block (RBBB & LAFB) on your ECG. If this ECG finsing is new and related to the appearance of chest pain, then it raises high suspicions of a recent cardiopulmonary disorder.

Coming to this point, I would refcommend performing the following tests:

- cardiac ultrasound (ECHO),
- chest X ray study,
- cardiac enzymes (CK-MB, Troponn I),
- exercise cardiac stress test

In case a cardiac ischemia is suggested by the above tests, then:

- a coronary angio CT,
- cardiac stress ECHO (dobutamine),
- or nuclear perfusional cardiac stress test

would clarify the cardiac ischemia issue and would give a strong recommendation for proceeding to coronary angiography (coronarography).

Otherwise, if elevated pulmonary artery systolic pressure and dilated right heart chambers are detected by ECHO, then suspicions on pulmonary embolism are raised and a ventilation/perfusion lung scan or pulmonary angio CT would be the next rationale diagnostic approach.

I recommend consulting with your attending physician on the above mentioned issues.

Hope to have been helpful to you!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

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