Chest Pain Undiagnoised

[wilkison]

I'm a 34 year old female with a few concerns about my nuclear stress test, echo and cardiac catheterization discrepancies. A brief background on why I was given these test:  

I was admitted in the hospital for chest discomfort and an abnormal Ekg.  I was placed on zocor, Metoprolol and nitroglycerin patch while hospitalized. The first night I wasnt feeling well woke up at 1 am with the sweats and chest discomfort. I was given a blood thinner and other meds I began to feel better in about a half an hour give or take( to where I could get back to sleep).  

The following day I had the nuclear and echo gram test. The 3rd day I had chest discomfort  again and was given nitroglycerin and immediately the discomfort was gone (first time I ever had a nitro tablet). This happened twice in my 4 day stay in the hospital.

First told I had a cardiomyopathy because my stress test showed diffuse hypokinesis, stress fraction of 37% and resting fraction of 42%. But then I was told it wasn't my heart because the echo showed 60-65 ejection fraction ( it was done the same day as the nuclear test) and the cardiac catheterization showed 60% as well( done the day after).
However, the doctor said I had a right sided aortic arch and kinks in my left main artery  with  an inferior to superior take off. He said this was abnormal.
In my records it also showed she has S1, S2 and a 1/6  systolic ejection murmur with some radiation to her carotids bilaterally.

Is my nuclear test just disregarded? Why did the nitro work? Could this so called abnormality  be causing my chest pain? Why the fraction fluctuations? Sorry for all the questions, just in need of guidance
So I was released no medications. I'm confused and a tad bit concerned. Any input on what my next step should be would be greatly appreciated.


Thank you
Anastacia

[wilkison]

Thank you so much.! Yes the ventriculogram was used to determine the EF. You've completely at eased me on this resting EF.

Is consideration of  another stress test by another method to confirm or to exclude the  12% EF drop during stress applicable?

What should be  the next step if any for investing the kink(at take off) in my left main artery  with  an inferior to superior take off? All that I know is that the doctor is concerned about it and wants to investigate. Could that cause spasms and chest discomfort?

[CCF HeartMD6]

It is difficult to say why there is such a variability (37-42% vs 60%) from your nuclear test and your echo and LV-gram that was done during your cath. However, all three of these tests use different modalities in determining ejection fraction - some are done via a calculation and others done just done visually.  If the EF of 60% was reported during your cardiac cath (by a ventriculogram) - that would be the one I would rely on the most (as that has historically been the gold standard).