Ischemia is a condition of the cardiac muscle precipitated by local mechanisms. It is not directly related to hypoxia in the systemic circulation, with the possible exception of rare and dramatic conditions of systemic severe hypoxia.
What is the difference between reading oxygen levels on an Oximeter and via an ABG blood test? Which is the best test or the best indication for INOCA patients?
The Oximeter reads the Oxygen saturation of circulating haemoglobin, that is the percentage of Hb bound to oxygen. ABG blood test provides much more detailed information on circulation arterial blood gases, including oxygen and Carbon dioxide concentrations, pH, Hb etc etc
Is Cadasil a known cause for INOCA?
CADASIL (Cerebral Autosomal Dominat Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a dominant autonomic disease associated with migraine, cognitive impairment, cerebral infarcts and eventually dementia. I am not aware of an association with INOCA
8.2% increased MACE over 5.4 years was recently reported by the WISE study – what does/could this mean for the significance of INOCA diagnosis/treatment for the future?
This observation further supports the notion that outcome of ischemic patients is dictated by extension and severity of myocardial ischemia more than by the mechanisms responsible for ischemia.
Is CMVD systemic or is it just in the coronary vessels?
This is a very important question with limited scientific evidence to support any answer. However, the physiology of the coronary circulation is so peculiar that systemic microvascular dysfunction (if it does exist) would have unique consequences in the coronary circulation.
Can Coronary Microvascular Dysfunction get better or will it just get worse?
Coronary Microvascular Dysfunction is a dynamic condition that can be stable or get better or worse in time, either spontaneously or in association with treatment. It has been reported that MD can resolve after a few months after an acute coronary syndrome.
Have you seen an increase in patients presenting with CAS/CMVD as a result of increased awareness?
I’m not sure that I have seen an increase in patients presenting with CAS/CMVD but we are in rather unusual times! Certainly before lockdown I had queried the diagnosis in several of my patients and sent them off to cardiology for investigation. I think it is more my increased awareness that has changed rather than the number of patients presenting.
Is it ok to have Vitamin D levels just above the lower limit of normal?
It depends! If you are just above the lower limit of normal and it is the start of the winter then I would be looking to optimise your level by taking a supplement as it is likely to drop further without strong sunlight exposure. If it is at the start of the summer months or you are expecting to go on a sunshine holiday and you will be spending lots of time outside then you will probably make enough vitamin D to optimise your levels. If for whatever reason you spend most of your time indoors or your skin is sensitive to the sun then you would be wise to continue a supplement of vitamin D all year round. Don’t forget that vitamin D is fat soluble and best taken with a meal containing some fat so it will be better absorbed.
What are the main symptoms of B12 Vitamin deficiency?
Vitamin B12 deficiency can affect every body system potentially. It is more common in vegetarians and vegans as it is mostly available from animal sources but also common in people taking certain medications which reduce its absorption from the stomach and anyone with malabsorption disorders such as coeliac disease or after gastric bypass surgery. I see patients presenting with all sorts of neurological symptoms like tingling, headaches, tremor, memory problems, dizziness, tinnitus, anxiety, depression and fatigue is very common.
What are the main symptoms of Vitamin D deficiency?
The common symptoms I find in general practice are musculoskeletal pains. But vitamin D is involved in so many other body processes, not just bone and muscle health. It has roles in the immune system, in blood sugar regulation, cancer prevention, it helps to reduce inflammation and is important in mental illness too. It is a factor in the development of osteoporosis and rickets in children if it is persistently very low.
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