Mild cardiomegaly?

Several conditions can lead to enlargement of the cardiac muscles. The most common is an arrhythmia such as atrial fibrillation. You don't mention this, or it hasn't turned up on an ECG or a Holter or Loop recorder.

The enlargement is usually a compensatory mechanism. Just as one can lift weights and watch one's muscles grow, the heart will grow muscle tissue, myocardial tissue, to help it to do what it is supposed to do, but is being prevented....somehow. This is as yet unknown.

Thanks for your reply. It makes sense.

FWIW, I haven't noticed a significant arrhythmia. I get a flutter now and then (a few a week? maybe a bit more?), but nothing significant. I asked my cardiologist about the relative new fluttering six months ago and he said they don't really worry about it until it reaches some incredibly high percentage of beats. I don't remember the number, only that mine was nowhere near that. If it can happen without symptoms, it could be going on I guess. My Apple Watch has always indicated there's no problem, but that may not be worth much.

I have a high CAC score, but no blockages greater than 50%. I guess my fear is that my heart is being slowly starved of oxygen. I run/walk or bike three or four times a week for between 30 min and an hour each session. I try to get in a couple of weight lifting sessions too, but those are sacrificed for other things pretty quickly. I called my cardiologist and asked whether I should modify this routine at all. I expect I'll hear back in the next few days. He's already scheduled the echo related to an aortic anuerysm, so I guess that will go a long way toward a diagnosis.

Oof. The waiting is the worst.

The waiting AND the uncertainty cause anxiety for almost all of us.

About blockages, 50% ain't great, but it's not bad, especially if you're north of about 65 or so. My own father was about to have a hip replacement when workups showed he was 100% blocked in his right carotid (in the side of the neck, feeding the brain), and 90% blocked on the other side. The wouldn't perform the hip replacement until he'd had a vein stripped from his ankle and sewn into the left side as a bypass measure. She, Dr. Ginting, the vascular surgeon, said she wouldn't even try to bypass the right side....it was a goner.

The one artery that you don't want occluded more than about 60% (and not be on a remedial measure of some kind, statins, heart surgery for bypass...whatever they come up with) is the Left Anterior Descending, or LAD. That's the widow maker, or so they call it because so many men succumb to that blockage. Your occlusions are unknown to me, perhaps not to you.

You say you have the odd flutter. That can be: bowel gas (transverse colon runs high tucked up under the diaphragm, or it can be palpitations, which is usually a signal that you have atrial fibrillation. Flutter is very difficult to detect for most 'wearers', and it tends to stay in place once it develops. AF begets AF, so it's considered a progressive disorder. It almost always gets worse over time, sometimes evolving over just a couple of weeks. So, the wisdom is to get a Holter or Loop recorder in place, maybe for a whole week, hopefully a length that might catch an arrythmia if it exists, and get a record and a definitive diagnosis. From there, a good EP will have you on his/her roster and you could be ablated in as little as 10 days, although two months might be more realistic for the better EPs.

You are right ... the uncertainty isn't great either. 🙂

Thanks again for your helpful explanations. I didn't know that the flutter might be bowel gas. Interesting.

I am still a few years under 65. I have some level of stenosis in my LAD, but it's "minimal" and "calcified". My RCA has all the problematic stenoses. I hope I can avoid AF, though I gather it can be associated with a high CAC score.

Do I understand correctly that they bypassed the carotid? For some reason, I thought they scraped out those blockages. They bypassed the partially blocked artery?

Bowel gas, and also stomach gas. I have had a sensation in my chest wall that I was about to enter AF (a sensation that has about a 79% predictive coefficient in my body) leaned forward, and belched a couple of times. Problem solved.

I don't know about scraping, but it must be tricky that close to the brain where tiny clumps might be flushed downstream, toward the brain, and cause strokes. Better to take a healthy vein that looks 'much younger' and splint it into place. Yes, around the only artery that was still working.....some.