DEAR DR. GOTT: I am a 56-year-old female. I have, over the last two years, lost 60 pounds with your no flour, no sugar diet and exercise. My blood work is great (my cholesterol dropped 40 points without medication). I have, however, been having bilateral upper chest wall/muscular discomfort off and on for the last two years. After negative cardiac enzyme blood tests in the emergency room and a normal stress test, I was diagnosed with costochondritis (rib pain secondary to cartilage inflammation). I have no shortness of breath with activity, no radiating pain, nausea, or fatigue when I have these occasional episodes. The pain is normally reproducible when I press the area.

My question is, I have done research regarding the new technology of CT angiography, which some state is better than regular angiography, especially for women in detecting small vessel cardiac blockage. It is also said to be safer than traditional angiographs. For my own peace of mind, I was wondering if this would be a valid test for me to have, and if so, is it as good a diagnostic tool as a traditional angiogram, which is invasive and carries certain risks.

DEAR READER: I believe in your case, CT angiography (study of blood vessels and arteries) is redundant. This procedure is relatively new but has it drawbacks. It is generally considered more accurate than an MRI, is less invasive, more cost effective and less painful. Some drawbacks to the procedure, however, are possible allergy to the contrast material used or skin damage at the IV site and the contrast takes up to 24 hours to leave the body. It is not recommended for individuals with kidney disease or severe diabetes because of the risk further kidney damage. Individuals who are very obese may not fit in the CT machine. It is also not reliable for small, twisted arteries or vessels on organs that move quickly, such as the heart and blocked vessels or abnormal heart function make it difficult to interpret the results.

In the case of inconclusive or abnormal results, traditional stress tests or angiographies are necessary. Since you have already had a normal stress test, it is not necessary to have CT angiography at this time.

As for your diagnosis of costochondritis (chest pain caused by rib or rib cartilage inflammation), I believe this is correct. It can be mild or severe and the pain can often be reproduced by pressing on the affected area. This is not a life-threatening condition. Effective treatment includes the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Pain usually resolves in a few days with treatment but in some patients can last several months. Try using over-the-counter medications to treat the discomfort; if it persists, see your doctor who may choose to run more tests and prescribe a stronger medicine such as prednisone.

I also want to congratulate you on your weight loss. Stick with it and continue exercising. Good luck.