Heart symptoms from Colitis?

Hi all, haven't posted for a long time - UC has been pretty well under control the past few years and nothing in that department has changed at all recently but....

The past few months I've had some minor pain in the chest area with some shortness of breath.
-EKG showed Left Bundle Branch Block (which was not there on a 2017 EKG) - nuclear stress test recommended
-Nuclear stress results were 'abnormal' and showed an area of the heart receiving less blood than it should
-Saw a cardiologist who described what I'm experiencing as angina and recommended angiogram to assess possible blockage/coronary artery disease
-Had the angiogram today and there is zero blockage - none at all (in fact the cardiologist described the blood vessels as 'pristine' which I thought was an odd choice of words, but there you have it)

So the cardiologist said my next step should be to see my GI to rule out UC and any effects that it might have on the heart, stomach, or upper GI as the cause of the angina.

Which brings me to my question....

I had never heard of any effects that UC has on the heart or upper GI so I asked the cardiologist to clarify if he was maybe talking about Chron's (which I did not have as of my last endoscope a few years ago). He said no he wasn't talking about Chron's but about certain effects that Colitis can have on either the stomach/esophagus or heart/lungs.

Does anyone know what he may have been referring to and specifically what conditions it is that he's expecting my GI doctor to rule out?

Thanks for any input here, I'm just trying to get prepared to talk to my GI doctor about it and maybe help point him in the right direction.

By definition, UC is inflammation limited to the large intestinal portion of the digestive tract. However, there are a variety of extra intestinal manifestations (EIMs) documented.

How can UC affect the heart? It's mostly in broadly vague ways that are a little hard to pin down through tests. There also might be some misunderstanding with this cardiologist in what UC can/cannot due (like UC causing Esophagus or stomach inflammation which it cannot). UC causes inflammation of the large intestine and inflammation elsewhere in the body is possible as an EIM (joint pains are joint inflammation, sinus inflammation, eye inflammation uveitis, etc etc). It is collateral damage from an immune attack targeted at the intestine, but the White Blood Cells, and other immune cells are circulating body wide during their journey. Immune cells are certainly on high-alert and might attack elsewhere. We tend to clot easier as UC patients, and are more prone to big vein clots like DVT or Pulmonary Embolism. Our blood work can be abnormal in expected and unexpected ways (some of which explain the likelihood of clotting, and other things of that nature). Certain medications, like mesalamine/5-ASA can cause heart inflammation in rare incidents (such as your Apriso) causing medication-induced Myocarditis/Pericarditis which is listed on that medication's informational insert. Beyond that, I am not sure what this cardiologist is referring to.

So, certainly as far as inflammation or clotting within the heart go, having UC or the medications you take for UC might have low odds of complications to your heart. There are of course other explanations to your heart symptoms, and those should likely be explored as well.

Certainly that is an interesting point, and I'd encourage you to report back on what your gasteroenteroligist shares about this when next you meet him/her.

Did some searchng on http://scholar.google.com/ for UC and heart complications.

Chronic inflammatory bowel disease and cardiovascular complications - 2006

Abstract
The most common extraintestinal manifestations of Crohn's disease and ulcerative colitis are iritis and uveitis, primary sclerosing cholangitis (PSC) and nodal erythema and pyoderma gangrenosum. Complications within the cardiovascular system seem to be uncommon, but there are no systematic investigations concerning the epidemiology of these manifestations. There are more than 100 cases reported about pericarditis and perimyocarditis in patients with inflammatory bowel disease. Other patients with Crohn's disease or ulcerative colitis suffer from vasculitis, representing a further mechanism of inflammatory diseases of the cardiovascular system. There are several case reports showing a combination of Takayasu's arteritis and Crohn's disease, and cross-reacting antibodies against gut mucosa and aortic tissue were found. Some patients developed thrombotic complications by activating the coagulation system, which can result in atrial thrombi, embolism of the pulmonary arteries, myocardial infarction and disseminated intravascular coagulopathy (DIC). Furthermore, a few case were reported about atrio ventricular blocks, amyloidosis of the heart, dilative cardiomyopathy and endomyocardial fibrosis in patients with chronic inflammatory bowel disease. Here, a 27-year-old patient with known ulcerative colitis for 2 years is reported, who presented in the authors' department with unstable angina pectoris. Coronary angiographic examination was immediately performed and diffuse intracoronary thrombi were found, which could be removed by the catheter procedure. A myocardial infarction did not develop. Because of positive anti neutrophil cytoplasmic antibodies (p-ANCA) a p-ANCA-positive arteritis of the coronary vessels with intracoronary thromboembolism due to ulcerative colitis was diagnosed. Systematic studies or investigations concerning the epidemiology of the cardiovascular complications are still lacking, so that an overview about the published data is given.

(unfortunately the rest pf the article is behind a payment gateway)

Source: https://europepmc.org/abstract/med/16802521

Anything medicine-induced clears within 48-hours of ceasing it. Mesalamine clears fast from the system as it's 90% topical.

I'm 53, not so scared at point since my cardiologist said he didn't see any imminent danger based on the results of the (conventional) angiogram and I do think he's a very good doctor so I trust that.  I am pretty confused though as to why he said the next steps are to see my GI, an ENT, and possibly a pulmonologist rather than doing other tests for other possible heart conditions.

For what it's worth, this is the write up on the nuclear stress test, my cardiologist explained it basically meant there was an area of the heart that was not getting enough blood flow to it and it was the area associated with the left anterior descending artery.

PROCEDURE:
Myocardial perfusion scan.
Resting dose is I11.6 mCi of Te-99m sestamibi. Stress dose was 32.1 mCi of Te-99m sestamibi.
Calculated ejection fraction is 56%. Transient ischemic dilation score is 0.94.
RESULTS:
There appears to be a small anterior septal wall motion abnormality. There appears to be a
small, anteroseptal perfusion defect in stress imaging, not seen on rest. This appears to be a small
area of ischemia.
CONCLUSION:
Probably abnormal nuclear stress test with ischemia versus artifact.