Chest pain with mild exercise

Leave a Comment

Submitted by Dr T on May 4, 2013 – 6:39pm

Dear Respected Sir
I am a Year 2 MBBS student and my dad is aged 59years.He is hypertensive and was doing well with 5Mg Amlodipine.(Norvasc).He is 96kgs/Height 174Cms. From the last 10 days he has been having chest pain which was more if he walked fast,it improved slightly with omeprazole.He has been on Etoricoxib 60mg from about 4 months due to arthritis.Before this he was taking Diclofenac Sodium from a eriod of 2 years.He is also taking Gabapentin 400 mg due to slip disc in c6. My dad did not want to visit a cardiologist as he claimis he dad similiar pain 30years ago. 
I forced him to see my professor in the hospital,A MRCP Cardiologist.The ECG was normal,he advised to come visit for a stress ECG.On doing the stress test,He started feeling pain at 4.5mins due to which test was stopped. The doctor advised to do an angiography and labelled the result as strong postive. He prescribed the following medicines: Clopidrogel 75mg,Bisoprolol fumerate 2.5mg,Aspirin 100mg,Atrovastatin 40mg.Amplodipine to be continiued. 
My dad has been in a state of denial and angry with me,he refiused to do the angiography and refused to take the medications,he calims that he is well and that I am trying to label him as diseased.He is being angry and sad. I have convinced him to take the other medication expect the beta blocker bisoprolol,he is takiing the Amplodipine 5mg. My question is whether the stress ECG can be false positive?Is there any other way to diagnose CAD non invasively. Is it Ok if he skips the Betablocker, His BP is controlled.It increased only while doing the strees till around 198 systolic. His right eye has been red from yesterday.Is this dangerous.(we did the stress ecg day before). 
I would like your expert advisein dealing wit this as I am extremely worried. Kindly reply at the earliest. Thank You for your time..
Hi Mamoon,
Your father has multiple risks for CAD that include hypertension and Obesity (with a BMI=31.7). His symptoms are suggestive of exercise induced angina and his stress test is strongly positive for CAD, confirming that his symptoms are heart related. Since his symptoms are recent I don’t believe he is a candidate for medical therapy alone, but should be considered for revascularisation, i.e. a stent or coronary bypass procedure (the latter usually preferable in patients with blockages in multiple coronary arteries.
Patients with extensive (“3 vessel”) disease that may include a “Left main stenosis”, diminished heart function and/or Diabetes do much better with a bypass operation. In situations where time is of the essence, such as an acute heart attack, a stent is may the best option if treatment is quickly enough. The same is probably also true for patients with only “one or two” vessel disease, although there are mini bypass operations that offer an equal if not superior treatment because it promises a much better long term protection. You can try different scenarios by taking this Patient Questionaire.
Hope this helps,

Leave a Reply

Your email address will not be published. Required fields are marked *