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Cardiac trouble
Name withheld
I am 78 and ailing from unstable angina since 1994. Presently I am taking Betacard 25 one tablet once a day and sobitrate 5 mg when pain is felt. There is no chest pain. But I feel the pain in the abdomen just below the last rib while taking a walk or while lifting something. If I take a 5 mg tab sobitrate sublingual the pain disappears. But my legs become clumsy/heavy and walking becomes difficult. My cardiologist advises me not to take sorbitrate too much. Before taking sorbitrate my BP was 140/90 and at times more. Now it is between 120/80 and 130/80. Can the present regime be continued?
Dr. P. Ramachandran, Senior Consultant-Interventional Cardiologist, replies:
Pain in the abdomen below the last rib especially while walking or lifting weight is called atypical angina. The clue to the disease is that the pain usually happens only after some exertion. The diagnosis of unstable angina is applicable when the pain in chest area happens for the first time; occurs at rest without any exertion; the pain lasts longer and responds less to rest and sublingual Nitrate; and post-CABG surgery or post-balloon/stent angioplasty.
You cannot have had diagnosis of unstable angina since 1994. Again age is not in your favour. Your intake of one tablet of Betacard 25 mg is far from adequate. Multiple classes of drugs are required to stem the disease. The best course for you would be to avoid walking soon after meals, walking with weights in hand or in a hurry. The sublingual tablet of Nitrate can be taken in a sitting posture and walking can be resumed after a while. Your cardiologist/physician will assess your current status and prescribe suitable drugs.
Name withheld:
My brother, 19, has Congenital Heart Disease. His diagnostic reports reveal the abnormality as Tetralogy of Fallot with infundibular and valvular pulmonary stenosis. Specialists examined him at the age of five. But surgery was not recommended. It was said that he should not strain himself. So far, there haven't been any complications. Can he lead a normal life without undergoing surgery?
Dr. P. Ramachandran, Senior Consultant-Interventional Cardiologist, replies:
Your brother must have missed the fun of childhood games and sports. This condition has four structural abnormalities, resulting in mixture of pure and impure blood in the body. The main defect is due to the narrowing and under development of the pulmonary artery in the lungs, the site of purification of blood. Such adolescents and adults cannot lead a normal life unless corrective surgery is undertaken. A recommendation not to do surgery at five years cannot be carried over till 19 years. Corrective surgery for Tetrology of Fallot is undertaken at a very early age with the body weight of about 10 kg. Fully corrected TOF kids can grow, study, work and get married and have children. Sometimes a second stage surgery is required along with the first to allow the growth of pulmonary arteries and the final surgery to correct all the defects. The surgery for TOF has progressed tremendously with very minimal risk and excellent outcomes. Please consult a cardiologist and cardiac surgeon with experience in "congenital disease surgery" and give your brother a chance to lead a normal life.
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