ASK THE DOC
Palpitation and chest pain
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Suggestions and advice from the cardiologist on our panel of doctors in response to readers' queries.
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N. Chalamaiah:
I am 48. I have CAD arterior wall MI anterior, thrombolysed on December 4 2004, with severe LV dysfunction. An angiogram indicated triple vessel disease. Doctors said that the pumping rate of heart is only 25 per cent. Unless the pumping rate improves no CABG can be taken up for the triple vessel disease. For the last five months I have been on medication only. No improvement in the pumping rate has been observed. But earlier I used to get palpitations with breathlessness. This does not occur now. How long should I wait for the pumping rate to improve and be ready for CABG? I have been using Covresyl,Imdur, Lasilactone, Cordarone, Lanoxin, Rosuvas, Ecosprin, Acitrom, Trika and Zaart one each day at the specified times.
Dr. V.V. Bashi, Chairman, CEntre for Thoracic and Cardiovascular Care, MIOT Hospitals, Chennai, replies:
You have sustained damage to the anterior wall of the heart and the pumping capacity of the heart is low. Since you have triple vessel disease, the blood supply to the healthy muscles of the heart is also much less than normal. Those patients with triple vessel disease and reduced pumping capacity of the heart derive maximum benefit after Coronary artery bypass graft surgery. By waiting on medications your symptoms have improved. This is an indication that you will improve with CABG. Your operation should be done without much delay and should be performed by a senior surgeon experienced in handling difficult cases. After surgery, your quality and quantity of life will be improved with fewer requirements of medications.
S. Radhakrisnan
I am a HT patient. I underwent a master health check up and found that I have MVP and fatty liver. I was advised to take Ecosprin 75 mg and Clopilet 75 mg and Atenolol 50 Mg for hypertension. I was also advised to take Udilive 300 mg daily 2 tab. Kindly enlighten me about the additional tablets to be taken. Will there be any side effects?
Answer: MVP means mitral valve prolapse. This is a weakness in one of the left-sided valves of the heart and normally observed in two per cent of normal population. If it is not associated with major leaks in the valve, palpitation or breathlessness, this does not require any treatment. Fatty liver means excessive deposition of fat in the liver and this does not need any specific treatment. Since you are a hypertensive patient you have to continue Atenolol. The tablets Aspirin and Clopilet are given to patients with coronary artery disease for thinning the blood. None of the reports you mentioned shows that you need those medications. Tab. Udilive also is not necessary unless trigylcerides in the blood is high.
Mathanur B. Senthil Kumar:
A couple of weeks back my uncle experienced a light pain in the heart. An ECHO test was taken and we were told that Angiogram test had to be done. After the Angiogram, the doctors said that there is a small block in the left vessel. They gave us a CD. They told that we have to do Angioplasty. When the same CD was given to some other doctor he told that there is nothing wrong in the test and every thing is fine. Why is there such a difference? What should we do?
Answer: I had a few patients coming to me with the same problem. Blocks in the arteries are assessed by the angiogram and the interpretation of the degree of block is done by visual as well as geometrical calculation in the latest machines. The degree of block interpreted by two persons can vary to a small extent, but not so much as you have mentioned. If the block is in a small vessel you may not need angioplasty. If it is in a larger vessel you will require angioplasty. My advice is to undergo another test called stress thallium, which will show the amount of involvement of the heart muscle with ischemia. If the area of ischaemia is small, you can continue with medical treatment. If the area of ischemia is large and a large vessel is narrowed angiographically you should consult your cardiologist regarding angioplasty.
M.C.P. Sinha:
I am 65. I suffered myocardial Ischemia at 32 years (1972). I was on Inderal-40, Atromid-s and Peritrate(sos)for 2-3 years.For 30 years I led a very active life and never had any problem.About two years ago (Oct '03) I felt heaviness in the chest and weakness with increase of B.P. on walking, which remained for about a month. My ECG and 2-D Echo is normal and TMT +ve with 98 percent of THR attained. Iam on Atenol-50,Ecosprin-150 and Atorva-10mg and leading an almost normal life. I walk three km every day. One doctor suggested immediate Angiography/Angioplasty whereas another suggested that I continue the usual diet, exercise and above mentioned medicines. I am a vegetarian, teetotaller, non-smoker, non-diabetic, slim and tall but having moderate high lipid profile. Should I undergo angioplasty or not?
Answer: You have a long history of heart disease, which is slowly progressing. You had heaviness on walking and your TMT is positive. So my advice to you is to undergo a Coronary Angiogram. This is only a diagnostic test to find out blocks. After seeing the reports it can be decided whether you need medicines, angioplasty or bypass surgery. There is a misconception among people that if you undergo angiogram you have to undergo angioplasty or bypass surgery. So I want to emphasise that coronary Angiography is only a diagnostic test like x-rays or blood tests and it is not a treatment.
R.M. Sivaraman:
I am 50. My lipid profile shows: Trigylcerides: 373 mg; HDL: 31 mg; LDL: 103 mg; Total Cholesterol: 209 mg. I want to know if there is any risk of heart attack? How can I reduce the triglycerides? What are the foods I should avoid and should I take any medication?
Answer: From the lipid profile alone one cannot predict the total risk of heart attack. Other risk factors are smoking, diabetes, hypertension, obesity and family history of heart disease. In your case trigylcerides is markedly elevated as compared to other fractions of cholesterol. The most common reasons for high triglyceride level are diabetes, consumption of alcohol and or genetic causes. If you are a diabetic, proper control is necessary. Avoid consumption of alcohol and deep fried dietary items. If the Triglycerides remain high you would require Tab. Gemfibozil in consultation with your physician. It is prudent to do a Treadmill test since you are middle aged and your lipid profile is abnormal.
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