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Has SOB, Pressure And Heaviness In Chest, Light Headedness And Weakness. No Chest Pain. Worrisome

Posted on Tue, 14 Aug 2012

Question: Husband has SOB,pressure and heaviness in chest. No chest pain. heart rate 44-60 most of last two days,bouts of nausea,hot feeling with feeling as if going to have a bowel movement. Lightheadedness,weakness,heavy arms and legs. No edema generally not feeling well. Heart XXXXXXX done 10 mo ago with20% blockage in coronary arteries. Left subclavian artery stent 3 mo ago. Had 90% blockage. Has been in ICU with testing done. No abnormal findings. Dismissed. Metropolol 50Mg daily,plavix 75Mg daily,81Mg aspirin daily. Frustated!

Answered by Dr. Anil Grover (8 hours later)

Hi there,

Thanks for writing in.
I am a medical specialist with an additional certification in Cardiology. I read your mail with diligence. Certain things still are not clear, please write back, so that I can be of help.
1. With 20% disease he should not have any symptoms like shortness of breath? Is
it associated with any wheeze? Does he become out of breath only on exertion?
2. If his day time heart rate is in 40s also- does he become more symptomatic
then? Why you say so or what makes him frustrated?

I am sure you are referring to 90% blockade of subclavian artery before the implantation of stent. Metoprolol is usually avoided in smokers especially those who are depressed or have bronchospasm. He has bradycardia (slow heart rate)that is one more reason to substitute this drug. Did the doctor discuss with you these things?
Looking forward to hear from you.

With Best Wishes
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anil Grover (18 hours later)

He is frustrated because he doesn't feel right and even when he takes a XXXXXXX breath he doesn't feel like he is getting enough air. Keeps having sensation of feeling hot and like he's going to have a bowel movement. SOB is all the time,even without exertion.heart rate increases to 60-70 when standing.was in icu with nitro drip, o2, morphine. Chestscan done...no emboli..venous doppler done.. Circ good . L subclavian stent without blockage.spo2 always 98-100%. He was given a script for imdur and dismissed. Still didn't know what dx was and feels no better.

Answered by Dr. Anil Grover (4 hours later)

Hi,
Please do not take offence to my questioning. Of course he feels frustrated because he does not feel alright. I was trying to find out which organ to blame lungs or heart and, my question was impolite. Please accept my heartfelt apologies for the same.
Well, with no wheeze and no bradycardia to blame with oxygen saturation going to 98-100% we are certainly not dealing with congestive heart failure or bronchospasm. Chest scan excludes Pulmonary Thromboembolism. That brings us back to coronary arteries where blockage is 20% at least doctors thought so and discharged him on coronary vasodilator drugs which are not effective. So, either he has small vessel coronary artery disease or we are still missing some major occlusion of artery which is not seen at all (for example intermediate artery total occlusion). SOB, Heaviness & Pressure are all angina equivalent symptoms. I have empathy for him for we as medical professionals have failed him to provide a diagnosis and treat him properly.

Will it be possible to have an independent second opinion of a cardiologist from different place? Without examining the patient and seeing his coronary angiography (running on CD), it is not possible for me to pin point the diagnosis. Regards.
With Best Wishes
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar