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

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


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

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