Hi XXXXXXX

Thanks for writing in.
I am qualified and certified cardiologist. I read your mail with diligence.
Coming to chest pain first:
Typical pain related to heart is “retro sterna” (Central) squeezing associated with sweating and increased heart rate and it radiates to neck and left arm. Important is the fact in what setting the pain occurs. You have normal coronary artery a rare possibility of coronary artery spasm remains but an EKG during pain would show changes secondly while doing coronary angiography your doctor would have looked for it.
My own feeling is you have Gastro Esophageal Reflux Disease(GERD), meaning that your gastric contents which are acidic spill into esophagus which is alkaline and causes irritation and pain. You can do a little pharmacological therapeutic trial by taking OTC antacids one and 3 hours after meals, secondly never lie down for half an hour after meals keep yourself straight rather just walk around or sit and watch a TV show, allowing stomach to empty into intestine. If that relieves you have a diagnosis.

At age 30, you have some identified risk factors for coronary artery disease; others you can fill in by personal knowledge and investigations. The idea is if you have a back ground of more known risk factors your chances of pain (even atypical pain) originating as a result of heart are much more despite normal coronaries'

At any age, following is the list of risk factors for future development of Coronary Artery Disease. Let me enumerate and you can place yourself the risk you are carrying ('*' means you have the risk factor, '+/-' means I do not know and about others you know better):-

A: MODIFIABLE RISK FACTORS
Diabetes +/-
Hypertension*
Smoking+/-
Stress* (globalized world and modern life styles; Yogis and children <3 Yr. escape)
Obesity and Sedentary Life Style +/- ( your height and weight is not known to me)
High Bad Cholesterol and Lipid Component +/-
Total Cholesterol above 190 mg%, LDL above 130 mg%, VLDL above 40 mg%,
Triglycerides above 150 mg%, Apolipoprotein B above reference value
Low Good Cholesterol and Lipid Component: +/- (not mentioned)
Apolipoprotein a below reference range for the lab and
HDL below 40 mg% for man & and 50 mg% for woman
B: NON MODIFIABLE RISK FACTORS
Family History 0f Coronary Heart Disease*
Increasing age*
Being a Man (as opposed to women) till the age 45*

From the list, above you have some risk factors. family history and hypertensioh you have identified. Therefore, I will strongly recommend start to reduce the burden. For normal coronaries ought to remain normal for another 60 years.
Strategies include:
1. Treat the risk factors you have: you are taking anti hypertensive drugs, please do not leave these. Add progressive muscular relaxation exercises (originally fromi one of the asana of yoga called it is called Savasana: corpse pose if literally translated. This has opposite effect to heavy isometric exercise (which a hypertensive person avoid). Additionally, this is a great stress buster.

No yoga session is complete without the final pose – Savasana. The body needs this time to understand the new information it has received through practicing yoga. Even though Savasana is a resting pose, it’s not the same a sleeping! You should stay present and aware during the five to ten minute duration of final relaxation.

Instructions:

1. Come to lie down on the back.

2. Let the feet fall out to either side.

3. Bring the arms alongside the body, but slightly separated from the body, and turn the palms to face upwards.

4. Relax the whole body, including the face. Let the body feel heavy.

5. Let the breath occur naturally.

6. To come out, first begin to the deepen the breath. Then move the fingers and toes, awakening the body.

7. Bring the knees into the chest and roll over to one side, keep the eyes closed.

8. Slowly bring yourself back up into a sitting position.

Second thing is to maintain ideal body weight, avoid junk food and isotonic exercises. Brisk walking at the rate of 5 KM/ Hr for 40 minutes (whether on treadmill or outside) every day will go a long way.

To compete the list of anti risk factors as I call them. If you are overweight It is never too late to change. With your weight everything you do will have to be under supervision. It need not be cardiologist but your primary doctor can guide your way back to health - I am happy to read that because of family history you got even coronary angiography done. You may need drugs (which has been advised correctly) and he/she (or ask the dietitian) to advise you about diet low in calories and cholesterol, advise you on quantum of exercise. You ought to keep your weight under control for you do not want heart attack. If you like non vegetarian you cannot take red meat but there is no bar (in taking certainly quantity had to be less) on egg white, roasted chicken and roasted fish.

So DIET DRUGS AND EXERCISE IS MY ANSWER TO RISK FACTORS

Hope you found something useful in this answer. If you have any follow-up query I shall be happy to answer.

Regards


With Best Wishes

Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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