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Suggest Remedies For Severe Anxiety And Chest Pain In A Diabetic
Question: Dear doctor
I am diabetic for last 10 years. Recently had chest pain and anxiety. TMT test and lipid profile was normal. Bit still I experience chest pain(left side and lower side of chest which increases if pressure is put on chest). No pain experienced in centre of chest. Pls suggest if further test needs to be done. I am taking humalog and lantus for diabetics and ramistar 2.5mg for BP.
I am diabetic for last 10 years. Recently had chest pain and anxiety. TMT test and lipid profile was normal. Bit still I experience chest pain(left side and lower side of chest which increases if pressure is put on chest). No pain experienced in centre of chest. Pls suggest if further test needs to be done. I am taking humalog and lantus for diabetics and ramistar 2.5mg for BP.
Brief Answer:
No test required furthur, if needed CT coronary angiogram would b way ahed
Detailed Answer:
Hello,
I am Dr. Mody and I would be addressing your concern.
I went through the history you have provided .
Now the risk factor for heart events for you is diabetes, hypertension and an urban stressful life, but the thing against the same is your age. You are still young. So if we go by statistics you fall in the intermediate risk for coronary event in future.
Now considering that you TMT is normal so in 75% probability you don't have any obstructive coronary stenosis (blocks more than 70 %) and your heart is able to compensate well during stress. In ideal circumstances no further test is needed and the pain you feel is mostly not cardiac.
However if you wish to be extra sure and we want to diagnose those minor blocks, which if present justifies secondary prevention and we can start you on low dose blood thinner and statins (cholesterol medication), The next step would be to do a CT coronary angiogram, Here the heart arteries are seen anatomically in a CT scan without an invasive procedure.
If this is normal you need no Further evaluation as it's sensitivity is 99.5 %.
The medication for diabetes and blood pressure is good enough and you should strive to keep your HbA1c less than 7 and blood pressure less than 125 / 75 at all times .
Hoping I could help.
Let me know if any clarification needed.
Do follow up with the reports .
Regards Dr Priyank Mody
No test required furthur, if needed CT coronary angiogram would b way ahed
Detailed Answer:
Hello,
I am Dr. Mody and I would be addressing your concern.
I went through the history you have provided .
Now the risk factor for heart events for you is diabetes, hypertension and an urban stressful life, but the thing against the same is your age. You are still young. So if we go by statistics you fall in the intermediate risk for coronary event in future.
Now considering that you TMT is normal so in 75% probability you don't have any obstructive coronary stenosis (blocks more than 70 %) and your heart is able to compensate well during stress. In ideal circumstances no further test is needed and the pain you feel is mostly not cardiac.
However if you wish to be extra sure and we want to diagnose those minor blocks, which if present justifies secondary prevention and we can start you on low dose blood thinner and statins (cholesterol medication), The next step would be to do a CT coronary angiogram, Here the heart arteries are seen anatomically in a CT scan without an invasive procedure.
If this is normal you need no Further evaluation as it's sensitivity is 99.5 %.
The medication for diabetes and blood pressure is good enough and you should strive to keep your HbA1c less than 7 and blood pressure less than 125 / 75 at all times .
Hoping I could help.
Let me know if any clarification needed.
Do follow up with the reports .
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Doctor
Pls go through my reports (Lipis & TMT). Its like a stabbing pain on left side of chest & below nipple seems to be muscular ( i do light weight exercise ,4-5 days a week) as it increases while pressing.
Doctor has also given me Evion 400mg for 2 months & Pregab m 75 for 15 days.
Pls go through my reports (Lipis & TMT). Its like a stabbing pain on left side of chest & below nipple seems to be muscular ( i do light weight exercise ,4-5 days a week) as it increases while pressing.
Doctor has also given me Evion 400mg for 2 months & Pregab m 75 for 15 days.
Brief Answer:
Yes the pain surely is muscular :)
Detailed Answer:
Hello Mr Sehgal,
I went through both the reports .
In the stress test , you have performed very good , With that even if tomorrow you decide to to run a marathon or go hiking you will be able to do so .
Also the pain you describe is not characteristic of heart pain .
So I recommended that no furthur investigation to rule out heart is needed .
We have to understand that TMT rules out obstructive blockages .Ie. blockages more than 70 % which will reduce blood supply when you are exerting causing symptoms and ecg changes.
But it will not detect minor blockages , however this minor blockage will never cause symptoms . So your symptoms are for sure not because of the heart .
Than y CT angiography ?
Because that should be the next step to rule out anatomical minor blockages which may not cause change in the stress test and We can get a calcium scoring and risk stratification so as to take precaution to prevent future cardiac events
The medication you have described will strengthen the nerves which may have become weak due to long standing diabetes .
It's just you have to take precaution because of your diabetes and things would be just fine in future .
The lipid profile everything is good , just we may work upon bring your hdl more than 45 .
You may consider taking supplement, Omega 3 fatty acid ( cod fish ) 1 gm twice a day .
Rest wishing you the best of health.
Let me know if any clarification is needed and I would be happy to help .
Regards Dr Priyank Mody.
Yes the pain surely is muscular :)
Detailed Answer:
Hello Mr Sehgal,
I went through both the reports .
In the stress test , you have performed very good , With that even if tomorrow you decide to to run a marathon or go hiking you will be able to do so .
Also the pain you describe is not characteristic of heart pain .
So I recommended that no furthur investigation to rule out heart is needed .
We have to understand that TMT rules out obstructive blockages .Ie. blockages more than 70 % which will reduce blood supply when you are exerting causing symptoms and ecg changes.
But it will not detect minor blockages , however this minor blockage will never cause symptoms . So your symptoms are for sure not because of the heart .
Than y CT angiography ?
Because that should be the next step to rule out anatomical minor blockages which may not cause change in the stress test and We can get a calcium scoring and risk stratification so as to take precaution to prevent future cardiac events
The medication you have described will strengthen the nerves which may have become weak due to long standing diabetes .
It's just you have to take precaution because of your diabetes and things would be just fine in future .
The lipid profile everything is good , just we may work upon bring your hdl more than 45 .
You may consider taking supplement, Omega 3 fatty acid ( cod fish ) 1 gm twice a day .
Rest wishing you the best of health.
Let me know if any clarification is needed and I would be happy to help .
Regards Dr Priyank Mody.
Above answer was peer-reviewed by :
Dr. Naveen Kumar
Dear Doctor
Thanks for your guidance. I am pretty much relieved now from anxiety. Just need one suggestion from you :my father(age 65, diabetic,bp) suffered heat attack on 6th December 2015 & underwent angioplasty, detected 100% blockage in main arterie rest were cleared. No previous history of heart disease in our family. Now what precautions should I take to safeguard me against this and at what intervals I should go for test(pls advice test name). my sugar for last 2 months are under control now (fasting less than 100, pp less than 160), BP reading 130/80. I am taking fish oil for last 1month(omega 3fatty acid 435mg per day, EPA 200mg, DHA 200mg).
Thanks for your guidance. I am pretty much relieved now from anxiety. Just need one suggestion from you :my father(age 65, diabetic,bp) suffered heat attack on 6th December 2015 & underwent angioplasty, detected 100% blockage in main arterie rest were cleared. No previous history of heart disease in our family. Now what precautions should I take to safeguard me against this and at what intervals I should go for test(pls advice test name). my sugar for last 2 months are under control now (fasting less than 100, pp less than 160), BP reading 130/80. I am taking fish oil for last 1month(omega 3fatty acid 435mg per day, EPA 200mg, DHA 200mg).
Brief Answer:
TMT every 12 -18 months from now on as routine
Detailed Answer:
Hello ,
Your risk factors are diabetes and family history.
The best u can do is control your sugar , blood pressure and cholesterol.
All the reports you have mentioned and attached are perfect, nothing more needed .
Make it a habit of doing TMT every 1 year to 18 months , not just for positive or negative but to compare the same with your previous TMT so you van know where do you stand in terms of exercise tolerance. That's it from cardiac point of view .
Avoid unnecessary stress and anxiety and it will only add to trouble and will never be helpful.
Let me know if any further help is ever required.
Do rate for other's reference.
Regards Dr Mody
TMT every 12 -18 months from now on as routine
Detailed Answer:
Hello ,
Your risk factors are diabetes and family history.
The best u can do is control your sugar , blood pressure and cholesterol.
All the reports you have mentioned and attached are perfect, nothing more needed .
Make it a habit of doing TMT every 1 year to 18 months , not just for positive or negative but to compare the same with your previous TMT so you van know where do you stand in terms of exercise tolerance. That's it from cardiac point of view .
Avoid unnecessary stress and anxiety and it will only add to trouble and will never be helpful.
Let me know if any further help is ever required.
Do rate for other's reference.
Regards Dr Mody
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Sonia Raina
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