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Taking Amlodipine For Blood Pressure. On Colsprin. Angiography Normal. Reason For Chest Pain?

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Posted on Mon, 6 May 2013
Question: One and a half year ago I went through angiography to rule out TMT positive test. Angiography
results were normal. However , my doctor continued me on medication of colsprin etc for another seven months.
I am not diabitic however family history exist.

From last year onwards I have increased by physical activity and am presently doing average 100km walk plus around 50km cycling per month.

Offlate when I start my morning brisk walk ( avg 8min 40sec for a Km) I get a throbbing pain in the top part of
left chest which subsides after few minutes. However sometimes a very mild sensation remains throughout the
period. Of the 7.35 Km walk/jog that I do nearly everyday thesedays I do interval jogging after the first 2.25 Kms walk.

Why do I get these pains ? I am an vegetarian and eat fruits in the morning , salad in the afternoon mixed with
cooked veg and in normal cooked dinner.

I am taking 1.25mg amlodipin for Blood pressure daily which I do miss sometime. I have also been
diagonesed for prostate (BPH)
doctor
Answered by Dr. Anantharamakrishnan (2 hours later)
Dear XXXXXX,
Welcome to Health Care Magic

A negative angiography in a situation of positive TMT and symptoms is Micro-vascular Disease...
The pain is angina despite good effort tolerance and walk through phenomenon.
You have excellent life style – diet and exercise...

Resting ECG shows Inferior wall ischemia / markedly positive Infero-Lateral changes on exercise
LDL is a bit high for this situation – 70 or below will be ideal.

The dose of amlodipine is rather small / you can double it to 2.5 mg.
You can add a small dose of beta-blocker- extended release Metoprolol
You can add long acting nitroglycerine
You can add clopidogrel to aspirin.
You should a statin – it has benefits beyond cholesterol too (anti-oxidant)

Repeat the stress test with thallium

Take care
Wishing speedy recovery
God bless
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anantharamakrishnan (16 minutes later)
Why does the pain only starts at the begining and subsides after a few minutes in the workout. During the rest of workout there is no pain or just mild sensatation.

I was already on extended release Metoprolol
and clopidogrel and aspirin for for 6 to 7 months after angio.

Should I continue to only walk or continue with my walk + jog activity.
What care needs to be taken if I do not want to add your recommended medicine

doctor
Answered by Dr. Anantharamakrishnan (55 minutes later)
That is called walk-through phenomenon - due to recruitment of collateral vessels and some temporory restoration of blood supply
It is better to take clopidogrel and aspirin for life.../ preferable with Metoprolol too
Walking is safer than jogging...
No more specific area of care to recommend except to have regular follow up and/or another opinion
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anantharamakrishnan (20 hours later)
I do intermittent cycling also,
However, the starting pain does not seem to occur (walk-through phenomenon ) in case of cycling.
I did a 7.35 Kms cycling today at the speed of approx 1 Km per 2mins 50sec.
( WWW.WWWW.WW ) . I did not have
the pain as discussed above. On 7th of this month I did a 51.76 Kms cycling ibn 3 hrs 05 mins and did not feel the pain. Normally the pain/cramp is on the back of chest near the shoulder blades.

On few days I also have mild pain on right side of the chest. Am I overdoing the excecise bit because on some days I do 5 to 6 suryanamaskar and 5BX 4 minutes plan. The total duration of workout comes to approx 1 hr 20 mins.

On days of 7.3 Kms walk plus jog I measure my pulse and find it to be in the range of 110 +/- 5 ( full 1 min count) having done the last 250m as walk only.

Morning BP today was 126/72 with 67 pulse (electronic device).

However I do have mild headache on left side on some days like today also. I wear glasses and have dry eye syndrome.

How threatening is the situation. My next review with my local doctor ( not the Apollo) is 3 months down the line. What lifestyle should I follow because I like to jog as soon as I am walking in the morning breeze just like a dog cannot stop its urge to pee on a pole.

I have uploaded my angio report also

Regards
doctor
Answered by Dr. Anantharamakrishnan (2 hours later)

In fixed obstructive lesions, the amount of effort bringing on the symptom is also fixed and predictable. Here, it is not predictable / it is variable - it depends on the speed and amount of collaterals recruited..

Angio report is OK / ...except LDL above 100

The situation is stable
Barring accidents, there is no obvious immediate threat...

Exercise has addictive potential! / Several neuro-endocrine hormones - endorphins in particular - are responsible, causing a sensation of happiness...
Anything in moderation is OK. You may reduce the speed / split the duration

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

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

Cardiologist

Practicing since :1966

Answered : 4505 Questions

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Taking Amlodipine For Blood Pressure. On Colsprin. Angiography Normal. Reason For Chest Pain?

Dear XXXXXX,
Welcome to Health Care Magic

A negative angiography in a situation of positive TMT and symptoms is Micro-vascular Disease...
The pain is angina despite good effort tolerance and walk through phenomenon.
You have excellent life style – diet and exercise...

Resting ECG shows Inferior wall ischemia / markedly positive Infero-Lateral changes on exercise
LDL is a bit high for this situation – 70 or below will be ideal.

The dose of amlodipine is rather small / you can double it to 2.5 mg.
You can add a small dose of beta-blocker- extended release Metoprolol
You can add long acting nitroglycerine
You can add clopidogrel to aspirin.
You should a statin – it has benefits beyond cholesterol too (anti-oxidant)

Repeat the stress test with thallium

Take care
Wishing speedy recovery
God bless
Good luck