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What Causes Recurrent Heart Attack Despite Taking Medication?
Question: Hello Dr.,
I am 83. I had cardiac bypass five and a half years ago which prevented an actual heart attack at that time (a very timely failed stress echo signaled the need before an actual attack). I also had one stent (LAD) put in at XXXXXXX Presbyterian in 2003 after enzyme testing showed an actual mild hear attack. I am now on vacation in another country. While I exercise regularly at home (three miles walking most days) without symptoms, I had a sleepless last night while flying all night and then the stress of having to practically jog a very long distance through Heathrow airport to catch a connecting flight (not comfortable). Then after walking quite a bit this morning, I suddenly became quite dizzy and uncomfortable. I sat down, rested and took a full strength aspirin and a metoprolol (25 mg). I interpreted these symptoms as an episode of silent, painless angina that might have proceeded to an MI if I had continued to walk on.
My question. Should I bother to go to a strange hospital and Dr for an evaluation immediately? I am no longer acutely dizzy or uncomfortable. I do have nitro tablets on hand as well as more beta blockers and aspirin.
I am 83. I had cardiac bypass five and a half years ago which prevented an actual heart attack at that time (a very timely failed stress echo signaled the need before an actual attack). I also had one stent (LAD) put in at XXXXXXX Presbyterian in 2003 after enzyme testing showed an actual mild hear attack. I am now on vacation in another country. While I exercise regularly at home (three miles walking most days) without symptoms, I had a sleepless last night while flying all night and then the stress of having to practically jog a very long distance through Heathrow airport to catch a connecting flight (not comfortable). Then after walking quite a bit this morning, I suddenly became quite dizzy and uncomfortable. I sat down, rested and took a full strength aspirin and a metoprolol (25 mg). I interpreted these symptoms as an episode of silent, painless angina that might have proceeded to an MI if I had continued to walk on.
My question. Should I bother to go to a strange hospital and Dr for an evaluation immediately? I am no longer acutely dizzy or uncomfortable. I do have nitro tablets on hand as well as more beta blockers and aspirin.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I read carefully your question and would explain that based on your symptoms, it is difficult to come into a conclusion related to a possible silent cardiac ischemic event, because your symptoms are non specific.
Nevertheless, a cardiac related condition can't be excluded, as you have a previous known coronary artery disease and you have gone through a complex revascularization procedure (CABG) and theoretically, there exists a probability that a graft becomes complicated.
From the other side, even an abnormal blood pressure fluctuation may be responsible for such a clinical symptomatology.
I don't know exactly for how long are you going to stay away from your living area, but I would suggest that you schedule a cardiologist visit when you come back home.
Meanwhile I would recommend you to check your blood pressure and if you experience again similar complains or even additional symptomatology, you should consult the nearest ER doctor.
In case of any unexpected acute event, I recommend you to keep present your nitro tablet.
If you experience chest pain, suspicious for myocardial ischemia, you may use 1-2 nitroglycerin tablets (first rule out low blood pressure presence). In case of symptoms persistence, you should immediately run to the nearest hospital.
Hope to have been helpful!
Feel free to ask any other questions whenever you need!
Best regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I read carefully your question and would explain that based on your symptoms, it is difficult to come into a conclusion related to a possible silent cardiac ischemic event, because your symptoms are non specific.
Nevertheless, a cardiac related condition can't be excluded, as you have a previous known coronary artery disease and you have gone through a complex revascularization procedure (CABG) and theoretically, there exists a probability that a graft becomes complicated.
From the other side, even an abnormal blood pressure fluctuation may be responsible for such a clinical symptomatology.
I don't know exactly for how long are you going to stay away from your living area, but I would suggest that you schedule a cardiologist visit when you come back home.
Meanwhile I would recommend you to check your blood pressure and if you experience again similar complains or even additional symptomatology, you should consult the nearest ER doctor.
In case of any unexpected acute event, I recommend you to keep present your nitro tablet.
If you experience chest pain, suspicious for myocardial ischemia, you may use 1-2 nitroglycerin tablets (first rule out low blood pressure presence). In case of symptoms persistence, you should immediately run to the nearest hospital.
Hope to have been helpful!
Feel free to ask any other questions whenever you need!
Best regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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