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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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ECG Detected Tweaks, Have Stents, High BP. On Ramipril, Ecosprin. Suggest?

I have to undergo a TMT as the Cardiologist recently found tweaks in my ECG of 15th Dec 2012. He advised me to discontinue Metropolol for 5 days before coming for the TMT. Ufortunately. I have not taken Metropolol since 17th Dec and not able to get my TMT done as per schedule on 22nd Jan. My BP was recorded as 138/78 on 16th Dec and was 160/88 today. I am an old case of CAD with three stent implants on 25th Feb 2010. I am taking 200 mg Finofibrate,5 mg Ramipril in the morning and 40 mg Attorovastitin, 75 mg Ecosprin , 75 mg Cleopidrgel,25 mg Metropolol in the night every day. Please explain what is the meaning of tweaks in ECG and whether this high BP is due to local effect of not taking Metropolol for last so many days. Also, when I stretch my chest upwards lately, I am feeling a little pain in the rib cage towards the left side. What could this symptom be ?
Fri, 1 Feb 2013
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Emergency Medicine Specialist 's  Response
Hi
Thanks for your query
Welcome to HCM
Patients with coronary artery blockages may have minimal symptoms and an unremarkable or unchanged ECG while at rest. However, symptoms and signs of heart disease may become unmasked by exposing the heart to the stress of exercise. so in that case TMT advised
Beta blocker should stop prior to TMT becauseSensitivity for exercise-induced ST depression are significantly decreased in patients who are taking beta-blockers and do not reach target heart rate
As you are not taking beta blocker for long time thus anti hypertensive effects of this gone which is a cause of your raised blood pressure
Finally local pain over chest which aggravated by stretching would not be due to heart problem it would be muscular in origin and simple painkiller may benefited you
Take care
Have a good health
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Cardiologist, Interventional Dr. (Prof.) Subroto Mandal's  Response
Hello and welcome,
first of all as per your history, you should continue metoprolol without fail. Regarding tweaks in ECG, generally this is not a medical term as per my knowledge, but whenever we find some some minor changes or non significant changes, we call as tweaks in ECG. even you can ask your doctor.
as far as your TMT is concern you should undergo the test.
Thank you for your queary

Wish you Healthy Heart

SUBROTO

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ECG Detected Tweaks, Have Stents, High BP. On Ramipril, Ecosprin. Suggest?

Hi Thanks for your query Welcome to HCM Patients with coronary artery blockages may have minimal symptoms and an unremarkable or unchanged ECG while at rest. However, symptoms and signs of heart disease may become unmasked by exposing the heart to the stress of exercise. so in that case TMT advised Beta blocker should stop prior to TMT becauseSensitivity for exercise-induced ST depression are significantly decreased in patients who are taking beta-blockers and do not reach target heart rate As you are not taking beta blocker for long time thus anti hypertensive effects of this gone which is a cause of your raised blood pressure Finally local pain over chest which aggravated by stretching would not be due to heart problem it would be muscular in origin and simple painkiller may benefited you Take care Have a good health