Q. My mother is admitted with chest pain. How serious is her illness?
Hi doctor,
My mother, who is 62 years old, has been hospitalized for two days due to sudden sweating, chest pain and left hand pain. When she was admitted her BP was 190/110 mmHg. She is also a diabetic (150/270) and undergoing tremendous stress due to sudden personal loss. She underwent ECG and 2D echo. I have attached the reports here. Her doctor said that she was on the verge of a heart attack when admitted. Her ECG is said to be abnormal and 2D echo depicts CAD and diastolic dysfunction. Currently, she has been treated to lower her blood pressure. Her doctor told me to do TMT and angiography, if TMT appears positive. Could you please let me know by seeing the reports how serious the illness is. I would like to know the future course of action in terms of tests and treatment.
Hi,
Welcome to icliniq.com.
I have gone through her reports (attachment removed to protect patient identity). It can be unstable angina or MI (myocardial infarction). Please let me know the troponin I value. If it is negative repeatedly, then stress test is advisable. If positive, then straight coronary angiography is advisable.
The Probable causes:
The probable causes are Diabetes mellitus and Hypertension.
Investigations to be done:Do Troponin I value.
Differential diagnosis:The differential diagnosis is non-cardiac chest pain like muscular.
Probable diagnosis:The probable diagnosis is acute coronary syndrome (includes both MI and unstable angina due to sudden obstruction of blood flow to heart).
Treatment plan:Do trop I or trop T and then repeat after 12 hours from onset of pain, if the initial value is negative. If positive, then do angiography. If still negative, then do a stress test.
Regarding follow up:Revert back with the reports to a cardiologist online.
Thank you doctor,
She was admitted before three days. Should I ask my health care provider to perform trop I now if not done already? I have attached the complete file of my mother. ECG records are arranged from newest to oldest order. My doctor asked to wait for two or three days before proceeding for any further tests. When on Nicorandil 12 drops per minute, her BP becomes 120/80 mmHg, otherwise it jumps to 150/80 mmHg. Is that a sign of any real problem to be investigated further? Her doctor said that it would take 15 days to get her BP levels back to normal. Her ECG clearly shows ST wave depression. Is that sign of concern? Will it come back to normal with medication? My concern is not to waste time if there is any possibility of CAD or real damage to the heart that needs attention.
Hello,
Welcome back to icliniq.com.
As per the reports you sent (attachment removed to protect patient identity), if taken on different days, then it does not show any progressive or regressive changes. There are changes, but are fixed. So, if the first and the last ECG are not on the same day, then there is no immediate cause for concern. But, after confirming that repeat trop I or trop T is negative, she has to undergo stress test for 10 METS (one of stress test parameters) without any chest discomfort or any increased ECG change. Then only we can label her discomfort to be non-cardiac.
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