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Q. How to treat a 64- year old person who is complaining of chest tightness and pressure?

Answered by
Dr. Muhammad Zubayer Alam
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 27, 2022

Hello doctor,

A patient of age 64 has been experiencing symptoms of squeezing breathlessness or pressure in the chest for the past year in the sitting position.

The patient works in an environmentment that is more prone to cotton dust issues.

The patient did :

(1) Echocardiogram before a year (as per the translated copy) shows,

- Normal left ventricular function and dimension.

- Normal right ventricular function and dimension.

- Mitral leakage mild to moderate.

- Light tricuspid leakage.

- Dry pericarditis.

- Normal dimension aorta.

(2) I have attached the results of sleep apnea tests done last year.

(3) According to the colonoscopy report, the patient had polyps in the gut removed. And the patient was recently diagnosed with knee arthritis.

He takes the following medications regularly,

(1) Tablet Atorvastatin 20 mg.

(2) Tablet Riva-Atenolol 50 mg.

(3) Sandoz perindopril and Indapamide 4 to 1.25 mg.

(4) Calcite D 500 mg to 400 IU.

I showed the test reports to an online general physician. The doctor said she should consult a pulmonologist to rule out and treat pulmonary arterial hypertension, her pulmonary artery pressure is sys 34 mm Hg.

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#

Hi,

Welcome to icliniq.com.

Thanks for the query. I can understand your concern.

According to your statement, your patient has been suffering from squeezing breathlessness or pressure in the chest during sitting position for the past year.

According to the echo report, pulmonary arterial pressure is 34 mmHg and if PAP (Pulmonary Artery Pressure) is more than or equal to 25 mmHg, then it may indicate the presence of pulmonary hypertension.

Your patient may need some investigations like CT (Computed tomography), pulmonary angiogram to obtain an image of pulmonary arteries, Repeat ECHO (echocardiogram) to exclude any cardiac abnormalities, HRCT ( High-resolution computed tomography) of the chest as the patient had a history of exposure to cotton dust, sleep apnea test should also be done as the patient had a history of mild sleep apnea in her previous test, pulmonary function tests to know respiratory causes, etc.

Treatment depends on causes. So, your patient should undergo the above-mentioned investigations to detect the underlying causes for the patient's present sufferings and then treat them accordingly.

Take care. In case of any other queries kindly reach back.

Hello doctor,

My mother had covid omicron two weeks ago. One week ago, we did the covid test, and she was found covid negative. But she is very weak and has a slight cough and headache. She did a chest x-ray today, and the images are attached. We have an appointment with the doctor tomorrow.

Based on the x-ray report, the doctor might recommend her an antibiotic Riva azithromycin 250 mg tablet (Image attached). Please advise whether or not she should take this?

#

Hello,

Welcome back to icliniq.com.

Thanks for the query. According to the x-ray films attached here (attachment removed to protect the patient's identity), pulmonary infections are found. For that reason, the doctor has already advised taking antibiotics like Azithromycin. Your patient's present pulmonary infections may be resulted from the previous Covid 19 infection or as a consequence of Covid 19 infection. So, the pulmonary infection may be derived from a viral origin, and antibiotics have no role in viral infection. But during viral infections or after viral infections, the body is more prone to develop any secondary opportunistic infections like any type of pulmonary infections. As your patient has already developed pulmonary infection according to the chest x-ray view, antibiotics like Azithromycin are indicated here to prevent secondary infections. Your patient should undergo HRCT (high resolution computed tomography) of the chest to determine the involvement of infection on different lobes and severity scores. If HRCT of the chest reveals the presence of covid pneumonia or pneumonia as a complication of covid infection, then antiviral medications may be needed along with antibiotics. Weakness is a common outcome of post-covid infection which may persist from days to months. Take care. Let me know if I can assist you further.


The Probable causes:

Covid 19 infection

Investigations to be done:

HRCT of Chest


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