I had a massive heart attack 15 years ago. Now, I have right sided chest pain. Please help.

Hello doctor,

I had a massive heart attack 15 years ago. I am 54 years old now with a height of 173 cm and weight 64 kg. Within two weeks, angioplasty was done for me in LAD (left anterior descending) coronary artery. After four years, I had undergone bypass surgery for four vessels. Every year, during the medical check-up, my TMT result was showing negative. This year also my TMT is negative and the report is as follows:

Total exercise period was 12 minutes and achieved 88 % of maximum predicted heart rate with a calculated workload of 14.30 METs. There was no significant respiratory symptom related to exercise. The exercise was terminated due to fatigue and the achievement of target heart rate. The resting blood pressure and response to exercise were normal. Resting ECG was normal. Exercise ECG: ST depression during exercise 4 stage, ST level was -0.90 mm in V5. Maximum HR is 88 %. Maximum workload 14.30 METs and the conclusion is good exercise capacity and negative TMT.

My other reports are EF as per echocardiogram is 55 %. Blood sugar and cholesterol reports are normal. My current medication is as follows. Tablet Nikoran 5 mg twice a day, tablet Tenolol 12.5 mg once a day at night, tablet Rosuvastatin 10 mg once in a day and tablet Clavix 75 mg once in a day.

My problem is that I am getting pain and heaviness on the right side of my chest since 10 years after bypass surgery. Because of this, I am feeling shortness of breath and heaviness in the chest while walking. I consulted a heart specialist and gastroenterologist. Sonography, CT scan reports for chest and abdomen are normal. Colonoscopy and endoscopy reports are normal. During barium x-ray, reflux was detected. The gastroenterologist has prescribed me anti-reflux tablet Nexpro Fast 40 mg, which I have been taking since five years. I am very strict about consuming less oil, less fat and less sugar in my diet. My problem has come down but not got eliminated.

One physician has advised me to go for angiography to rule out the right side pain and heaviness problem. But my cardiologist is not suggesting an angiography because of negative TMT report and said a right side chest problem is not related to the heart. What is your opinion? Could you please advise me what can I do now? What is the solution for this?

Hi doctor,

Thank you very much for your reply. My pain and heaviness is from the front, back and below the right side of the rib. Because of this, I feel little short of breath during normal condition. When I walk, initially, I feel right side heaviness and short of breath. After walking one kilometer, it gradually goes away and I feel better. During TMT, I have not experienced any chest pain. In fact, after completion of TMT, I was feeling better. I also started believing that this pain and heaviness is because of nerves or surgical problem. Two months back, my gastroenterologist had prescribed me Nexito 10 for one month. During that period, I was a little comfortable. I am not taking a large meal and go to bed after an hour. I am happy to know that you are not suggesting angiogram. During my TMT, the cardiologist has stopped Tenolol 12.5 before 24 hours and continued Nikoran 5. Is it fine? The reason for asking this question is that many cardiologists are suggesting to stop Nikoran 5 mg also before TMT. What is your view on this?