I have a discomfort under my sternum when I walk up a slope. What do you suggest?

Q. I have a discomfort under my sternum when I walk up a slope. What do you suggest?

Answered by
Dr. Muhammad Majid Hanif
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Jan 18, 2018 and last reviewed on: Jun 09, 2023

Hello doctor,

I have a very localized discomfort under my sternum when I exercise. Generally, it does not occur with just walking on level ground but on even a gentle slope (incline), I begin to notice it. I have had an echocardiogram. The cardiologist recommended an angiogram and possibly an angioplasty. I would like to communicate with a second cardiologist and discuss the possibility of just doing diet changes plus some kind of drug regimen. I am prepared to pay for the consultation independent of any insurance. Two consultations where there was a general discussion about the issue and a second consultation where the physician has reviewed my medical records is what I am thinking might be best. I would like a cardiologist to review the details of my condition and test results and provide a recommendation as to the best course of action for me. Right now, I am just trying to understand that this is something that you do and that going forward from here is useful. I would like to be able to see something about the physician who would be reviewing my case.



Welcome to icliniq.com.

I have reviewed your health query and have understood you may be having what is called ischemic heart disease. In this disease, the vessels supplying blood to the heart muscles itself, get clogged due to any reason. When there is the partial blockage (incomplete blockage) the patient does not feel pain all the times. But when there is more demand (as you walk on the inclined area, do strenuous physical work, climb stairs, etc.), the heart has to pump more and more blood to the body. But there is no much blood supply to the heart's own muscles. This causes a debt of blood and so oxygen to the heart itself and causes ischemic pain in the heart. You feel a discomfort due to all of this (this is the pathophysiology of this issue in simple words). You may feel free to add your latest reports to assist in this case. I would definitely be happy to review and get back to you as soon as possible. We may proceed from there later on. Regards.

Hello doctor,

I have attached a file that contains every test result. I am going to call to see what is involved in releasing X-rays, stress EKG, and stress echocardiogram if you think they would be helpful. Please provide information on how you would like to proceed. One other thing. I took three medicines last night. They seem to have resulted in some improvement in my overall condition, but there was a touch of wooziness associated with them as well. In my next note, I will let you know what they are. My current medications are Long-term prior to last night (once per day), I took Levothyroxine 175 mcg and Aspirin 85 mg. First taken last night (prescribed by cardiologist) once per day, I took Isosorbide mononitrate ER 30 mg tablet, Atenol 25 mg tablet and Atorvastatin 40 mg tablet. I found a single PDF file that contains every recent test I have had, and the medicines I am taking. What I have sent you contain all the information in this file. I am leaning to canceling the angiogram to provide more time for consultation but I would like to hear your thoughts on that. What I would like beyond that is to arrange for you to do a formal review of my case including reviewing the image data. If you feel like that is the thing to do please advise how to proceed. Thanks.



Welcome back to icliniq.com.

Thanks for uploading the data here (attachment removed to protect patient identity). You may upload more for my review especially the EKG, stress test and echo reports. I found it encouraging that after taking these medications you felt a bit better. They are very potent and good medications for patients who have heart issues like you are experiencing off and on. These medications are to keep you pain-free to some extent and helps alleviate anxiety too. Aspirin you need to take as advised as this would help your heart and veins in the long run. If you avoid strenuous physical work and take medications as prescribed, I am hopeful you would feel better. But remember none of these agents would reverse the already set blockage and we cannot do much to actually reverse that. You need to go for angiography in the future if God forbid some more blockage ensues, and that is a possibility as there is already a set ground for the same in heart vessels. If you feel better, I would recommend going with angiography as this would help us determine how much and where actually the blockage is. And, if felt appropriate, your cardiologist would go for the angioplasty in the same sitting so that the blockage is totally removed. In this way, the heart would have full blood supply as and whenever needed. It improves life much. The medications your cardiologist gave you improve the blood flow through blood vessels and will help alleviate the discomfort. Lifestyle changes are very important here. You need to ask your Physician to help you with details in this regard. The active problems are Diabetes type 2 with hyperglycemia, diabetes type 2 with hyperlipidemia, hypertension (high blood pressure) and hypothyroidism (low thyroid). With these active problems, it is better to remain in touch with your cardiologist as these are major risk factors for heart diseases. And if your cardiologist suggests an angiogram, it would be better to go for it. Hope this helps.

Hello doctor,

Thank you very much. That sounds like good advice. I had a long talk with my brother-in-law today who suffered a heart attack and then had a stent put it. Even though he was quite a bit worse off than I am now at one point, he has gradually recovered to the point that he is better off than I am right now. A friend of mine has also done very well after the procedure. I think this is enough to make me feel good about going forward. I still wonder a bit whether diet and drugs might have been enough, but it sounds like you do not think so. I would like to forward you the digital data and have you review it. I feel like I owe you or the company that runs this site more money for your services and I am prepared to pay more especially if you review the image data. Please let me know about that. Anyway, thanks again and no matter what I will let you know how it goes, assuming that I am around to do that. Do you think there are any questions that I should be asking about the procedure? Techniques, stents, surgeon, odds of success, etc. or is it just time to move forward and rely on other people's decision making?



Welcome back to icliniq.com.

Regarding your doubts, if diet and drugs might have been enough, it might have been enough before the blockage, in absence of other risk factors for heart diseases like ischemic heart disease. I would go with your decision and your cardiologist can better let you know in a more informed way how safe and successful this procedure is nowadays and forever. I hope your hospital's cardiology team is one of the best ones and you may rely on their expertise. Hopefully, it goes well. Keep me informed. You are always welcome for any future consultations too.

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