Patient's Query
Hello doctor,
I experience localized discomfort under my sternum when I exercise. Generally, it does not occur during regular walking on level ground, but I begin to notice it even on a gentle slope. I have undergone an echocardiogram, and my cardiologist recommended an angiogram and possibly an angioplasty. I would like to consult a second cardiologist to discuss the possibility of managing my condition through dietary changes and a medication regimen. I am willing to pay for the consultation independently of any insurance.
I believe it would be beneficial to have two consultations: one for a general discussion about my condition and another where the physician reviews my medical records. I would like a cardiologist to evaluate the details of my condition and test results and provide recommendations for the best course of action. Right now, I am trying to confirm that this is a service you offer and that proceeding in this manner would be useful. Additionally, I would like to know more about the physician who would be reviewing my case.
Thank you.
Hello,
Welcome to icliniq.com.
I have reviewed your health query and understand that you may be experiencing ischemic heart disease. In this condition, the blood vessels supplying the heart muscles can become clogged for various reasons. With partial blockage (incomplete blockage), patients may not feel pain all the time. However, when there is an increased demand on the heart—such as walking on an incline, doing strenuous physical work, or climbing stairs—the heart must pump more blood to the body. Unfortunately, there may not be enough blood supply to the heart muscles themselves. This results in a deficit of blood and oxygen for the heart, leading to ischemic pain.
You may feel discomfort due to this process (this is a simplified explanation of the pathophysiology). Please feel free to share your latest reports to assist in this case. I would be happy to review them and get back to you as soon as possible, and we can proceed from there.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I have attached a file containing all my test results. I will also call to inquire about the process for releasing my X-rays, stress EKG, and stress echocardiogram if you think they would be helpful. Please let me know how you would like to proceed.
Additionally, I took three medications last night that seem to have improved my overall condition, although I experienced some wooziness as a side effect. I will let you know the names of those medications in my next message. My current long-term medications (taken once per day prior to last night) are Levothyroxine 175 mcg and Aspirin 85 mg. The medications I took last night (prescribed by my cardiologist, also taken once per day) are Isosorbide mononitrate ER 30 mg, Atenolol 25 mg, and Atorvastatin 40 mg.
I found a single PDF file that contains all my recent test results and the medications I am taking, and I have included all the information from that file. I am considering canceling the angiogram to allow for more time for consultation, but I would like to hear your thoughts on that.
Furthermore, I would like to arrange for you to conduct a formal review of my case, including an evaluation of the image data. If you believe this is the best course of action, please advise on how to proceed.
Thank you.
Hello,
Welcome back to icliniq.com.
Thank you for uploading the data (attachment removed to protect patient identity). You may upload more for my review, especially the EKG (electrocardiogram), stress test, and echo reports. I found it encouraging that you felt a bit better after taking these medications. They are potent and beneficial for patients experiencing intermittent heart issues like yours. These medications aim to keep you relatively pain-free and can also help alleviate anxiety.
It is important to take Aspirin as advised, as it will help your heart and veins in the long run. If you avoid strenuous physical activities and take your medications as prescribed, I am hopeful that you will continue to feel better. However, remember that none of these medications can reverse existing blockages, and we cannot do much to address that issue.
You may need to undergo angiography in the future if, unfortunately, more blockages develop, which is a possibility given the current state of your heart vessels. If you feel better, I recommend proceeding with angiography, as it will help us determine the extent and location of any blockages. If deemed appropriate, your cardiologist may perform angioplasty during the same procedure to remove the blockage completely. This would ensure that your heart receives a full blood supply as needed, significantly improving your quality of life.
The medications your cardiologist prescribed will enhance blood flow through your blood vessels and help alleviate discomfort. Lifestyle changes are also crucial in this regard. I encourage you to ask your physician for more details about these changes.
Your current active problems include type 2 diabetes with hyperglycemia, type 2 diabetes with hyperlipidemia, hypertension (high blood pressure), and hypothyroidism (low thyroid). With these conditions, it is essential to stay in touch with your cardiologist, as they are significant risk factors for heart disease. If your cardiologist suggests an angiogram, it would be advisable to go for it.
I hope this information helps.
Patient's Query
Hello doctor,
Thank you for the reply.
That sounds like good advice. I had a long talk with my brother-in-law today, who suffered a heart attack and subsequently had a stent placed. Even though he was much worse off than I am now at one point, he has gradually recovered to the point where he is doing better than I am right now. A friend of mine has also done very well after the procedure. This gives me confidence about moving forward.
I still wonder whether diet and medication alone might have been sufficient, but it seems you do not think so. I would like to send you the digital data for your review. I feel that I owe you or the company that runs this site additional payment for your services, and I am prepared to pay more, especially if you review the image data. Please let me know about that.
Thank you again, and regardless of the outcome, I will keep you informed about how things go, assuming I am able to do so. Do you think there are any questions I should be asking about the procedure? For example, I am curious about techniques, stents, the surgeon, odds of success, etc., or is it better to just move forward and rely on the decisions of others?
Hello,
Welcome back to icliniq.com.
Regarding your concerns about whether diet and medication might have been sufficient, they may have been adequate before the blockage, particularly in the absence of other risk factors for heart disease, such as ischemic heart disease. I support your decision, and your cardiologist can provide you with more informed insights about how safe and successful this procedure is today and in the future. I hope your hospital's cardiology team is among the best, and you can rely on their expertise.
I wish you the best, and please keep me informed. You are always welcome to reach out for any future consultations as well.
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Answered byDr. Muhammad Majid Hanif
Medically reviewed byDr. K. Shobana
Same symptoms don't mean you have the same problem. Consult a doctor now!
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