Brief Answer:
My opinion as follows

Detailed Answer:

Hi,

Considering your situation, it is important performing a comprehensive differential diagnosis between GERD and mild myocardial ischemia (as detected in your myocardial SPECT).

For this reason, I would first recommend adding a PPI (omeprazole, pantoprazole, etc.) which can help against GERD.

I would also recommend adding Clopidogrel and nitrates (isorbide 5-mononitrate) to your actual therapy in order to prevent further cardiac ischemia.

It is also important increasing the dose of statins (if you are using a low dose).

As you know, a better management of blood pressure values, avoiding straining physical activity and a healthy lifestyle (Mediterranean diet, regular physical activity, reduce weight if you are overweight) are very important in slowing the progression of coronary artery disease.

If after all these changes to your therapy, the chest discomfort persists, considering the fact that you have an excellent cardiac function (despite your past history of CABG), I would recommend undergoing coronary artery angiogram, for possible coronary stenting if needed, in order to prevent further damage to the myocardial tissue.

I know that this is not what you wish, but I would encourage you to do it if necessary.

Hope you will find this answer helpful! I remain at your disposal for any further questions whenever you need!
Regards,
Dr. Iliri

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