Question: Hello,
This query is related to patient recovery after LAD stenting (80% blockage). 1 stent (ABSORB). Age 45, male. OSA (using CPAP daily for 4 yrs, under control). Smoker for 25+ yrs, quit 1 wk before stenting. No alcohol since procedure, 4 units per week before that.
2 months have now passed since angioplasty, currently on PAN 40, Ecosprin 150 and Prasita 10 mg. Following hospital diet chart religiously.
Weight at time of procedure was 83 kg, now 76 kg after 2 months. Weight loss rate reduced significantly recently - less than 1 kg in last 2 wks.
Q1: Frequent shortness of breath (almost every other day, mainly late evening/night but happens during day as well), continuing from 1 wk before procedure (when heart medication started). No such symptom earlier to that time (blockage discovered during preventive health checkup, positive TMT; no chest pain or shortness of breath). Visited hospital emergency multiple times since procedure (4-5) on such occasions. Vitals/ecg found normal each time (ecg always has ST-T changes in leads v2 to v4, which apparently is normal for the patient). Hence heart related cause ruled out by doctor. Pulmonary Function Test also done, found normal. Recent sleep study repeated, some minor CPAP recalibration done. However shortness of breath continues. When occurring, does not necessarily increase with exertion (sometimes yes, sometimes no).
How to find out if the shortness of breath is a medication side effect?
Note: shortness of breath was accompanied by a feeling of extreme fatigue earlier. Recent blood tests to diagnose extreme fatigue (result of latest hospital visit) found deficiency of vitamin B12 and D. On medication thereof for 2 wks ... feeling of fatigue in the evening less now.
Also, no chest pain. Only some hard (slow) palpitation approx 1-2 hr (only) after breakfast on some days, seems on those when weight training is done in the morning (see Q2 below) lasting less than 15 secs at a stretch, and happening 2 or 3 times XXXXXXX within a span of 10 to 15 mts.

Q2: Walking twice daily to lose weight. Between 35 to 50 minutes each. Also started slow running for last 3 wks (once daily, along with walking), And started 15-20 mts of light weight training for last 2 wks, in the morning.
Question: Is light weight training ok at this point? With 2.5 kg dumb bells, for 20 mts 5 days a week? Could that be resulting in palpitations 3 hrs after weight training (only slight shortness of breath felt at times during the training), i.e., 1-2 hrs after breakfast as mentioned above?

Thank you for any response basis the data provided.

Hello Doctor,

Thanks for your response.

Latest ECG report has been uploaded. This was done when the patient visited hospital emergency on 12th September, with breathing problems and extreme fatigue.

Also, please note that patient's BP has consistently been 120-130 / 70 - 80. Same has been measured once a week on an average since the angioplasty in end July'13, during normal post procedure follow-ups as well as during emergency hospital visits (due to shortness of breath and fatigue).

Lastly, to further clarify, the modified summary would probably be:
Patient has frequent shortness of breath, sometimes at rest and sometimes (NOT ALWAYS) on mild to moderate exertion, and is under treatment for IHD AND OSAS.
Patient also experiences occasional hard (NOT RAPID) palpitations late mornings, approximately 1-2 hours after breakfast and 2-3 hours after morning exercise.
[ Never earlier or later in the day ]. From a timing perspective, patient has been experiencing such palpitations after commencing slow running plus light weight training. Palpitations have not yet happened on days when patient has only walked in the morning.

Patient Queries:

1) Is it possible to experience shortness of breath due to the medication: PAN 40, Ecosprin 150 and Prasita 10 mg (plus Atorlip F which the patient has been on for past 5 years)?

2) Given the morning palpitations or even otherwise, is light weight training fine at this point (after 2 months of angioplasty procedure) from a cardiac perspective? Light = 2.5 kg dumb bells; 20 minutes per day X 5 days a week

Many thanks in advance for your response to the specific queries.

Hello Doctor,
I have uploaded the report, hope it is the right one.
Regards

Sorry, Doctor. I do not have an Echo report post stenting. Is it customary to get one done within 2-3 months after the procedure? What other tests should also typically be done in that timeframe?

No problem for the delay.