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Recurring chest pain. Numbness in arm. Had heart attack. Taken Lopressor and Norvasc

Subsequent to NSTEMI heart attack 20 weeks ago with elevated troponin but no CA blockages found in two cath studies (nothing meriting PCI/stenting), I was placed on low-dosages of Lopressor, Norvasc , ASA, clopidigrel(Plavix) and simvastatin with Nitrostat 0.4mg PRN for chest pain. The cardiologist has discontinued the Plavix and the Ca-channel blocker (originally prescribed by another cardiologist one week after my first admission on the suspicion that the recurring chest pain may be vasospastic in origin, i.e. Prinzmetal s. The pain is never related to exertion, rather it occurs during the night awakening me or occasionally just before hour of sleep or shortly after awakening (unstable angina?) To rule out the possibility that we were chasing the wrong thing, my cardiologist prescribed a course of omeprazole (PPI) and when pain recurred shifted to trial of ranitidine ( histamine H2 antagonist ). Recurring chest pain, often associated with numbness in left hand and/or pain in left arm, is always relieved within one to three minutes following use of Nitro. If, in fact, these episodes are gastroesophageal in origin rather than cardio, would you expect the Nitro to be so consistently effective? I lie flat on my back with legs elevated after administering Nitro and this does not interfere with effectiveness in resolving the pain.
Asked On : Sat, 17 Nov 2012
Answers:  1 Views:  113
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Cardiologist 's  Response
Thanks for writing in.
I am a qualified and certified cardiologist. I read your mail with dilgence.
However, according to world health organisation diagnosis of MI (whehter ST elevation or Non STelevation) in your case Non STE infarct should satisfy 2 out 3 of the following crieria:1. Typical Retro sternal pain, deep squeezing, central going towards jaws or radiating towards left arm associated with shortness of breath and symptoms like sweating. Pain, unless treated, ought to continue for >20 minutes. You did not have this. 2. Elevation of cardiac enzymes, serum myoglobin, Serum Creatine Phospho Kinase MB fraction (CPK-MB) or Troponin T or Troponin I levels elevation. Reports of these must have been awaited.3. Typical EKG changes where ST elevation suggests ischemia, initially tall T waves occur in hyper acute stage later on these get inverted and q wave suggests necrosis (which can occur in absence of q wave also). Therefore, you have a borderline EKG. No enzyme changes, therefore, my personal view is diagnosis is dubious. Symptoms you describe are more likely those of Gastro Esophageal Reflux disease (GERD) for which you are taking partial treatment. Please ask a direct question or premium question your queries can be answered and you can attach your EKG also. Good Luck.

Dr Anil Grover
Answered: Sun, 18 Nov 2012
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