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Dr. Andrew Rynne

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48 years old, overweight. Why do I feel breathlessness while walking or climbing stairs?

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Dr. Anantharamakrishnan

Cardiologist

Practicing since :1966

Answered : 4506 Questions

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Posted on Wed, 30 Jan 2013 in Hypertension and Heart Disease
Question: Hi Doctor,

i am 48 yrs old, Indian male. Married, non-diabetic, do not drink or smoke,177 cm tall, weigh 84 kgs. I sometimes feel breathlessness while walking fast or climbing stairs.

Patient could exercise for 07 minutes and 24 seconds of the XXXXXXX Protocol and achieved a workload of 8.90 mets. He attained a peak heart rate of 164 beats/minute which is 94% of the predicted maximum. The exercise was terminated owing to attainment of target heart rate. There was no classical angina. Clinically the blood pressure response shows mild increase from 120/70 to 140/70 and there was no S3 and S4 gallop in the recovery period. In the pre exercise there was no significant ST segment change. At peak exercise there was 1.5-1.6mm ST segment depression in leads 2,3 aVF and 0.4 – 1.2 mm in leads V3V6. Increased ST segment response appeared in the 3rd-4th minute of the exercise at the heart rate of 130bpm and lasted for 1-2 minute into the recovery period.
E0sinophils was 20,
Cholestral-serum /plasma : 170
Triglycerides : 70
vldl cholestral - serum 4
hdl cholestral serum plasma : 28
total cholestral hdl ratio : 4.4
ldl cholestral ( direct) - serum/plasma : 92

mildly positive ST segment response. good exercise tolerance.
doctor
Answered by Dr. Anantharamakrishnan 8 hours later
Hi friend,
Welcome to Health Care Magic

You are OVERWEIGHT.
Your LDL CHOLESTEROL (bad cholesterol) is normal; it could be lower – down to 70!
You will benefit from Life style changes – Physical ACTIVITY & reducing / low cholesterol DIET.

TMT (Tread Mill Test) is positive – depression mm or more / 80 millisecond beyond J point.
That is an indication for further work up.
Occasionally there may be false positive or false negatives.
The best solution is Angiography. It is the only way to directly ‘see’ the block, if any – and its location, extent, severity and so on. It is the gold standard against which all other investigations are compared. Why are you opting for non-invasive investigation?
     
An alternative thing to do will be to repeat the stress test with Thallium isotope – Thallium stress TMT – to see whether the blood arriving at the heart muscle. / CT angiogram (124 slice or higher) can show the anatomy of blood vessels

The aim of any investigation is to modify the treatment, based on the result. Intervention – dilatation with balloon and placing a stent (Angioplasty) - or CABG (Coronary Artery Bypass Graft) may be advised based on the results.

Aspirin in small doses helps – acts on platelets and helps to reduce clot formation.
You may also benefit from statin and Beta-blocker...
Your treating doctor will prescribe appropriately.

Take care
Wishing speedy recovery
God bless
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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