Does chest discomfort require a repeat coronary evaluation?
You already had a bypass and a LAD stenting in past and now the symptoms of chest discomfort getting subsided with a Nitrate group of medication quite specifically points towards the need of a repeat coronary evaluation to make sure there is no significant progression of the atherosclerotic process.
Tachycardia and Chest discomfort and Gerd both can present in a similar way but only angina get subsided with a Nitrate. Also, cardiac evaluation should be done at first place to avoid any life-threatening event.
So its highly advisable that you should personally consult your cardiologist once and this the possibilities with him also and get evaluated.
Hope I have answered your query. Let me know if I can assist you further.
Iam being observed and monitored
1. My question was is there a way to conclude an angina or GERD when the ecg and cardiac enzymes are normal ? Or just nitrates is the only test ?
2. What do u say about tachycardia is a result or cause of chest heaviness ?
3. Up to what extent can u go to investigate the coronaries repeat angio?
I read the following information somewhere and let me know ur opinion on this article
‘Fortunately, the return of angina after coronary artery bypass grafting has minimal impact on survival and is not predictive of imminent infarct. (J Thorac Cardiovasc Surg 1998;116:440-53)’
many of patients who took NTG during GERD tend to report a relieve of symptoms
symptoms of GERD may be relieved by NTG, but never explained the real reason.
Nitro seems to make anyone everyone feel better regardless of the etiology of their pain. I've seen ppl with MSK pain, gerd, pleuritic pain, all say the pain was relieved with nitro.
In that instance the mechanism may also be different than what we think i.e. coronary vasodilation.
Yes, only a few patients do get relieved by Nitrates in GERD but on further evaluation, it was found that most of them had some degree of coronary involvement also, so the important point here as I already said is first to rule out coronary issues because that can claim a patient life, not GERD.
1. Coronary angiography is the gold standard to evaluate coronaries.
2. Tachycardia can be caused due to any sort of stressful situation due to sympathetic stimulation.
3. Repeat angio can be done any number of times if justified.
Hope I answered your query.
Dr Bhanu Partap, Cardiologist
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