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Feeling fatigue, tightness in chest and shortness of breath. Family history of A-Fib. What's wrong?

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I have been having tightness in my chest and shortness of breath and fatigue with exercise, especially walking up stairs and hills. Echo cardiogram and treadmill stress test are normal. My doctor gave my some nitro pills to try and they seem to work.(taken only prior to exercise) I don't have HBP and my weight is normal. I m 66 years old and in good shape, otherwise. My mom, brother, and sister have A-fib. I don't, but do have increased heart palpitations when exercising more heavily. My cholesterol is 217.
Posted Sat, 9 Mar 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 4 hours later
Hi friend,
Welcome to Health Care Magic

Your past history doesn't seem to have any relation to the problem now.
Your family history of A-Fib is not the same as and has only indirect relation to - history of Coronary Artery Disease (CAD).
Your present history of BP / weight sounds well.

Your complaint of tightness on effort is highly suggestive of CAD.
Relief by ‘nitro’ is also supportive, but not conclusive – spasm of food pipe may also be relieved.

Negative ECHO / and negative exercise test – in particular – is reassuring.
However, there may be false positives at times / and in view of the typical symptoms, it is better to do more tests.           
The next step is repeat stress test – TMT (Treadmill Exercise ECG) with thallium isotope – will be the ideal way to evaluate ischemia. Stress ECHO helps too. This is to assess the physiology (function).      
If there is any suggestion, the next step is to see the anatomy – CT angio is non-invasive study for the anatomy / If suggestive, one needs to undergo catheterisation and coronary angiography with a view for possible intervention. Coronary arteriography is invasive but it is the gold standard for this.

Apropos palpitation, HOLTER (24 to 48 hour ambulatory monitoring) is to be done to analyse and plan for further management, if a routine ECG does not show,

Your cholesterol is borderline.
You need to have life style modifications – diet and exercise.
Recheck in 2 months – if still high, you will need drugs like statin.

Keep following up with your cardiologist / Internist. They are doing good job and you are sound positive.

Take care
Wishing speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Feeling fatigue, tightness in chest and shortness of breath. Family history of A-Fib. What's wrong? 15 hours later
I have not yet seen a cardiologist. Although my echo and ECG were done at rest, and were normal, my primary care doctor didn't feel further testing was warranted, but since my symptoms occur while doing physical activity I asked if a referral to a cardiologist might be helpful. I also have been having a morning cough. I live in a rural town and would be willing to travel to Portland Oregon where more advanced testing is available. How can I best convey this to my PCP as my symptoms are now occuring more often. I don't want to give up my daily walking routine which is 3-4 miles a day. (nice to be retired). Since microvascular disease occurs more often in women of my age, is it just a presumption that the only treatment is with nitro for episodes, since it seems to work, at least in the short run?
Answered by Dr. Anantharamakrishnan 5 hours later

There is nothing wrong in continuing the ‘nitro’ – if one gets relief.
There are long acting preparations that can be used on a regular basis / in addition to the immediate acting ones used as rescue, during the episodes.
It can also be used in expectant situations – prophylaxis.

Other drugs could also help.
Aspirin (75 / 100 mg) prevents clumping of platelets, which leads to blood clots.
It helps in long term.
There are other drugs like beta-blockers.
Discuss with your doctor.

Increase in severity or frequency is an indication for early investigation.      
Appropriate treatment demands proper diagnosis.
Diagnosis depends on investigations.
Resting ECG does not exclude the problem.
If the history is suggestive as in your case, a normal resting ECG itself is an indication to for exercise ECG.
Without the tests, the diagnosis it guess work – and treatment based on guess is like building castles in the air..
One should not miss a treatable condition - after all, the purpose is to prevent heart attack / improve length and quality of life..
Micro-vascular disease is an exclusion diagnosis – if the coronary angiogram does not show epicardial artery narrowing.
It is better to do the test and know than keep guessing and threat of a possible is better to be safe than sorry.

Above answer was peer-reviewed by
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