Need to consult a cardiologist
Please refer to the detailed answer below
After going through the medical details provided by you I can understand your concern for your husband's health and before giving any opinion I would like to know the results of the nuclear study that has been done lately.
Kindly upload the report image or write in detail about the summary of the results.
Dr Bhanu XXXXXXX
(NM Myocardial Perfusion Spect/CT Stress) Hx of CAD with previous bypass
(NM Myocardial Perfusion Spect CT Rest) Hx of CAD with previous bypass
TECHNIQUE: Multiple tomographic images have been obtained following a
standard dose of Tc-99m Tetrofosmin injected intravenously at rest and
again after dipyridamole stress test. Both non-gated and gated images have
been generated. Both supine and prone images have been obtained. .
TECHNICAL FACTORS: Good quality gated tomographic myocardial perfusion
images acquired following dipyridamole stress and at rest.
LV EJECTION FRACTION (%): > 65% > 65%
LV END-DIASTOLIC VOLUME (ML): 36 ML 37 ML
LV END-SYSTOLIC VOLUME (ML): 6 ML 7 ML
TRANSIENT ISCHEMIC DILATATION: Visually not present.
1. MYOCARDIAL PERFUSION:
- Rest and stress images demonstrate a mildly partial reversible perfusion
defect present involving the distal inferior and inferoapical segments.
This is likely related to a combination of attenuation artifact with
contribution of counts from the adjacent gut activity. However, a mild
ischemia involving the distal RCA territory cannot be excluded.
- Elsewhere, no other reversible perfusion defects were identified.
- No evidence of scar.
2. LV FUNCTION: REST - Normal LV size and ejection fraction. Normal wall
motion and thickening.
POST-STRESS- No significant change compared to rest imaging.
***** FINAL REPORT *****
First of all my apologies for the delayed response.
After summarising the medical history and all your reports one thing which I have noticed is that there is no anti-anginal in the medicine prescription which your husband is taking so adding up a nitrate is advisable.
Now as he has done all the stress tests without facing any difficulty or any chest pain so in my opinion the discomfort which he is having is quite unlikely to be because of the cardiac issues. Before focusing on the cardiac side I would like to suggest you to add up some proton pump and abettors like omeprazole or pantoprazole and completely avoiding spicy salty and fried food stuff To deal with his gastritis issue And if even after all this that his chest discomfort doesn’t resolve then getting a coronary Angiography done to confirm the patency of the grafts is highly advisable.
I hope this information will help you decide the right path.
Dr Bhanu Partap
Yes he is taking notoglycerine sos and omeprazole 1/day as mentioned in my clinical details
When the chest pain comes he takes the PPI and nitro glycerine together and is difcult to say which one relieves the pain after say..... 15-20 mts to sometimes a couple of hrs.
And as u must be knowing nitro can relieve esophageal spams also?
Can GI pain produce left shoulder radiation?
Not common but yes small proportion of patients who had esophagitis does presents with symptoms very typical of angina including shoulder radiation of pain.
Why don’t you try giving him ppi alone first and see whether it responds or not. If it does then it’s clear that underlying esophagitis is the cause. Otherwise you should definitely consider getting an Angiography done.
Dr Bhanu Partap
Thanks for your advise
Then with all due respect Ma’am we both know getting an Angiography is the only answer to this question.
Go ahead with it and it’s highly likely that it’s gonna come normal. At least then you can spend time at peace without worrying for angina.
Dr Bhanu Partap
Does angiogram after 2 yrs after cardiac bypass carry and increased risk during or after procedure ?