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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What are the symptoms of heart attack?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6973 Questions

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Posted on Tue, 28 Apr 2015 in Hypertension and Heart Disease
Question: Patient is 64 years old female. Beginning of this year her pressure is fluctuation in the range of 180 or 170 or 160 or 140 over 90 or 80s. Doctor tried different medications but still dont work. She has history of hypertension and very anxiety prone.
Her routine chest xrays are always bundle block ekg with no signs of heart attack.
Recently her cardiologist did all basic tests like sonogram of heart, eco, etc and all is ok. But now he prefers to do a nuclear stress test. Now my questions are as follows:
1.The radiation that is used in nuclear test is ok?
2. If the test is not normal is the next step angioplast?
3. Is angioplast safe and what happens next ?
The bundle block ekg has been like this for years and another doctor told me that it is not a serious condition and leave it as is.
After doing stress test and angioplast , will her pressure be normal.
A doctor told me that for a 64 year old 150 over 90 bp is ok.

Please advise
Thanks
Mr XXXXXXX
New York
USA
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
Optimal treatment for high BP and rationale diagnostic tools are needed.

Detailed Answer:
Hello Mr Kumar!

Thank you for asking on HCM!
Regarding your concern I would explain that in treating hypertension, first we have to be sure we have excluded secondary hypertension (that is high BP caused by any body organ dysfunctions or metabolic disorders, such as renal, adrenal, thyroid disorders, etc even severe anxiety may trigger high BP). So, sometimes anxiety is shown to be the trigger and herald hypertension. Treating concomitantly anxiety in the appropriate way may help resolve better high BP too. Optimal anti-hypertensive therapy should be tried, coupled by other effective measures like lowering body weight, a balanced dietary daily salt intake, healthy diet (I would recommend Mediterranean diet), physical activity, a healthy life-style in general.
Regarding your questions I would explain:
(1) Radiation during nuclear stress test imposes a slightly increased risk for cancer to the patient. Newer imaging techniques and screening better the patient who really needs to undergo the test would reduce such radiation.
I would recommend first a traditional standard exercise stress test (though it is not as sensitive and specific as nuclear stress test) if it is feasible.
(2) Yes! If the nuclear stress test result is considered positive the next rationale test would be coronary angiography and eventually coronary angioplasty, if necessary and feasible.
(3) Coronary angioplasty generally is a safe procedure that offers a prompt blood flow restoration. There are some particular caution that should be considered, like taking after stenting a regularly scheduled anti thrombotic therapy as prescribed and periodic medical follow up.

Stress test and angioplasty help to detect and treat properly a possible coronary artery problem, but don't directly help to treat high blood pressure. So, the best thing to be done regarding hypertension is to proceed with an appropriate anti-hypertensive & anxiolytics therapy, and other measurements I mentioned above. remember 150/90 mm Hg is not OK for the 64 year old patient.

Hope to have been helpful to you.
Feel free to ask me whenever you need. Greetings! Dr. Iliri
Above answer was peer-reviewed by : Dr. Shanthi.E
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