Frequent Heart Attack Symptoms .. is there a diagnosis !!

[dr_amro]

السلام عليكمـ

hi doctors ,

this is a case that i met by chance on a medical site wrote by a patient
while am was reading it , i feel it complicated
and tried to solve it's puzzle rapidly but in vain

but still trying to find a solution or at least some sort of right medical describtion of the case that the brain accepte as we are doctors

I try some explanations after a long time of search on the internet and cardiology textbooks that I will tell during our discussion here

plz don't easitate the case
try to take it seriously as it may encounter us during our expremintal life as a physician
and at all we will be mustly responsible to give a right diagnosis or at least pring the patient on the safe and right side of treatment and psychic comfort

that was the case


Age: 53
Sex: Male
Past Diagnoses: See below
Past Surgeries: None
Family History None
Current Medication: 25 mg Atenolol,10 mg Amlodipine “Norvask”, 10 mg Lipitor, .5 mg Clonazepam.

Over the last several years I have been admitted to the emergency room several times with heart attack symptoms. On these occasions diagnostic testing has ranged from blood tests for enzymes and x-rays to a cardiac cauterization. My PCP keeps on top of this problem and recently noticed that my EKG was showing a slow recovery. I was sent back to my cardiologist who I have a great deal of faith in and he performed an echocardiogram and Thallium stress test once again. At the beginning of the test the EKG monitor registered a V2 level warning however, as my heart rate climbed to 135 BPM “4.5 MPH 13 Degree Incline” the level normalized. My echocardiogram showed that my heart was very strong. These attacks continue off and on yet all I know is that the testing shows no damage to the heart or occlusion of the arteries. It seems that my cardiologist feels that I am in no danger and mentioned that the EKG can be misleading and that the echocardiogram and Thallium stress were the best source of information: Can you add any additional explanations for my condition. Blood Preasure is controlled " 134 / 76 today"

what's your opinions ؟

is that a normal case
or there may be some thing invisible not reached by his doctor

try to discuss

thx alot

[dr_amro]

where r u all ؟؟

[DrNour/Nour]

Here but thinking
a_h



السلام عليكم ورحمة الله وبركاته


This case is very useful and complicated to us not to the pt , dr amro

First , My openion not against the pt cardiologist

Why??

AS,,,

1/ Although the pt has recurrent heart attacks ,but controlled early at the suitable time successfully .

2 /The patient also is at high risk for cardiac and coronary diseases
( notced that from his medication history that used to control HPN (Atenelol,NORVAS )
AND hypercholestrol (Liptol) AND (Diazepam) , anti stress and anexity .
and Although that he is allready controlled (near normal Bl Pr 134 / 76 )


Hence , My openion , not to worry the patient and not ignor him
but give him the instructions needed to prevent him from another heart attack
( simple exercise , control diet , drugs ,,others .



Consequently, the patient's condition is normal at this time ,compaired to his history ,but need more observation .


thanx dr amro
waiting more cases
but in pediatrics

[dr_amro]

ok dr nour
am with u that the doctor doesn't fail in his managment but what about that frequent attacks .. that reccure the pt. it should have an explanation .. and the explanation must be present for no further attacks

what about the printzmetal's angina

a form of coronary artery spasm which is not always associated by coronary artery blockage and can occur in otherwise perfect normal heart
here one coronary artery may intermittently go into spasm and when this happens the classic symptoms of heart attack will appear
also with the classic changes in ECG like S-T depression and within maximum 20 minutes the symptoms subsides and the case return fully normal
and so the case may be missed as even with stress ECG the coronary may not be showing the classic spasm to cause ECG apnormalities

so i think that the patient's doctor should done him a provocative test during the angiography by introducing a drug into the suspected coronary which induce the suspected artery to reproduce the spasm
and the case is diagnosed so


that may be an explanation

what's ur opinions ؟؟