I'm a 54 year old male. I have adult onset diabetes, which is being controlled by diet. I had a thallium stress test a few weeks ago that was ordered by my doctor after I told him about an episode of chest pain. The only symptom I'd had was chest pain and it was not related to resting or exertion. The doctor ordered the test as a percuasion. The test came back positive. The cardiologist felt the results showed what might be a blockage in an artery at the bottom of the heart, near the rib cage. He couldn't be sure that there was a blockage, but seeing as the blockage showed only after exercise he felt there was a blockage. He said that the only way to be sure would be to perform an angiogram, but he felt the defect was so minor that even if something was found he would probably recommend not doing anything. He prescribed baby aspirin with no follow up.
Yesterday, I went back to my doctor to get a medical clearance for surgery to repair a deviated septum and remove polyps from my nose. The doctor said, because of my history of diabetes, and this newly discovered heart disease he recommended that I postpone this elective surgery, and prescribed ATENOLOL, I'm not sure if it was 50 or 100 mgs.
Can you explain why he is prescribing a beta blocker when the cardiologist only prescribed aspirin. I've had no problems with blood pressure, angina or other conditions that ATENOLOL is usually prescribed for. I really don't want to start taking it after reading some of the side effects and finding that there may be problems if I stop taking it.
Dear Bill, thank you for your question. Diabetes is a major risk factor for
coronary artery disease and we therefore aggressively treat diabetics and pursue
a diagnosis of coronary artery disease. In your case, your stress test suggested
that you have a blockage in the right coronary artery that supplies the inferior
wall of the left ventricle (bottom of the heart). Stress tests are known to be
accurate 80-85% of the time in the best case scenario. It's hard to determine
just from a stress test whether a blockage is minor or severe and what that means
for someone's prognosis. Aspirin should be given to all patients with suspected
coronary artery disease because it inhibits platelet function to reduce the chance
that a clot will form at the site of a blockage to cause a heart attack. Beta
blockers slow the heart rate and reduce blood pressure to also reduce the
chance of developing a heart attack. Even though you only had one episode of
chest pain, your stress test suggests a blockage; that's why your doctor prescribed
a beta blocker. Diabetics often don't experience chest pain with known
blockages or have atypical symptoms since the nerves supplying the heart are
affected by diabetes and don't work correctly. Since your elective nasal surgery
was cancelled due to your stress test result and since you were started on a beta
blocker which you have legitimate concerns over, it seems that a more definitive
diagnosis should be made. The only way to tell for sure if you have a blockage
is to perform an angiogram / heart catheterization to directly image the coronary
arteries. If a blockage is found, a number of different treatment options could
be considered. It is difficult to make an accurate prediction of the severity or
prognostic significance of a blockage soley on the basis of a stress test.
Your lipid and cholesterol levels should be checked and aggressively treated
if they are elevated since hyperlipidemia also is a major risk factor for coronary
disease. Thus, angiography may help clear up many issue with your health care
at this point. I'm not sure why your cardiologist didn't put you on a beta
blocker but you should speak with him and relate your concerns. I hope you find
this information useful.
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