Re: What should I do?

Posted By CCF CARDIO MD - MTR on June 19, 1998 at 21:34:39:

In Reply to: What should I do? posted by Roger Duffey on June 16, 1998 at 11:50:32:






I am a 45 year old male who is 5'8" and weighs about 275 lbs.  I have a
high stress job, I eat badly and don't exercise.  I just quit smoking 5
days ago and am taking Zyban.  I have high blood pressure and am on medi-
cation (Zestril or Prinivil).  I have been experiencing intermittent chest
pain and increasing shortness of breath since the first week of May.  I
have been trying to rest for
the past 3 weeks as I have been feeling worse.  The chest pain appears
after exertion or something stressful (no exertion).  I also have sleep
apnea (sleep study scheduled in 3 weeks), fatigue, and insomnia.  
I am terrified that I have emphysema, lung cancer and/or heart trouble.
I have refused to tell my doctor about this; I am afraid if I go in to get
a stress test, I will have a heart attack on the treadmill.
My maternal uncle has diabetes; I have no health history from my biological
father due to adoption.  I had a chest x-ray done last fall; a shadow
appeared on the film and the Dr. reported that it could be from an old
bout of pneumonia, which I've never had to my knowledge.
I am confused as to what should be my plan of action?  Thank you.



  _____
Dear Roger, thank you for your question.  I see from your reply on 6/18
that you were recently diagnosed with pneumonia.  However, I certainly
agree that you should have a stress test to rule out significant coronary
artery disease.  Coronary artery disease, also known as atherosclerosis,
is the most serious cause of chest pain and needs to be investigated or at
least considered when someone complains of chest pain.   Typical chest pain
in this disease is called angina and generally occurs with exertion when
the heart needs higher rates of blood flow but can't accomplish that due
to narrowings in the coronary arteries.  Anginal pain often travels to
the neck and arms and can be accompanied by nausea, sweating, shortness of
breath, and sometimes, vomiting.   The shortness of breath that you complain
of could be due to many different causes like sleep apnea, smoking, or from
a pneumonia.  Common risk factors for coronary artery disease include:
- Male gender  - Age > 65  - Smoking  - High cholesterol levels
- Obesity      - High blood pressure   - Diabetes  - Family history of early
coronary disease in primary relatives under the age of 55
It appears that you have multiple risk factors for coronary disease but that
doesn't mean that you're going to have significant blockages.  Some things
you can do to limit your risk of coronary disease would be to lose weight
(but only with a supervised program that includes exercise and dietary
monitoring and instruction), continue to avoid smoking, make sure that your
blood pressure is well-controlled, and have your cholesterol checked and treated
if it is too high (LDL cholesterol > 100 is consderied too high for someone
with multiple risk factors like you have).  There are rarely complications with
a stress test so you shouldn't have to worry about having a heart attack during
this procedure.  One medication I would recommend that you start taking now
is one adult strenth coated aspirin which would provide much benefit with
few side effects.  Aspirin helps prevent the development of a heart attack in
patients with coronary disease so we recommend it for everyone in whom we
are still trying to come to a diagnosis for their chest pain.  I would speak
to your doctor about your concerns about having emphysema or lung cancer
and he could rule out those diagnoses by evaluating your chest x-ray.  Good
luck with your stress test and with working on the risk factors that I mentioned.
Information provided in the heart forum is for general purposes only.
Specific diagnoses and therapies can only be provided by your physician.