Suggest therapy for asthma
Patient: Dear Doctor,   I am 31 years old, male living in Mumbai. I have had a brief history of heart diagnostic starting a year ago. I had applied for a life insurance policy with SBI for which I was asked to get a health check up done at a reputed hospital in Mumbai. The cardiologist over there took my ECG and said that he cannot do a stress test as I was suffering from a heart disease 'cardiomyopathy' and he said 'my heart is growing in size and I will need a heart transplant 10-15 years later'. He asked me to get an angiogram done. But I thought I was hale and health and I ignored his suggestion to get an angio done.   A few months later, I started getting some pain in the chest - sometimes burning, squeezing etc on the left part of the chest. It was not severe ever but mild pain. I went to a cardiologist (different one from the earlier one) and got an echo test and a stress test done. As per the reports, the echo test was normal while the stress test said "border line positive for ischemia". The doctor however said this is likely to be a false positive as there was baseline abormality in my ECG and asked me to come after 3 months if the pain persists. As it so happened, the pain continued to come on and off. In the meantime, my father was diagnosed with liver cancer and I shifted base to Bangalore. Since I was getting these pains, I wanted to get them checked thoroughly and went to a cardiologist in Bangalore. He saw the reports and said the same thing that it is likely to be false positive. He did an echo test and said it was very likely false positive. He also said that if the pain continues, he will recommend a stress myoview. Unfortunately my father passed away within three months of diagnosis and I moved back to Mumbai. I visited the doctor again as I started getting palpitations and the pain continued to come. He said that it must be due to stress and he continues to think it is false positive. He however said that for my own comfort, I should get a CT-angiography done.   I have read fair bit on the internet about all these tests and heart diseasees. I have read about all the risks involved in each of the procedures that have been recommended to me so far. I am not able to make out which is the right procedure for me.  I am allergic to pollen and get asthma while in Bangalore. In Mumbai I am quite stable. I use siroflo inhaler occasionally. Apart from this I dont have any other health problems. My BP usually is 130-140/80-85. heart rate ranges 75-95. My cholesterol levels are not that great HDL -31, LDL -142, triglycerides - 199. Let me explain you about my pain: 1. It comes at various ponts on the left chest 2. Sometimes it is a burning sensation, sometimes squeezing, sometimes pains the way a wound would pain 3. The pain is off and on - average 4-5 times a week and lasts for a few seconds 4. Sometimes when I exhale, I get a pain along a column inside the chest. Feels as if something is rubbing 5. It has never been severe; mild pain and I continue to do my daily work as usual 6. I dont remember getting any chest pain while excercising. 7. At times when it pains, I feel like moving my chest to avoid pain.  Can you please help me with what can be the cause for my pain and which test should I go for to know whether I have any heart disease or if yes, what is it? I have been an athletic individual for a long time. In the last 8-10 weeks, I feel my heart is pounding very hard and I can feel my heart beat a lot. I can see the left part of my chest shakes rhythmically with the heart beat.  Please do let me know if you need any other information regarding my problem.  Thanks. Doctor: Hello,Thank you for asking at HCM.I went through your history and would like to make suggestions for you as follows: (I will reply to you in a step-by-step manner)1. I should clarify that I should not suggest you any test for cardiac evaluation. These can be best suggested by cardiologists only. From your detailed workup, I can assume that at least two cardiologists believe that you are not having any significant heart disease at present. 2. I would like to know especially more about your allergies and asthma. This is because asthma can cause chest pains, an acute episode can cause even chest tightness. Not only that, an entity called "GERD" (gastroesophageal reflux disease) may be associated with asthma and it can cause burning type of chest pains.3. Hence, I would not interfere with your cardiac workup, but I would like to know - a. Since what age do you have asthma? What are the symptoms? What is the frequency of your symptoms? How you manage it? How was your asthma diagnosed?b. What are your nose/sinus symptoms? Do you have running nose, sneezing, nose obstruction, headache, facial heaviness, repeated throat clearing, etc? c. Do you have any symptoms like - regurgitation of sour fluids/foods after taking meals, especially after heavy/spicy meals or after lying down? Do you have sensation of nausea or vomit frequently?d. What are the medications that you frequently use or have used so far for allergies and asthma? What are any other medications that you use frequently/regularly?e. Is stress an important factor in your life?f. How is your digestion in general? DO you have repeated abdomen pains, constipation or diarrhoea?4. Above things are very important as - some of the asthma medications can cause palpitations, some of the asthma medications can worsen GERD. I would like to know whether you can correlate your symptoms with any particular drug/food intake.Hope above suggestions will be helpful to you.Should you have any further query, please feel free to ask at HCM.Wish you the best of the health ahead.Thank you & Regards.