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Chest pain recurred

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Old 09-18-2012, 09:47 PM   #1
Join Date: Sep 2007
Location: Tunbridge Wells, Kent, UK
Posts: 65
asc01 HB User
Question Chest pain recurred

I 'm 66 and have had Type 2 diabetes for about 2 years, and hypertension for about 6, also raised cholesterol. My untreated BP was around 180-200/110-120 - so not good! Back in 2007 I was getting quite a bit of chest pain and was investigated, but with treatment my BP fell to around 115-130/65-80 and I had no problems. (At this time I was not diagnosed with diabetes. I have had a mild cardiac murmur since childhood, but this is considered insignificant.

There is a strong history of hypertension - both parents had it severely, several aunts and cousins were hypertensive and died of heart problems. My father had several heart attacks from age 60 and died of left ventricular failure. My mother had congestive cardiac failure.

Investigations in 2007
Treadmill stress test
Radio-isotope stress test - very slight narrowing of LAD, but considered
Echocardiogram - mild left ventricular hypertrophy, presumably from BP

Over the past couple of years my BP has been rising, with my diastolic consistently above 85, and I was surprised that my GP only made one change to my medication. This last couple of weeks the chest pain on exertion or stress has returned, sometimes radiating to my neck. Yesterday my BP was 145/95 and I asked if I could add propranolol - also for my essential tremor.

I should like my BP to be below 130/80 as I have diabetes and a the above family history of heart disease.

My cholesterol is slightly raised at around 5.5. I had to come off simvastatin because of muscle pain, and was changed to bezofibrate 400mg daily. I've not had a cholesterol reading since then.

My blood glucose and HbA1c have been good.

Current main medication:
Adizem XL 120mg daily (diltiazem)
Lisinopril 20mg daily
Propranolol 40mg twice daily (added yesterday)
Bezafibrate 400mg daily
Metformin 500mg twice daily
Isosorbide mononitrate 10mg daily, increasing to twice daily (from 5 days)
GTN spray as required

My GP was unsure whether to refer me again today, but we agreed to see how things go with the added medication and review in a month, or earlier if there is no improvement.

Does this seem reasonable?

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Old 09-19-2012, 01:24 AM   #2
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Join Date: Sep 2011
Location: Orange County, CA, USA
Posts: 103
Michael949 HB UserMichael949 HB UserMichael949 HB User
Re: Chest pain recurred

Well, let's look over your situation

They knew about the murmur you had since you were a kid and decided you didn't need treatment, which I'm assuming is mitral valve prolapse that has not caused you any symptoms or gotten worse. That's good

You had a stess test which showed you are not likely suffering from coronary artery disease. Also very good

You're left ventricle is slightly enlarged due to years of untreated hypertension. When they see that on the echo, the only way to deal with it is to lower your blood pressure. And really, you should be making that a priority since you are a diabetic

The problem I see is that you are both on an ACE Inhibitor and a beta blocker, but your BP is still 145/90. I took Propanolol before and it's a very week drug. Ask your doc about atenolol - it's very effective for both lowering your BP and heart rate

The biggest issue you have is that you need to be under the care of a cardiologist. Although right now your situation isn't life threatening, I think the problems you have would be treated much more effectively by someone who specializes in cardiovascular diseases versus your general practicioner

Old 09-19-2012, 11:18 AM   #3
Join Date: Sep 2007
Location: Tunbridge Wells, Kent, UK
Posts: 65
asc01 HB User
Re: Chest pain recurred

I only started the beta blocker yesterday. Home checking of my BP today shows that it is coming down. The reason for choosing propranolol over atenolol is that it is also the most effective beta blocker for essential tremor - more so than atenolol etc. I am being reviewed in four weeks and if I am still having discomfort then I am having an urgent referral.

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chest pain, diabetes, high cholesterol, hypertension

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