35 year old pt having mild chest pain last 2 year and feel breathlessness and more lain in chest after 50 to 100 meter walk. pt do not any work last 2 year. pt on atrovastatin 20 mg last one month but no relief this tablet start after lipid profile. bp 110 /70mmhg pulse 85 /minute spo2 98% GMT and echo cardiography report are attached. respected sir/mam suggest rx.

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I don't feel pain chest is cardiac in origin. This looks to be simple angina or CAD. His stress test is negative except vent extra systoles.rest of vitals are normal.better put him on rousavastatin+clopidogril+aspirin150mg one tab daily and watch in followup.also look for bsl and support by antacids and ppi
Ventricular ectopics. Uncommon in 35 yes but however angiogram is well appreciated , mean while start on Verapamil Hcl 40mg bd +Metaprolol SR 25 mg od HS + Ecospirin 75 mg in the afternoon after meal + Jogging, cycling or early morning walk
Dyspnea on exertion (NYHA Grade 3) with VPC's s/o irritable myocardium.... I think we shd do holter monitoring in such a young patient to see any evidence of Arrythmia occuring intermittently with presence of any Aberrant pathway
S1q3t3 appearance pulmonary embolus / confirm hrct ct chest / d dimer test / rx low molecular wt heparin sub cut. Ff by warfarin or the newer noacs epixaban / plum embolus stockings
Thanks mam
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X ray chest is important.Give Augmentin cap 3 times a day Warm water sips and paracetamol.X ray report ?
Advice for coronary angiogram and put him on isosorbide mononitrate 30 mg od
Angina of efforts. Monotrate, amlodipine, statin .confirm diabetes ,
Advocate coronary angiography echo cardiography
Angiography immediately. don't waste time
Its a case of ventricular ectopics.
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