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Saturday, June 13, 2009


Posted by Prahallad Panda on 9:39 PM 1 comments

Coronary circulationImage via Wikipedia
Some eleven years back one known to me asked about his relative who was getting pain in his left shoulder and becoming breathless while walking.The presumptive diagnosis was somewhat straight forward.And an ECG revealed that he is suffering from Myocardial Ischaemia.The typical description of angina pectoris pain is a feeling of severe compression of chest ,a squeezing or a sharp pain in the left lower chest lasting for minutes and radiating to neck,shoulder tip,axilla,Lt. arm,back,right side of chest and upper abdomen.Unfortunately this typical description is lacking in many.

Other symptoms of Myocardial Ichaemia include sweating,breathlessness,stupor,fainting , vomiting and many other atypical ones.
But in a physically active person with regular brisk walk having some burning symptom of upper abdomen and normal ECG in two different occassions ,it is hard to digest that he is suffering from myocardial ischaemia.But later his description of this burning sensation and discomfort of upper abdomen while walking, compelling him to take breaks two to three times in about two kilometers distance should have given rise to suspicion of ischaemia.
Eventually an ECG on that day revealed a change in ECG prompting an urgent treatment.Further an angiography revealed narrowing in one of the branches of a main coronary artery and he was treated according.Also it was noticed that the artery in question was little less in caliber than usual.During review of literature in the Wiley Interscience database it was seen that narrow coronay may go for spasm.And I think this must be happening during an exercise while there is demand for more oxygen in the myocardium i.e. heart muscle.

But the lesson is that highest degree of suspicion till ischaemic heart disease is excluded 

My heart, my leads applied to my body with my ...Image via Wikipedia

This blog, the 100th post is dedicated to my senior colleague Dr.S.Patra and my elder son Sipun the author of
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