Ask general practitioner Maarten: Angina pectoris with too much effort
Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand.
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Dear Martin,
I am 66 years old, BMI 24,9, blood pressure 130/80. Use Fluoxetine 20 mg/day and a small amount of fresh Turmeric every day. Now in the last month I have had an attack of stable angina pectoris 3 times with too much exertion.
An ECG heart and X-ray chest were made yesterday, they looked good. Isosorbide dinitrate from the doctor.
Now I am considering taking the anticoagulant carbasalate calcium 100mg (if available in Thailand). Is that a good idea?
Yours faithfully,
F.
*****
Dear F,
On a resting ECG you cannot see whether there is ischemia (too little oxygen) for the heart. An exercise ECG is the gold standard for this. Fluoxetine can cause heart problems.
To see the coronary arteries, one can make a cardio resonance.
Stable angina pectoris means that you have no complaints at rest.
The lung x-ray is good to see the lungs and the heart shadow.
Fluoxetine is an antidepressant that does not work. That has been sufficiently demonstrated. Fluoxetine can cause heart problems
However, stopping is very difficult and you can only do that by reducing very slowly. For example 20 mg every 3 weeks, or even slower.
Isosorbide dinitrate dilates, among other things, the coronary arteries, so that the heart muscle can receive more blood. Side effects include headache.
More convenient is nitro spray for emergencies. The nitrate tablets for under the tongue quickly lose their effect.
Carbasalate calcium is not available here. Well Aspen 81 for example. That's aspirin. Works just as well.
Yours faithfully,
Dr. Maarten