Ask your GP Maarten: Medicines for chest pain

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 and writes about medical facts.

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• Overweight
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Dear Martin,

I am H. and am 72 years old, live in Thailand, have been on medicine for chest pain for years. The last year when I go to bed I am panting and that is over after a few minutes. Tired quickly with exertion.

According to the doctor here, my heart muscles are going in well, but they are going out too slowly. But my heart is otherwise good. That's why I get tired quickly, he says. Now he is trying to solve it with other medicines.

My question is, are these drugs all necessary? My lung capacity is 3 liters but this has been the case for 40 years.

• Drink almost no alcohol
• Don't smoke either
• 5 kg too heavy
• Blood pressure 120/70

I use:

• Omeprazole 20 mg every other day
• Rebamipide 100 mg (but I have no stomach problems so I don't think it's necessary).
• Nebivolol 5mg
• Losartan 50mg
• Pravata 20mg
• Harnal 0.4 mg

Regards,

H.

******

Dear h,

To start with the Rebapimide. This is an old remedy with limited effectiveness. You do not have stomach problems because you are taking Omeprazole. Because rumors have been surfacing lately that Omeprazole can cause osteoporosis (bone loss), I recommend a scan and a DEXA (DXA). Measuring osteoporosis with MRI is highly exaggerated and does not give better results.

Treatment for osteoporosis is simple and can be done with a biphosphonate. There are several of them. The newer ones are easier to use but no better than, say, Alendronate. It is not necessary to have a scan done every year, because breakdown and recovery are normally a very slow process. Once every three to five years is sufficient, unless there are exceptional circumstances that speed up the process.

However, that was not your question.

You take three drugs that affect blood pressure:

• Nebivolol (a beta-blocker with vasodilator properties)
• Losartan is a so-called ARB (angiotensin II receptor blocker).
• Harnal (Tamsulosin) an alpha-blocker, usually used for the prostate.

If your cholesterol is not extremely high, you can omit the pravastatin. As a prophylaxis it is useless above 70 and can cause more trouble than good.

Perhaps a calcium blocker such as Amlodipine could be given instead of the Losartan. This gives the heart muscle more air. The disadvantage is that many people get headaches in the beginning.

First, however, I would do an exercise test to measure heart function and possibly a coronary angiography to view the coronary arteries. Without that, it's gambling.

Concerning your overweight: Recently it has been found that people who drink alcohol moderately between the ages of seventy and eighty, drink coffee and are moderately overweight live longer and better. That is taken back.

Yours faithfully,

Martin Vasbinder