Q: My father is 53 years old, weighs 84 kgs and his blood pressure is 120/90. He does not smoke or take alcohol. He takes the medicines: Foracort 200MG - 8AM & 8PM and Unicontin 400MG - 8PM for asthma. He has hypertension since 5 years. He suffered severe chest discomfort and was advised an angiography. The report: TYPE III CAD – Triple vessel distal lesion in LAD proximal lesion in D1 – 50 TO 70%. PVL branch lesion OM1 – 60-70% lesion. He was then advised PTCA + Stent to OM1. The PTCA report: dilated with 2mm and 2.5mm world pass balloon, no dissection, mild residual. In view of small calcified vessel and acceptable POBA result, stent was not deployed. Still the patient is suffering from chest discomfort. Second time angiogram was performed at the Apollo hospital, Hyderabad and also stress thallium test was done. The test result was negative. Still the patient was suffering from chest discomfort / tightness. A third angiogram was done and no change in the vessels were seen. The following medicines are advised: Angigem cd 10mg, Imdur 60 mg, Nikoram 5 mg, Zosta 20 mg, Plagril 75 mg, Sorbitrate 5mg SOS and Prothiadine 25mg. Even after all the above tests and using the medicines the patient is still getting chest discomfort / tightness in the heart.

A:Chest pain is a very common complaint, and sometimes when no cardiac source can be discovered, it is reasonable to call it Da Costas syndrome, or a variant of this such as Tietzes syndrome. In either case the treatment may be local chest massage with an embrocation to relax spastic muscles, or the use of an oral medication for pain (a muscle relaxant or an analgesic) or an antianxiety / relaxant. Some physicians advise injecting the chest wall at the site of the pain with a local anaesthetic or a steroid, or even doing a nerve block of the intercostal nerve. A similar and less hazardous approach would be acupuncture if given by an expert in Chinese medical practice. Many patients with chest pain end up receiving multiple hospitalisations or undergoing repeated expensive investigations, and face the danger of having a real problem overlooked if wolf has been cried so often that it is difficult to recognise the real new problem should one happen to occur.