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Question:

My grandmother has Alzheimer's. How can we best evaluate her chest pain?

My grandmother has Alzheimer's and she has been having pain in her chest for more than a week. This pain comes and goes. We fear she has a heart problem or a clotted vein. We went to many doctors but the problem is that the doctors don't know any type of examination that can be done for her because she has Alzheimer's and can't cooperate in the examination. Can you please tell me any possible way of finding if she has a clotted vein without the need for her to put forth effort? Thank you. 

submitted by Nadine from Egypt on 4/20/2013

Answer:

Michael J. Mihalick, MDby Texas Heart Institute cardiologist, Michael J. Mihalick, MD  

Dear Nadine, Evaluating medical complaints in patients that are unable to provide a history or cooperate is very difficult and frustrating. The chest discomfort that your grandmother complains about may not even be cardiac. You might get some clues by reviewing her past medical history. Is there a history of heart disease or gastrointestinal symptoms? An initial trial of ranitidine or prilosec should be considered. If she is hypertensive, she could be given a beta blocker such as metoprolol which would also be effective if the chest pain was cardiac. Simple over the counter pain medications such as aspirin or acetominophen should be tried and will not be harmful.

In this situation, the primary goal is to relieve symptoms without causing harm.  If one is suspicious that the pain is cardiac, a nitroglycerine tablet can be safely administered. Many years ago I published a study of over 100 consecutive patients over the age of 70 that were given nitroglycerine. They tolerated it well, except for one patient who was probably a bit dehydrated. She did well after we had her lie down and elevated her legs for a few minutes.

Remember, patients of your grandmother's age are quite likely to have coronary artery disease which may or may not be causing the symptoms. This is why functional testing is so important. 

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Updated April 2013
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