instruction: hello doctor I am 42 years old single parent with two kids aged 15 and 10 the last 19 years I have had several stress related in my view ailments history erratic bowel syndrome 19 years back corrected now polycystic ovaries corrected now was on metformin for one year severe migraines twice a week that lasted 3 days corrected now hyperthyearoidism which got over corrected to hypothyearoidism and therefore medication was stopped was on eltroxin 25 mug I was diagnosed with be issues and chest pain years back I was on lonzaep for anxiety and prothiaden 50 my a day ten 25 my for be had a c for continuous periods biopsy was clear ten was stopped and nebistar my once a day was initiated by my cardiologist along with 20 my telmisartan I was also diagnosed with arterial stiffness persiscope cardiovascular analysis report enclosed I experienced alopecia and lost almost all my hair I got it back after treatment the cardiologist increased thelma to twice daily 20 my along with nebistar my recently my concerns and questions the be continues to fluctuate going as high as 170 10 and then dropping very suddenly to very low be rises typically in the evenings while it is very low at night I understand that this is the case naturally while I understand the concept of be fluctuating all day and looking at the average I am worried that when it is very low I am probably aggravating the situation by taking a medicine to low it further app reports taken all these years are enclosed when the be is high mostly I have chest discomfort and pain in the chest for 4 days and then subsides on its own I am concerned that my arteries are inflamed please see reports on high sensitivity reactive protein when I had continuous migraine and chest pain I went in for a coronary angio and a brain mri reports enclosed acute ischemic foi is there a correlation my cardiologist was concerned about my echo tests and the be shooting up very quickly during the stress test can you explain what the test implies and the connection between the inflammation and these tests results my stress levels overall are definitely better I am consulting a psychotherapist for the last years practising yoga however the be seems to have shot up again the last few weeks is it because of the extreme winters I am undergoing a stressful situation at the moment on the whole I would like to know if I am at risk of a stroke if yes what is the probability is there inflammation if so how bad is it how can I control reverse it why does the chest pain persist the pain is usually followed along with high be when I particularly have a heavy session in psychotherapy or overthink some issues what do I do when the be reaches dangerous levels like 170 10 are there any drugs that I should avoid what are the safe supplements that I can have for magnesium I am taking omega supplements are there any follow on tests and medications that you recommend I got a full health check done four months back and kidney tumors etc have been ruled out happy to share additional reports in case needed
output: hello I would largely comment from cardiac point of view so overall other than be your cardiac status is normal your heart function is normal and no rwma your blood vessels were clean on it coronary angiography so I do not think there is anything to worry from cardiac perspective regarding chest pain if be is elevated then it can cause some strain over the heart and cause chest pain but it would be limited to time during which be is elevated now considering that you did not have any chest pain during stress test and be was elevated during stress test pain is probably unrelated to be or heart if you are having any ventricular ectopic or extra beats then it can cause some dull ache in chest now other aspect is be you have tendency for be elevation due to your genetic make up which is part of cos etc how much do you weigh also your psychological issues tend to worsen be may rise during exercising and considering your high be tendency it may excessively rise during exercising other factors which can worsen be is stress high salt intake like pickles nsaids like brufen or other pain killers migraine medicines or even any pain can worsen be so avoid pain killers other than paracetamol or tramadol plenty of fruits have low salt diet regular exercises try to keep weight under control if be elevates then you may have an additional dose of telmisartan maximum you may up to 80 my in a day also while taking be readings you should keep your arm relaxed take 3 readings at a time and take be after rest of 10 min if be is rising persistently in the evening then additional dose of telmisartan may be added in the afternoon hours before the expected be rise your average in last abpm was fine and occasional high readings are not worrisome regarding inflammation best way to settle inflammation is healthy lifestyle like avoiding fatty oily and high calorie diet having regular exercises like brisk walking or running according to capacity also you should get your lipid profile done and stations like rosuvastatin prescribed to settle this inflammation dinner should be light now regarding your stroke risk it is better to get a neurologist opinion the changes may be related to inadequate be in the past but you should also obtain carotid artery doppler for source of emboli also transesophageal echo should be obtained to rule out possibility of patent formanen oval as a source of emboli