<s>[INST] Hi doctor, I am 70 years old. I have intermittent chest pain. For the past three months, I could not walk fast and climb stairs. But, I was doing it before normally. I suffer from shortness of breath with palpation and when the chest pain persist the breathing problem is severe. I underwent ECG and echo test last month, in which the results are normal. In the CBC test, it showed an elevated WBC (21800). I was asked to take an x-ray chest PA view. The result was normal. I have low BP (80/60 mmHg) due to which I got numbness in hands and legs. I was unable to respond back due to dry mouth or tongue with severe chest pain and giddiness last month. I was also asked to take brain MRI and EEG test. The results were normal. The only thing it showed was that I have sinus in MRI report. My general physician prescribed me Inderal 10 mg for palpation, Razo 20 mg, Bifilac, Mont and C-tax O 200 mg. Now, the chest pain started again, and it lasts three days. The pain is like stabbing and as such a rock is kept. Kindly advise me what can I do further. Do I need to take any further checkup for the heart? I was advised for Holter monitoring, which is yet to be done. I am waiting for your reply. Many thanks in advance. [/INST] Hi. I have noted all your details. Your symptoms can be most likely because of congestive cardiac failure. Cardiac failure is not an indicative of a defect in the heart, but it is a situation when the heart pumps weaker than what is deemed as natural. Therefore, the blood flows at a slower rate to the heart and the body that in turn increases pressure in the heart. In an attempt to hold more blood, the heart stretches the chambers. Though this strenuous effort may keep the blood moving, it would gradually and inevitably weary the heart with all the effort. Subsequently, the kidney responds by retaining more salt and fluid in the body. These fluids may accumulate in different parts of the body, mainly in the legs, feet, ankles leading to congestion in the body. This condition in medical terminology is referred to as congestive heart failure. The most common cause of CHF at the age of 70 is coronary artery disease. I would suggest you some of the baseline tests of cardiology to rule out any element of coronary artery disease apart from 2D echocardiography. Stress test as any ischemia to cardiac muscles will be reflected in the stress test. Along with 2D echo, they have a sensitivity rate of more than 85% to rule out coronary artery disease. Other tests advised are as follows: As per your query, the medicines you are on have nothing to do with your symptoms. For further information consult a cardiologist online --> </s>