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Dear Sir/Madam, Please review the following report. I am a 47 year old Caucasian male. My height is 6ft and I weigh 207ibs. I keep myself in good physical shape and frequently use the gym (4-5 times per week) my main exercise is weight training (1hr) followed by 20mins of cardio. I eat a well-balanced healthy diet. I am a non-smoker and only drink occasionally. I have no family history of Heart condition. I recently completed a four week cycle of anabolic steroids (20mg Dianabol daily and T-entbolin 250mg twice a week) This is my first time using steroids. My last steroid intake was 26th June 2015. On 26th June I arrived on the Island of Ibiza, Spain for a week’s vacation. The following day I was invited to a party where the following drugs were consumed: Cocaine and MDMA crystals. I also consumed 50mg of Viagra (First time used). On 27th June I was admitted to hospital after an over-dose of MDMA. After 2hrs I discharged myself still under the influence of the drug. I went back to my hotel and spent the next two days trying to recoup. On the 3rd day (30thJune) I was suffering from chest pains. It was a constant tightness with a burning sensation in the center area of the chest. I went back to the Hospital where the following tests were done. 1) ECG. The Doctor confirmed that more test were required due to an abnormal reading. 2) Chest X-ray confirmed inflammation around the Heart. 3) Blood work, (I assume CRP test) confirmed High CRP. 1.44mg/dl I was re-admitted and spent the next two nights in Hospital. On the 2nd Day a Cardiologist performed an ultrasound and found no damage to the heart or tissue. On the 3rd day and just before being discharged I completed a stress test where the same Cardiologist confirmed that my results were all normal. The Cardiologist explained that my condition was a side effect of taking large amounts of cocaine. I was told that I would need a 5-6 week therapy of NSAIDs. I was prescribed 100mg of Aspirin and told I should take one week off from the gym. I was given a report (In Spanish) to give to my Doctor and then discharged. I live and work in the Middle East. Because the report mentions cocaine and MDMA I am not able to present this to any Doctor, as the consequence could be severe. Due to the Hospital report being in Spanish, I was unable to determine if 100mg of Aspirin was a daily intake or every 5-6hrs (after meals). So, for the first week I had taken it as a daily dose. Since then, I have translated the report, but it’s still unclear as to the dosage. Around July 8th, I returned to the gym. (Steroid Free) I noticed while working out a tingling sensation in my face. Over the next few days my chest seemed to be a little tighter than before I started working out, so I have decided to take a break from the gym until things get better. Also, I seem to suffer from fatigue, more than normal, especially late afternoon. After doing some research, and speaking with my local pharmacist I’ve been taking (for the last 7-8 days) 1500mg of Aspirin a day (500mg every 7hrs, after meals) along with twice daily a protein inhibitor (Nexium, Esomeprazole 20mg) I think initially, it seemed to help. Four weeks have passed and I am still suffering with the same symptoms. They are: Heaviness/Tightness in the center chest area accompanied sometimes with a burning sensation. Some days are better than others, although it seems worse at night or while lying down. This has also brought on panic attacks and problems sleeping at night. I was addicted to cocaine for just over a year, but have been clean for the past three years. My addiction was more of a weekend heavy session and occasionally midweek. I used to have a similar chest complaint after a heavy binge, but this would subside after 2-3 Days. My Questions are: 1) Should I be taking 1500mg of Aspirin per day along with the protein inhibitor? If not, what is the recommended dosage? 2) Is there any other medications I should be taking? 3) How long should I wait to get another check-up? 4) What should my next check-up consist of? I.e. Blood-work, ECG, Chest X-ray? 5) Can I do a light exercise routine? 6) What symptoms should I be looking for if things take a turn for the worst? I’m trying to stay positive, but the last few weeks I have been consumed with the whole situation and feel very anxious. Any advice would be much appreciated. On request, I can upload the original Hospital report (translated to English). Thank you kindly for your time, Regards, Steve

Category: Cardiologist

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Category: Internal Medicine Specialist
 26 Doctors Online

Thank you for your query at
I have gone through your reports and i would be happy to see the original hospital report ( translated in English). With the symptoms you have described , it looks you are suffering from Acid Peptic Disease probably aggravated by cocaine , aspirin.
I suggest till you are absolutely fine , avoid alcohol ,cocaine and anabolic steroids.
Your present symptoms like central chest pain occasionally burning sensation is typical of Acid Peptic Disease and is getting aggravated by aspirin, so stop aspirin and continue to take proton pump inhibitors.
As long as you don't have any chest pain on exertion which gets relieved by rest , then you may not be suffering from heart disease .
Ideally your symptoms should subside with proton pump inhibitors within few days to weeks , if not relieved the you have to meet a medical gastroenterologist.
Since your test were negative for heart problem ,ideally you can do stress test after one year.
Every year you should do Lipid profile , Fasting Blood Sugar , Liver Function test.
Stay Positive and eat plenty of green vegetables and fruits to supplement necessary vitamins and you can be back to gym for light exercise within few days.
Dr Satish

Patient replied :

Good Day Dr E. Satish Kumar,
Thank you for your response.
Please find attached a copy of my Hospital report.
As you can see the following blood-work results show that both my C-reactive protein 1.57 (H) and TROPONIN: 17,345 ng / mL (H) are both in the High range. This due to the fact that a large amount of Cocaine was consumed. Would it make sense, to wait for a few weeks and then repeat the same test (Blood-work) to compare the results? If the results are the same, this may indicate damage to the heart muscles?
As directed, I will stop taking the Aspirin, but will continue with the proton pump inhibitors.
When I spent the two nights in Hospital, I made a promise to myself, I will turn my life around and cocaine will definitely be a thing of the past.
I look forward to your response,
Kindl regards,

Dear Steve,
Good to hear that you have determined to have a healthy lifestyle.Do your CRP , ECG , ECHO-CARDIOGRAM after 1 month followed by stress test. During this time if you have any chest pain on exertion , I would suggest to meet a cardiologist.
I was unable to open the document you have sent me.
Dr Satish

Patient replied :

Good Day Dr. Satish,
I’ve been taking a PPI for two weeks now (once a day). My chest does not feel as heavy as before, however, I have noticed a slight feeling of being short of breath and still with a constant burning feeling to the sternum. It’s the same sensation as when you drink a shot of strong alcohol. This is also sometimes accompanied by a dull aching pain (same area). Although my symptoms have been constant, if I were to give you a pain factor number, it would be three out of ten. It's just a little uncomfortable. Although back at work, I am resting as much as I can with no visits to the gym. My sleeping routine is better along with my anxiety level (a couple of weeks ago I was getting panic attacks). I have not noticed any chest pain on exertion, although, I have not been back to the gym. I will follow your advice and take PPI twice a day along with one 100mg of Aspirin daily. I intend to get a full examination in the next 3-4 weeks and will upload all results.
Thank you very kindly for your time.
Warm regards,

How are you feeling after all drugs, are you feeling better after taking proton pump inhibitors. I have seen your discharge summary, I am of the suggestion that high troponin is secondary due to drugs, which will subsides after some time and mean while I suggest to take some rest and avoid any exercises. Do ECG, echocardiogram and stress test after 1 month of the onset of your symptoms to decide the next plan of action. Meanwhile if have any chest pain on exertion , I would suggest you meet a Cardiologist. Continue proton pump inhibitors twice a day 30 minutes before food.
I also suggest to take aspirin 100 mg once day after food and if the repeat stress test is negative you can stop tab aspirin and continue to avoid cocaine , MDMA and steroids.
You can send me the ecg, echocardiogram and stress test when you repeat it at a later date.

Dr Satish

Great to see that your in the road to recovery ,
I would suggest proton pump inhibitors twice a day
Avoid spicy foods
Take frequent and small meals so as to avoid gastritis
Avoid Gym but you can go for walk as long as your are comfortable
For one week stop Tab Aspirin and see whether your central chest disappears , because sometimes aspirin an aggravate gastritis.
If you don't get proper sleep you can take alprazolom 0.25 mg at bed time till you come back to routine.
Once you finish your tests you can send for review.

Dr. E. Satish Kumar
Category: Internal Medicine Specialist
Fellowship, Cardiology - Tamil Nadu Doctor M.G.R. Medical University - DNB, Cardiology, 2002 – 2005Training in Germany in Complicated AngioplastiesMedical School - Maharaja Krushna Chandra Gajapati Medical college, MBBBS MD, Int Medicine, 1989 – 1999.
Trained in Rota Abalation for treating Calcific coronary artery disease in Japan
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