### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hello I am a female 43 years old. Have had a PE about 6 years ago. I have 4 gene mutations wich are MTHFR and PAI-1. I have an Ivac filter in my vena cava. I have had chest pains for a long time now ,been to emergency rooms countless times. they never find anything. I recently moved to a very remote area and dont have any Specialty Drs. here. I last saw my hematologist in Dec 2012. He said he thought it was showers of micro clotting and to double up on my asprin and folic acid every other day. That worked for a few months but know the chest pain is back and it moves around and is very unsettling, it also seems to get worse with my menstral cycle. I dont know what to do anymore. Any suggestions?  I have to pay to get an answer? Figures

### output:

Hello..... As your details it seems that you are suffering from Congenital hypercoagulable disease. In this case, the blood getting thick day by day and causes clots at any site. Most common is lower large vein due to more stagnant condition. This clot frequently embolizes to chest and causes chest pain that is called Pulmonary embolism. With your description, you are suffering from Chronic pulmonary embolism that also causes right heart chamber enlargement and bilateral leg swelling. But you did not mention regarding breathlessness and leg swelling except chest pain on and off. Definitely this chest pain is due to microclot in pulmonary vessel. But the treatment you are taking is very ineffective. Aspirin is not enough alone to prevent the clot formation and keep the blood thin. So my advice is to start Tab Action with lower dose 2 mg once a day along with aspirin with folic acid. And do your Prothrombin time (PT INR) at regular interval of 15-30 days to keep your INR 2 to 2.5Thank You