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

### input:
Ihave been having these symptoms for almost a year. I get tightness in my upper chest and sometimes my neck. Every two or threes months I will have a near syncopal epsiode. Sometimes associated with a short quick walk or slow stride up a filght of stairs. I get very dizzy, sometimes tunnel vision. I usually have to set down or put my head between my legs. This is accompianied by a feeling of SOB. Although I feel like I am exchanging air at the time. The new symptom is the feeling of my heart skipping a beat. This has happen the last couple of days. I have a high family history of heart and stroke disease. I have been taking Vitoran for almost three years for high colestoral, It is now under 175 with a ratio of 3 to 5. When the symptoms started I had an EKG, stress test and stress echo. These have all been normal. I even had a heart cath, which showed a 30% narrowing of my anterior desending coronary artery and a couple of lesser narrowings in two other vessels. I take paxil (20mg) a day for depression. I have taken this for over 10 years. My job is often stressfull, but I am an even keeled non flustered individual. Everytime I go to the doctor things check out normal. I am beginning to fill like I m going crazy and am becomming increasings concerned.

### output:

I understand your symptoms have been troubling you now and then, but we need to know the age, what brings the relief and what your habits are. Usually your pattern symptoms arise due to heart or/and lungs being diseased, but you have reports of normalcy in EKG and Stress tests with good perfusion of heart at the beginning. If you have been taking the cholesterol lowering agents only recently and a smoker and alcoholic and not had any blood pressure monitoring in the past and BMI is around 28, it will be good to reassess heart function along with ruling cholesterol rise noted due to metabolic reasons as well. This time hence see an experienced Endocrinology as well. Hope you will have complete answer for your problem