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

### input:
I am a 64 year old male who has been treated for high blood pressure for about 30 years. I am taking Labetalol, Ramipril, Hydrochlorothiazide, Amlopidene and Chlopodigrel. For the past year and a half I have been having the following symptoms - chest tightness, dizzyness, and nausea. These symptoms occur when I go from a condition of rest and begin to walk. They last 10-15 seconds and then disappear. Once they end I can walk for several miles seldom with a reoccurrence. I ve noticed them when I am on a treadmill and they usually begin almost immediately. While I am having them my heart rate increases rapidly, usually from low 70 s to around 95-100 in that 10-15 second period. My heart rate then begins to decline and at the same time the symptoms disappear. Usually I can continue a 2 mile walk without a reoccurance. The strange thing is I never have these symptoms when my stomach is empty but almost always will have them after eating. I have had 3 stress tests (all negative) and my doctor has me lined up for a heart catheterization next week. Since they only occur on a full or somewhat full stomach could they be caused by something like an ulcer or other stomach related cause? The feeling is very uncomfortable.

### output:

Hello, considering that age, hypertension are risk factors of a heart related issue and the Symptoms you describe can many a time referred as anginal pain, it's always wise to rule out underlying cardiac pathology.  Also, treadmill stress test (TMT) is not the best test when the suspicion of heart issue is high. The sensitivity of TMT is around 75% meaning we may miss 1 in every 4 patients.  However once the cardiac pathology is ruled out either by cardiac perfusion scan or catheterization, as you truly mentioned an underlying stomach pathology should be suspected particularly some reflux gastritis, the symptom favoring the same is that your pain subsides after the initial walk, and later you are able to walk for long time without any significant pain. A trial of it antacid like imperative 40 mg may be taken for 3 weeks before breakfast.  However, as I would again say It's prudent to rule out underlying cardiac if any before considering alternative.  Regards 