<s>[INST] Hello Doctor, I am 68 yrs old with type 2 diabetes since 2yrs with hypertension since one year and using dutasteride related Tablets. 10 days back I had severe chest pain for ten minutes while I was vacuuming the house.I had stress and echo tests .It is opinioned possibility of apical ischaemia.Could you please give some advice Doctor. XXXX [/INST] Hello, Apical ischemia is very common and can cause chest pains. Especially due to your age, having diabetes and hypertension, the risk is high for heart blood vessels to be affected and cause ischemic disease. You will need to have the tests to see how severe the blockage is and further guide the treatment. Medications and lifestyle changes are indicated and in some cases, the doctor may also recommend surgery. Hope I have answered your query. Let me know if I can assist you further.  </s>