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Hi Rohith, the generic form of medication you are taking is a combination of olmesartan and hydrochlorthiazide. The medication hydrocholrthiazide is a diuretic which means it causes urinary loss of water and sodium. Therefore fatigue and tiredness could be due to fluid depletion. I recommend you to change the medication if you have intolerable side effects. Since this medication causes dehydration , take adequate amount of fluids every day to keep yourself hydrated. I hope as the first step towards blood pressure control, you have cut down salt in your diet. Daily exercise also helps in blood pressure control (Try getting at least 30 to 60 minutes of moderately intense physical activity most days of the week. You can even break up your workout time into 10-minute sessions)

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The increase in heart rate is due to stimulation of sympathetic nervous system by caffeine. To identify the exact nature of chest discomfort , more information of chest discomfort/apin, type , any radiation, association with exertion, any sweating , dizziness with chest discomfort is needed. Also information about family history of heart disease, age, risk factors like hypertension, diabetes, smoking, sedentary lifestyle is important to assess your risk for heart disease.

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The most important issue concerning me is the family history. Your father did not have any risk factors for heart disease but died of heart condition at age of 33. It would be important to know if there were any other family members with sudden cardiac death. If you have any symptoms like chest tightness or shortness of breath with exertion or any fainting spells, I recommend you that follow up with cardiologist, get an electrocardiogram and echocardiogram to rule out any abnormalities of the heart. HDL level less than 1.01 mmol/l is not ideal. Different lifestyle changes to increase HDL levels include losing weight (in overweight individuals, for every 6 pounds (2.7 kilograms) you lose, your HDL may increase by 1 mg/dL (0.03 mmol/L), becoming physically active (within two months of starting, frequent aerobic exercise can increase HDL cholesterol by about 5 percent in otherwise healthy sedentary adults), eating healthy food (between 25 and 35 percent of your total daily calories can come from fat — but saturated fat should account for less than 7 percent of your total daily calories) . Nuts, fish and other foods containing omega-3 fatty acids are other good choices for improving your LDL cholesterol to HDL cholesterol ratio.

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From the information provided, it appears that only significant risk factor for heart disease in your case is family history. Typical presentation of chest pain related to heart disease would be chest discomfort or tightness, brought on by exertion, and improving with rest with radiation to shoulders, jaw, or inner arm. If chest pain was associated with sweating, shortness of breath, it would be concerning for angina pain. The chest pain in your case is reproducible with movement (when you bend down), this is not typical for angina chest pain. If the pain increases with respiratory movements, it is more likely musculo-skeletal pain (related to muscle and bone in the chest region) and not related to heart. Have an EKG and blood cholesterol levels checked and seek consultation with your primary care physician.

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It is not clear why there is pressure like sensation on the right side. It is highly unlikely for it to be related to heart. The increase in heart rate following this sensation might probably be related to anxiety about this sensation.

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Recent results show that there is good prognosis after surgical repair. Life expectancy was normal. However, the chance of degenerative changes to coronary artery might be higher if there is persistence of dilatation of the coronary artery. In different previous studies, complete closure rates were seen in 50% to 100% patients. Your exercise capacity will be determined by recovery after surgery. If there was a stump after fistula, there is a risk of blood clot forming in the stump. If there was complete closure of fistula and there was no heart damage prior to surgery, your exercise capacity will probably not be affected .The atrial fibrillation that you developed after cardiac surgery might be a transient phenomenon with no long term effects. Keep an eye on your heart rhythm from time to time.

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If your father does not have any breathing difficulty while sleeping, it is less likely that it is related to heart or lung problem. Agitation or breathlessness at rest can be due to anxiety or worsening of dementia. I cannot explain why he has breathlessness only while resting and not while sleeping.

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From the information provided, it appears that you have multiple risk factors for cardiovascular disease. The presentation of angina in diabetics can be atypical. Diabetics are more likely to have significant coronary heart disease. The symptoms should not be taken lightly. Neglecting the symptoms might lead to potentially dangerous consequences. I strongly recommend that you immediately visit a doctor before it is too late.

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Blunt carotid and vertebral artery injury also known as blunt cerebro-vascular injury is extremely rare. Motor vehicle accidents are the most common cause of blunt cerebro-vascular injury. One can develop blunt cerebro-vascular injury with simple chiropractic manipulation, increased movements of the neck up or down during hair washing, “head banging” to music, “bottoms-up” drinking, rapid head turning, basically any significant movement of head. Blunt trauma can damage inner lining of blood vessel known as intima which can lead to clot formation. The clot can subsequently go the brain. you should consultation wiht a neurologist.