Less commonly a piece of cholesterol may break off and travel to the brain. These strokes are called thrombotic or embolic respectively. Thrombotic strokes are almost always due to partial blockages in the artery that are caused by cholesterol build up and hypertension. The arterial wall is damaged and a blood clot forms.
The other main type of stroke is hemorrhagic. The arterial wall is damaged by longstanding hypertension and finally bursts. Bleeding in the brain is a serious problem because the brain is in an enclosed space, the skull, and pressure builds up rapidly causing even more damage. Occasionally there may be a small aneurysm in the brain that ruptures due to high pressure.
Several things strike me about your story:
-Firstly, you seem to date the onset of pain to when you started the bp meds. Have you tried stopping the meds to see what happens to the pain?
-Secondly, you do not characterize the pain either as to quality, severity, inciting factors, relieving factors, exact location, or radiation. This is obviously important in trying to figure out the cause.
-Thirdly, although coronary artery disease has been thoroughly ruled out as well as microvascular disease, you suggest a possible connection with SVT. Have you had a Holter monitor or longer term monitoring to see if there is an association between the pain and the arrhythmia?
-Fourthly, have you had a GI work up? Since the most common cause of non-musculoskeletal chest pain is gastro-esophageal reflux. (I assume musculoskeletal issues have been excluded.)
Another cause of pain anywhere could be neurological. Is there anything that suggests a neurological cause of this pain? Of course, any pain is complicated by emotional factors. Are there any issues in your emotional life that might exacerbate pain? Finally, I do not think that you have anything to worry about as far as basketball is concerned. Based on the almost complete work-up you have had, the likelihood of your having a heart attack or damaging your heart during physical activity is remote.
2. A sense of security that now you have a safe reliable life-saving device implanted that will also improve your quality of life.
3. Infection risks, mainly at implant.
4. Rarely, removal of the device and leads if they become infected. This may require difficult lead extraction procedures.
4. Discomfort at implant site.
5. Necessity to monitor regularly.
6. Availability of remote monitoring so that your doctor will know in real time if anything is wrong.
6A. Confusion about remote monitoring in elderly patients.
7. Possibility of device malfunction or lead problems that may require revision of the implant.
8. Necessity to reprogram the device periodically to enable more effective control of the arrhythmia and heart function.
9. Necessity to replace the battery periodically, usually after at least 5 years, often much longer.
10. Necessity to upgrade the device as your father's condition changes.
There are other side effects but I would like to emphasize that, whatever the problems and they are not common, pacemakers are miraculous devices that save lives and enable improved quality of life. Just make sure that the doctor implanting the pacemaker is experienced and has a good track record and that the doctor following your father's device is experienced, responsible, honest, conscientious, and caring. These two doctors may be the same or different people.
Where are the blockages, i.e. in what arteries?
Did your brother have some sort of objective ischemic evaluation with a stress test done with an imaging modality?
Heart blockages cannot be cleared with medicine and lifestyle alterations alone. However, that does not mean they need to be treated with angioplasty. Is your brother being treated by a board-certified cardiologist who is up to date on the literature regarding this issue. See especially the ORBITA study and the COURAGE study.
That said, anything that diminishes stress and tension and anxiety is beneficial for the atherosclerotic process.