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Heart Disease (Expert Forum)
Chest discomfort with higher systolic blood pressure
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Chest discomfort with higher systolic blood pressure
by Cody, Jun 13, 2006 12:00AM
Dear Cleveland Clinic Physicians,
Background: Age 64; Present Daily Medications: Atenonol(50mg), Vasotec(20 mg), Hydrochlorothiazide(25mg), Imdur(30mg), Lipitor(20mg), Aspirin(81mg). Daily exercise: 30 minutes of jogging. Present lipid levels: LDL 40, HDL 59, Triglycerides 55, total cholesterol 110. Stentless angioplasty performed on LAD 8 years ago. Yearly nuclear stress tests all with similar and normal results.
Since the MI it seems every six to nine months or so I end up in the emergency room with chest discomfort and elevated systolic blood pressure. After the emergency room examination(3 to 4 hours) I am sent home and the emergency room physician tells me it is musculoskeletal or non-specific chest discomfort and the rise in blood pressure was due to being worried. In a day or two the discomforts disappear and the blood pressure returns to normal. My question concerns how does one really distinguish from cardiac chest discomfort and atypical chest discomfort(not caused by coronary heart disease)? Is part of my problem phychologial and does this occur with many patients(that is having a tendency to worry too much)? Also, how accurate are the Cardiolite stress tests? Would these stress tests also show an irregular heart beat?
Thanks,
Cody
Background: Age 64; Present Daily Medications: Atenonol(50mg), Vasotec(20 mg), Hydrochlorothiazide(25mg), Imdur(30mg), Lipitor(20mg), Aspirin(81mg). Daily exercise: 30 minutes of jogging. Present lipid levels: LDL 40, HDL 59, Triglycerides 55, total cholesterol 110. Stentless angioplasty performed on LAD 8 years ago. Yearly nuclear stress tests all with similar and normal results.
Since the MI it seems every six to nine months or so I end up in the emergency room with chest discomfort and elevated systolic blood pressure. After the emergency room examination(3 to 4 hours) I am sent home and the emergency room physician tells me it is musculoskeletal or non-specific chest discomfort and the rise in blood pressure was due to being worried. In a day or two the discomforts disappear and the blood pressure returns to normal. My question concerns how does one really distinguish from cardiac chest discomfort and atypical chest discomfort(not caused by coronary heart disease)? Is part of my problem phychologial and does this occur with many patients(that is having a tendency to worry too much)? Also, how accurate are the Cardiolite stress tests? Would these stress tests also show an irregular heart beat?
Thanks,
Cody
Doctor's Answer
by CCF-M.D.-MJM, Jun 13, 2006 12:00AM
Hi Cody,
Good questions but difficult to answer.
My question concerns how does one really distinguish from cardiac chest discomfort and atypical chest discomfort(not caused by coronary heart disease)?
Unfortunately the best way to know is to have it. People that have had heart attacks often recognize their anginal pain -- it tends to feel the same for the same person. The problem is that many people experience it in different ways -- pressure, indigestion, shortness of breath.
Typical anginal chest pain is increased with exertion, improves with rest, may be associated with sweating, nausea/vomiting, radiation to the left or right arm, neck or jaw, stress. Anginal chest pain can also happen at rest in the setting of unstable angina.
It can be very difficult to tell.
Is part of my problem phychologial and does this occur with many patients(that is having a tendency to worry too much)?
Anxiety can cause atypical chest pain syndromes. The best proof we have of this is young perfectly healthy patients that exercise without pain and develop chest pain the gets worse with rest. They often admit the feel anxious a lot, but some don't notice because they have been that way their whole life. It is possible that a small subset have coronary spasm, but this is difficult to prove.
It is difficult to know for sure how much of your chest pain is due to axiety, but it is easier to attribute it to anxiety in people with no history of coronary disease and a negative stress test. You situation sounds a bit trickier.
Also, how accurate are the Cardiolite stress tests?
Cardiolite stress tests are right about 70-80% of the time, but it depends on the population being tested. If you have a normal exercise stress test and a normal cardiolite, your prognosis is very good.
Would these stress tests also show an irregular heart beat?
It would as long as they are running a continuous EKG --- which I am sure they did.
Thanks for posting and good luck.
Good questions but difficult to answer.
My question concerns how does one really distinguish from cardiac chest discomfort and atypical chest discomfort(not caused by coronary heart disease)?
Unfortunately the best way to know is to have it. People that have had heart attacks often recognize their anginal pain -- it tends to feel the same for the same person. The problem is that many people experience it in different ways -- pressure, indigestion, shortness of breath.
Typical anginal chest pain is increased with exertion, improves with rest, may be associated with sweating, nausea/vomiting, radiation to the left or right arm, neck or jaw, stress. Anginal chest pain can also happen at rest in the setting of unstable angina.
It can be very difficult to tell.
Is part of my problem phychologial and does this occur with many patients(that is having a tendency to worry too much)?
Anxiety can cause atypical chest pain syndromes. The best proof we have of this is young perfectly healthy patients that exercise without pain and develop chest pain the gets worse with rest. They often admit the feel anxious a lot, but some don't notice because they have been that way their whole life. It is possible that a small subset have coronary spasm, but this is difficult to prove.
It is difficult to know for sure how much of your chest pain is due to axiety, but it is easier to attribute it to anxiety in people with no history of coronary disease and a negative stress test. You situation sounds a bit trickier.
Also, how accurate are the Cardiolite stress tests?
Cardiolite stress tests are right about 70-80% of the time, but it depends on the population being tested. If you have a normal exercise stress test and a normal cardiolite, your prognosis is very good.
Would these stress tests also show an irregular heart beat?
It would as long as they are running a continuous EKG --- which I am sure they did.
Thanks for posting and good luck.
As for the Cardiolite test - they say that it is very accurate, and I past it. My blood flow was very good. I did show some irregular heart rate when I got up to 110. They said that I did fine. They have now discovered that I have 5 blocked arteries , and I have been advised to have surgery. I ask the dr about passing that test, and he said that no test is perfect and they miss a lot.
If you have chest discomfort and the cardiologist will not look into it, then I would go to another one. I had a friend that went to the hospital ER for chest burning and they sent her home after blood work and keeping her for a while. She had a heart attack 2 days later. So much for the ER. You know if something is wrong with your body. Don't let someone discourage you from finding out what is wrong.
Let me know if I can help you.
I was very sorry to read your post about a potential clot or stroke. Hope you're feeling better and the stroke like symptoms are gone. I had no idea you could build a resistance to nitro. I hope they're managing your angina another way then. Best wishes to you (:
Cody,
I hope you're feeling well soon. As a general rule, I am not impressed with ER doctors either but they have 1 job, to assess if you're dying. If you're not they send you out the door. I too ended up in the ER with chest pain (I'm 33) and was told it was most likely musculoskeletal chest pain. It is reproducable when I push on my chest so that is it at least comforting! I truly hope you can find some relief or answers. Great question though, about how do you differentiate between cardiac chest pain