Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Heart Disease (Expert Forum)
Angina or Something More Serious?
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Angina or Something More Serious?
by AJ, Nov 21, 1999 12:00AM
Dear CC Doctors,
I would like to apologize upfront for the length of this letter. I am a 33 year old male.Let me give you a brief rundown on my family medical history and lifestyle :
Family History : My dad had a "minor" heart attack, if you
can call it that, at age 54, and immediately underwent
quadruple bypass surgery, which was successful. In 1993,
at age 61, he suffered a massive heart attack while sleeping
and passed away at the ER.
Although my blood sugar levels are normal, my mom's family
has a history of diabetes. They also have a history of cancer
and lupus as well.
Diet : I love fast food. Although I am able to cook for myself,
I have always found it more convenient to order out rather than cook.
Sedentary Lifestyle : I am a bartender/manager in a bar/restaurant/nightclub and am always busy.
Outside of that, I used to play golf at
least once a week, as well as softball whenever I could.
I also used to alternate weight training & walking/running
on the treadmill 4 times a week as well, but had since become lazy and fallen off of that.
Weight : For my height, I was and still am considered
overweight, but not obese, at least not yet.
Having said all that, here is my story.
Earlier this year (Thursday, 4/15/99) I was experiencing shortness of breath while driving home. This lasted for about
15 minutes and had subsided by the time I did get home.
After about another 15 minutes, it started up again, while at rest, sitting down watching tv, but I also began experiencing
a "dull aching pressure" in my chest area, more specifically, between the middle of my chest and my left nipple. I immediately called my primary care physician, explained my symptoms,
and he recommended that I go straight to the ER as soon
as possible, fearing that I may be experiencing a heart attack.
At the ER they immediately put me on oxygen for my breathing
and ran EKG and cardiac enzyme tests. After awhile I could breathe alright and the "dull aching pressure" in my chest
was slowly going away, so they took me off the oxygen.
I had stay and wait for the results of my cardiac enzyme test
to come back.
About 4 hours into my stay, I no longer felt any "dull aching pressure" but I did start to experience a little tightness
in my right middle/upper chest area. The nurse put me back
on oxygen as a precaution, and asked me to identify the pain level on a scale of 1 to 10, and I told her it was a 1.
It wasn't really a pain per se, but more of a discomfort.
Anyway she gave me one (1) metered dose of Nitrolingual Spray which worked almost immediately. The "pain" went away,
but I did experience a slight headache, which the nurse
said was normal because the Nitro is a vasodilator.
My EKG and cardiac enzyme test results came back negative.
So the ER doctor gave me a bottle of Nitrolingual Spray
to take home and the nurse helped me schedule an appointment
with a Cardiologist on Saturday April 17.
After the initial consultation, the Cardiologist suggested a Treadmill Stress Test for the following Thursday, April 22.
After walking and running to raise my heart rate to 169 beats
per minute, and checking my blood pressure at regular intervals, the test lasted about 10 minutes.
The cardiologist found nothing during the test to suggest any signs of cardiac problems, sent a copy of the test results to
my primary care physician, and recommended that if any more problems arise, follow up with him (my pcp).
Fast forward seven months to the present, and I have since lost 27 lbs. and 6" off my waist, through a combination of changing
my eating habits, along with incorporating walking into my
exercise routine. Although I have made dietary changes,
I still treat myself to two (2) fast food meals per week.
It seemed to be working just fine, until about a month ago.
I began experiencing slight twinges of "tightness" in my
right middle/upper chest area (more specifically, between
the sternum and my right nipple). On a scale of 1 to 10,
I would give it a 1.
They have all happened while at rest, with no physical exertion of any kind. Some of the first "symptoms" happened after I woke up from sleeping. I sleep on my right side with my right arm
raised above my head. At first, I thought I had strained a
muscle in my chest because the pain would usually happen only when my right arm was in a certain biomechanical position, like :
raising my right arm to comb my hair;
raising my right arm straight out to the side
raising my right arm straight up above my head, or
moving my right arm across my chest
After a couple of days, the "tightness" was gone. Then,
the "tightness" returned, but would happen in more everyday situations, not just whenever I raised or moved my right arm.
Some of the examples are :
Sometimes when I get up out of bed in the morning;
Sometimes when I bend over to brush my teeth.
Sometimes when I bend down to pick up something from the floor;
Sometimes when I stand up and / or sit down
They would happen infrequently, maybe once a day, or every
other day, until last week, when the frequency jumped to
almost every day, if not daily. What alarmed me the most
was that :
the frequency jumped rather quickly;
it seemed to happen with almost any kind of move that I made;
it didn't happen when I was physically exerting myself
(walking for example)
I have temporarily stopped walking to be on the safe side.
After much reading and research, I am beginning to suspect
that I may be suffering from a Coronary Artery Spasm and / or some sort of variant/unstable angina brought on by
Coronary Artery Disease.
If there is one good thing about these episodes is that I
don't experience any of the other "classic" symptoms, such
as shortness of breath, radiating pain in my shoulder,
jaw or arm, nausea, sweating, etc. But I also understand
that doesn't neccessarily mean that nothing is wrong with
me either.
My questions to you are :
Should I be worried?
Should I make an appointment to see my primary care physician right away, or should I skip him and go straight to the cardiologist instead?
If I do end up seeing a cardiologist, what type(s) of test(s)
do you think he would run to determine the cause(s) of my condition? What test(s) would you recommend?
I am also considering holding off on calling the doctor,
and starting aspirin therapy on a daily basis to see if this would help me at all (although I am hestitant to start without
my doctor's recommendation and approval).
Thank you for your time and consideration regarding my questions.
Any help, suggestions and / or information would be greatly appreciated.
Sincerely,
AJ
I would like to apologize upfront for the length of this letter. I am a 33 year old male.Let me give you a brief rundown on my family medical history and lifestyle :
Family History : My dad had a "minor" heart attack, if you
can call it that, at age 54, and immediately underwent
quadruple bypass surgery, which was successful. In 1993,
at age 61, he suffered a massive heart attack while sleeping
and passed away at the ER.
Although my blood sugar levels are normal, my mom's family
has a history of diabetes. They also have a history of cancer
and lupus as well.
Diet : I love fast food. Although I am able to cook for myself,
I have always found it more convenient to order out rather than cook.
Sedentary Lifestyle : I am a bartender/manager in a bar/restaurant/nightclub and am always busy.
Outside of that, I used to play golf at
least once a week, as well as softball whenever I could.
I also used to alternate weight training & walking/running
on the treadmill 4 times a week as well, but had since become lazy and fallen off of that.
Weight : For my height, I was and still am considered
overweight, but not obese, at least not yet.
Having said all that, here is my story.
Earlier this year (Thursday, 4/15/99) I was experiencing shortness of breath while driving home. This lasted for about
15 minutes and had subsided by the time I did get home.
After about another 15 minutes, it started up again, while at rest, sitting down watching tv, but I also began experiencing
a "dull aching pressure" in my chest area, more specifically, between the middle of my chest and my left nipple. I immediately called my primary care physician, explained my symptoms,
and he recommended that I go straight to the ER as soon
as possible, fearing that I may be experiencing a heart attack.
At the ER they immediately put me on oxygen for my breathing
and ran EKG and cardiac enzyme tests. After awhile I could breathe alright and the "dull aching pressure" in my chest
was slowly going away, so they took me off the oxygen.
I had stay and wait for the results of my cardiac enzyme test
to come back.
About 4 hours into my stay, I no longer felt any "dull aching pressure" but I did start to experience a little tightness
in my right middle/upper chest area. The nurse put me back
on oxygen as a precaution, and asked me to identify the pain level on a scale of 1 to 10, and I told her it was a 1.
It wasn't really a pain per se, but more of a discomfort.
Anyway she gave me one (1) metered dose of Nitrolingual Spray which worked almost immediately. The "pain" went away,
but I did experience a slight headache, which the nurse
said was normal because the Nitro is a vasodilator.
My EKG and cardiac enzyme test results came back negative.
So the ER doctor gave me a bottle of Nitrolingual Spray
to take home and the nurse helped me schedule an appointment
with a Cardiologist on Saturday April 17.
After the initial consultation, the Cardiologist suggested a Treadmill Stress Test for the following Thursday, April 22.
After walking and running to raise my heart rate to 169 beats
per minute, and checking my blood pressure at regular intervals, the test lasted about 10 minutes.
The cardiologist found nothing during the test to suggest any signs of cardiac problems, sent a copy of the test results to
my primary care physician, and recommended that if any more problems arise, follow up with him (my pcp).
Fast forward seven months to the present, and I have since lost 27 lbs. and 6" off my waist, through a combination of changing
my eating habits, along with incorporating walking into my
exercise routine. Although I have made dietary changes,
I still treat myself to two (2) fast food meals per week.
It seemed to be working just fine, until about a month ago.
I began experiencing slight twinges of "tightness" in my
right middle/upper chest area (more specifically, between
the sternum and my right nipple). On a scale of 1 to 10,
I would give it a 1.
They have all happened while at rest, with no physical exertion of any kind. Some of the first "symptoms" happened after I woke up from sleeping. I sleep on my right side with my right arm
raised above my head. At first, I thought I had strained a
muscle in my chest because the pain would usually happen only when my right arm was in a certain biomechanical position, like :
raising my right arm to comb my hair;
raising my right arm straight out to the side
raising my right arm straight up above my head, or
moving my right arm across my chest
After a couple of days, the "tightness" was gone. Then,
the "tightness" returned, but would happen in more everyday situations, not just whenever I raised or moved my right arm.
Some of the examples are :
Sometimes when I get up out of bed in the morning;
Sometimes when I bend over to brush my teeth.
Sometimes when I bend down to pick up something from the floor;
Sometimes when I stand up and / or sit down
They would happen infrequently, maybe once a day, or every
other day, until last week, when the frequency jumped to
almost every day, if not daily. What alarmed me the most
was that :
the frequency jumped rather quickly;
it seemed to happen with almost any kind of move that I made;
it didn't happen when I was physically exerting myself
(walking for example)
I have temporarily stopped walking to be on the safe side.
After much reading and research, I am beginning to suspect
that I may be suffering from a Coronary Artery Spasm and / or some sort of variant/unstable angina brought on by
Coronary Artery Disease.
If there is one good thing about these episodes is that I
don't experience any of the other "classic" symptoms, such
as shortness of breath, radiating pain in my shoulder,
jaw or arm, nausea, sweating, etc. But I also understand
that doesn't neccessarily mean that nothing is wrong with
me either.
My questions to you are :
Should I be worried?
Should I make an appointment to see my primary care physician right away, or should I skip him and go straight to the cardiologist instead?
If I do end up seeing a cardiologist, what type(s) of test(s)
do you think he would run to determine the cause(s) of my condition? What test(s) would you recommend?
I am also considering holding off on calling the doctor,
and starting aspirin therapy on a daily basis to see if this would help me at all (although I am hestitant to start without
my doctor's recommendation and approval).
Thank you for your time and consideration regarding my questions.
Any help, suggestions and / or information would be greatly appreciated.
Sincerely,
AJ
Doctor's Answer
by CCF CARDIO MD - DLB, Nov 22, 1999 12:00AM
I do not think you should self medicate or go right to the cardiologist. I think you should see your PCP. What you describe does not sound like coronary artery spasm. Your PCP can examine you and figure out if it is some sort of musculoskeletal pain or whether another round of cardiac testing is necessary.
