Angina or esophageal spasm?

[who_is_this]

48 y/o nonsmoking slightly overweight female.  Low total chol (144) and good hdl.  Mild hypertension on Lisinopril and HCTZ. No other meds.
2-3 years ago had a stress test and stress echo after very mild bout of what I thought was minor chest pain, all ok at that time.  I've pretty much dismissed any thoughts of problems since then.

Couple weeks ago while driving was hit with intense sternal chest burning/pressure that was so painful I felt I might pass out, but didn't.  A  burning "flush" type pain went up my throat to the lower part of my face. It took about 15 min for symptoms to abate while I contemplated calling 911.  I chalked it up to bad heartburn and thought I'd go to the doc if it happened again.

Last week, it happened again while I was simply sitting down.  Not quite as intense, but exactly the same severe burning in my chest, with the weird flush/burning up my throat to my lower face.  This time, it only lasted 6-7 min and wasn't quite as bad.  I didn't go to the doctor.  

I feel as though I would be very low risk for any cardiac blockage, due to my low cholesterol, nonsmoking etc.  Someone at work mentioned it could be an esophageal spasm.  I hate to be an alarmist, in light of the good stress testing a couple years ago and low risk status.  What is your take on this?  Should I to to the doc and have another stress test?  This happened at rest both times.  I have zero problems during strenuous activities.
Or just take a wait and see approach?  I don't generally ever have heartburn, but I suppose it could be reflux.  Thank you.

[Cleveland Clinic]

who,

I agree, without a lot of risk factors the likelyhood for your symptoms are coming from cardiac blockages is on the lower side. There is no way a quick paragraph on a web site could even come close to a substitue for a quick look over from a physician that knows you. Any time ou develop new or concerning symptoms, you should seek medical care. Even though other causes of chest pain may not have the immediate consequences of a heart attack or unstable angina, they potentially could cause some problems if left unchecked. Talk to your doc.

good luck

[andie3330]

Whoisthis - Based on your profile and symptoms it does seem more likely to be non-cardiac pain. I would be reassured also by the fact that your symptoms are not induced by exercise. Myself, I had atypical chest pain and a very low risk profile so I ended up having a CT scan angiogram which tured out normal. Since it is a non-invasive test with very little risk (unless you have problems with contrast media)it was the best option for me and I'm very glad I did it.

fwilson - I was very sad to see your last post because I know a lot of people who read this forum will be unnessasarily worried about it.  It is true that PVCs can sometimes be an INDICATOR of more serious heart problems, but that does NOT mean they are dangerous in and of themselves.  The people in the study you quoted had only a physical exam and holter monitoring, and just because they had no history of heart issues - they still may have had undetected heart disease. Anyone who has newly occuring PVCs or a increase in their PVCs surely must have further testing done to rule out an underlying condition. For example, they might have a stress test and an echocardiogram - or what ever the doc sees as appropriate given the persons risk profile. IF THOSE TESTS ARE NORMAL then the patient can be reassured that their PVCs are not indicative of a more serious condition and the PVCs are considered benign.  From the abstract you posted, it did not appear that the study participants had gone through and RECIEVED NORMAL RESULTS from additional testing prior to the study's five year time frame.  I think a non-scientist (many people on this forum)could easily read the abstract you posted and mistake correlation for causation. It is NOT the PVCs themselves that caused the negative events in the study participants, but rather, the underlying, albeit previously undetected, heart conditions. Yes, PVCs can be an indicator for heart disease but that doesn't mean they can't be benign in the absence of significant heart disease.

[who_is_this]

I only had it twice, so I'm not terribly inclined to take anything long term for it.  Just hoping it doesn't come back!  

[momto3girls]

Hi, who_is_this,

Love the name!  Your symptoms are exactly the same as mine.  Last week I ended up in the ER with same presenting symptoms, chest pain (cramping) and burning.  This has happened to me at rest and while working out on treadmill.  Well, to make a long story short, they discharged me and I didn't have a heart attack!  (Always good to hear) This is such a great topic that I'm sure applies to a lot of people here on the forum, as you'll see by the people who post.

I would go to a cardio dr. for peace of mind, if nothing else.  They'll probably repeat some of your previous tests and you'll feel much better.  You sound low risk to me (:  Also, I noticed that you were sitting both times you had this pain/burning.  That sounds more like esophagus to me then.  Most of mine is while at the computer (like now) and sitting down.  I'm being evaluated for esophageal spasm too.  Isn't it just so lovely that esophageal spasm can mimic angina?  I wonder how many patients go to the ER with the same symptoms thinking, this is it, the end of the road for me!  I was thinking of my husband and 3 little girls while in the ER and it turned out to NOT be my heart.  I followed up with my cardiologist last week, have had another event monitor for a week and when I had symptoms, it showed up as nothing!  Best of luck to you!  

Andie, thanks for chiming in about fwilson's last post.  I was very upset when I read it for the same reason's you were.  Very helpful that you clarified what he was asserting!  Hope you're feeling well!  Best wishes (:

[NanaRose]

I have had both esophageal spasms and true heart cardiac spasms. Some say they are identical but "with me"...I did know the difference AND Nitro will work on both.

PAC/PVC's...I was told they were all benign in nature  (via 24 hour holter monitor)  They were not normal as I had an undetected heart attack that was missed.  Finally ended in ER room with A-Fibs and Tachs and was brought back to NSR via IV.

[momto3girls]

Hi anacyde,

I wore the event monitor for only a week.  It looks very much like a holter only smaller.  (Only 2 leads also.)  Anytime I had a symptom, I pressed the button and it recorded the actual event and the 30 seconds before and after it.  You can record up to 3 events at a time (on mine anyway) then you call this 800# and transmit it through the phone.  They fax the daily results to your doctor and then your doctor updates you on what they found.  

On mine, all they saw was sinus tachy and pac's, pvc's.  Nothing new here!  Main reason was to try and correlate my chest pain symptoms with the monitor.  Good news was that it showed absolutely nothing as far as the chest pain was concerned.  Very reassuring.  I think it's a great tool but highly annoying!  For instance, while my husband and I were intimate, I had to push the button!  Not too romantic.  

Anyhow, I know the event monitor is better than a holter in that you can wear it longer, shower and such and just record when you have symptoms.  Niftly little gadget, isn't it?  Is your doctor giving you one?

[KAD]

You are annoying and out of line.  You are not a physician, so stop acting like one!

[Erik36]

Despite your stress test and echo 2-3 years ago and your low total cholesterol, I think it's very possible you have had a couple cardiac events. Possibly even two heart attacks. Esophageal spasms and pain can mimic heart-related pain so there is no way to tell the difference without proper testing. Women seem to get pain radiating to the neck and jaw during a heart attack. It's different for everyone. I think you should call your doctor and get re-evaluated ASAP. There are such things as false-negative stress tests. Things can also change a lot in 2-3 years. Remember, half of all heart attacks occur in people with low risk profiles. I'm not trying to scare you, I just think you should be safe and get checked out. Good luck.


Erik

[upbeat63]

I think the bigger thing to realize here, stepping away from research studies, which you will agree have inherent flaws of one sort or another, is that PVCs, risk or not, still have no single identifiable cause (sure lots of triggers), and sadly no real treatment options unless you consider the "sensation surpressing" beta-blockers or the toxic antiarrythmics or invasive ablation--which by the way is not recommended for PVCs after all!!!!

I think the one thing everyone can agree on is that PVCs are not well understood, can't easily be adequately controlled, are probably under-researched because the plain fact is people AREN'T dying left and right with/because of them and so researchers (pharmacuetical companies) aren't funding enough studies.

By the way, I still play the lottery even though I'm told my chances of being struck by lightning are higher than winning.

Laughter is the best medicine, not to diminish anyone's current health plight, but could we lighten up a bit?

And regarding the actual thread topic I have, on several occassions had excruciating pain with swallowing food which hints at yet one more trigger for the dreaded PVCs, vagal nerve irritation. Best thoughts for all.

[ihatepvc's]

Also my apologies for posting regarding another subject. I would like to say that I have read that entire study you posted (not just the abstract) and so has my husband who went to medical school. Examining studies like that is part of his job as a patent attorney specializing in pharmaceuticals. I think you know better than to cite an abstract like that which can be quite alarming to someone who has not read the entire article. This study involved people anywhere from 55 to 75 years of age. How do these statistics compare to the general population in this age group? They did not have full cardiac workups like most of us have, only a 48 hour elecrocardiolgraphic monitoring. These subjects had no "APPARENT" heart disease. Many of them had other risk factors like diabetes and were smokers. Also you fail to mention that that the vast majority of sudden death cases occured in those with other signigicant risk factors referred to in the study as having "an above average Framington risk score". It might relieve the women who had the misfortune of reading your abstract that these deaths occurred mostly in men. As for your not knowing where I was going with my cardiologist's comment of "you have a better chance of dying in a car crash", I meant "IT IS VERY UNLIKELY". I'm not sure where YOU are going! You seem determined to prove that you are going to die a sudden death as will the rest of us. It's not enough for you that most of these cardiologists keep themselves updated on these studies plus can speak from years of experience. If you want to be helpful, then be helpful. Posting an abstract like this just causes alarm and confusion.

[bama jane]

I have multiple rhythm problems and daily chest pain that the doc's do not think is my heart, how do you determine if it is esophageal spasm and is there a medication that anyone who has this has found that helps with the problem

[jeff 67]

Well said ... I guess some people are convinced there are conspiracies out there.

[momto3girls]

I hate pvc's, thanks so much for posting that response to fwilson!  You completely cleared up a lot of the confusion and anxiety he was bent on creating.  I wish there were a way to link your post with the other thread he posted on.  Anyhow, best wishes to you and your husband for sorting out that study.  I'm sure more than person here on the forum will appreciate it immensely!!

Who_is_this, I hope you're feeling better.  You said that you hardly ever have heartburn, I've read numerous web-sites that say you can have gerd issues without heartburn.  I would definitely follow up on it with a doctor to see what's going on.  Good luck to you (:

[who_is_this]

Thanks.

It's only something that happened twice, very slowly and insidiously but incredibly, breathtakingly painfully.  I think if it happens again, I'll probably go, but it's been over a week and it hasn't happened again.

[msmma]

"I think the one thing everyone can agree on is that PVCs are not well understood, can't easily be adequately controlled, are probably under-researched because the plain fact is people AREN'T dying left and right with/because of them and so researchers (pharmacuetical companies) aren't funding enough studies."

I completely agree with this statement.  However, at the same time, this infuriates me.  People are also NOT dying left and right from the common cold, yet millions of dollars of research has been done so that I can walk into my local Pharmacy and literally see hundreds of different medicenes for stuffy noses, coughs, etc..

Why are all these cold meds out there?  To address 'Quality of Life' issues, not life or death issues.  Seeing the PVC's also fall under that umbrella, I have a really hard time swallowing the fact that PVC's are not really researched because they are not life threatening.

Just my 2 cents...

Mike

[Fran71]

I too apologize for using this space to comment on the issue Fwilson has raised. Though I too find Fwilson's attitude a bit annoying, because he/she does seem to enjoy scaring people, I think the questions are reasonable because I too have run into similar studies and they left me wondering. But like many have pointed out, one needs to be very careful when reading scientific articles, and I thank those of you who took the time to elaborate on the full text of the article, which I haven't read yet. To mistake correlation for causation is I think the best way the problem was put. Selection bias is extremely dangerous. I was amazed to see that such a flawed study was published on an authoritative journal as this. The study can't be trash then. But I'm sure many authors will comment on it in the following issues. It would be interesting to pose the question to the cardios on this board, but I'm not sure if that would be just a waste of space, as so many people are waiting to post their questions.

Take care all
Fran

[jmike1_]

I love this site, but must admit sometimes I get a headache from reading all the posts.  I think it is quite valuable to share experiences that we've all had to comfort and help each other, and give advice on various good med facilities.  But, seems to me that many (not just FWilson) spend some time on the internet or reading med journals and start giving medical advice based on the poster's issue rather than simply sharing what they went through.  I think it is highly unsafe and should be left for the medical experts - who are wonderful in providing quick responses on this site.  

Anyway, regarding the original post, if you are concerned about your symptoms, nothing compares to getting a good look-over.  I've had the burning chest sensation (although I've been told men's and women's symptoms are quite different),as well as other symptoms such as upper back pain and chest pressure.  I passed all my stress tests and EKGs.  The doctors didn't think I had (and still aren't convinced) that my pain was cardiac related.  By the way, I'm 39 and don't smoke and exercise regularly.  They thought it might be reflux, so I've had the "tube down the throat" test, which was negative.  However, after a heart cath (which I've now had 4 times), I have 4 stents in my LAD for four 80% blockages.  Not saying/recommending this is what you have, but if your symptoms concern you, you should be checked out.  Even if it is not cardio, you still don't want to have the fear of a potential problem weighing on you.  Good luck, and I hope everything turns out well.

[ihatepvc's]

I don't really understand why you are challenging everyone to show you studies when several of them are listed for comparison purposes in the study you posted:

"Kennedy et al followed 73 subjects with frequent vpc's and found favorable prognoses in all subjects. Fleg and Kennedy followed 98 healthy subjects with different frequencies of vpc's and did not find any increased risk. In a study of 301 asymptomatic men, Hinkle et al found a 10-fold increase in the risk for sudden death associated with greater than 50 vpc's hour in a 6 hour holter recording and this was mainly due to increased risk in men with risk factors for coronary heart disease. Rodstein et al did not find any increased risk in 712 subjects with vpc's on standard electrocardiolgraphy in long term follow up. However, in the presence of elevated blood pressure or other risk factors together with vpc's, mortality was more than two-fold. The Tecumseh epidemiologic study reported a threefold increase in the age-adjusted rate of sudden death in subjects with vpc's on standard electrocardiography. A later study showed that many of these subjects had other risk factors for coronary heart disease as well."

[tickertock]

From what I gather PVCs in themselves are regarded as benign regardless of frequency. Persons with one the cardiac syndromes,a significant structural abnormality, a previous MI or CAD, then the frequency of PVCs appear to be a marker of increased mortality, just my undertanding only.

If one has been assured by their cardio and has gotten a 2nd opinion with a confirmed benign prognosis regarding PVCs, my suggestion would be to move on from there and try to conquer the anxiety they cause, I know its hard but it is the best thing to do.

[who_is_this]

If I were a newbie to Medhelp and didn't understand how it works, I would be EXTREMELY PISSED that some felt it ok to start a raging debate under my thread, and the thread of several others who had made other posts.

I felt I got a lot of answers, but someone else new to the site might be justifiably upset that someone elses agenda filled up most all the comments.

DROP IT!  Neither side is going to "win" your debate.

[tickertock]

I just want suggest the next time you feel those symtoms to go the ER, my cousin who is 51 year male had similiar symtoms,had them again last Friday night, good thing he went to the ER, He had a significant MI and had to be air lifted. He actually had to be stabilized for a day before the stent could be placed. I might add he was smoker though which the doctor probably hastened his tendency toward CAD from his fathers side of the family.Maybe it might be wise to get checked before you get symtoms again, just my opinion I'm not a doctor. Also want to add you're absolutely right neither side will "win" the debate regarding PVCs.Good luck and take care of yourself.

[who_is_this]

Thanks.  I'm a lunatic.  I keep telling myself I'll go, but I doubt I will.

[keith.uk]

A related discussion, unstable angina and  esophageal spasm was started.