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Chest discomfort with higher systolic blood pressure

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
11 Responses
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Avatar universal
Al, (and others with similar symptoms...)

I just found this forum while searching for a site to help convince me its NOT necessary to make a trip to the ER.  (Female, 41, chest pain, yadda, yadda).  Anyway, I decided to go through the relatively minor hassle of registering so I could post this info for you:

There is a very rare condition known as APS (antiphospholipid antibodies syndrome).  I have it.  It can be relatively benign, or it can be disabling, as in my case.  It often mimics MS, and "they" are finding that a good number of patients have even been misdiagnosed as having MS when they in fact have APS (sometimes known as APLS or Hughes Syndrome).  It's rare to find a doctor who knows about APS, and even rarer to find one who, if he/she knows about it, knows how to treat it properly.  Almost no one tests for it.

In a nutshell, APS is a blood clotting disease.  Having read your posts, you do "fit the profile," especially with this ongoing headache right now and the recent weird stroke-like incident, what might have been a "migraine stroke," or a TIA.

In any event, it's worth checking out.  Treatment is with anticoagulants, either Coumadin (most people), or Lovenox injections (unstable APS patients), which is what I'm using now.

I don't know if I'll ever find my way back to this forum, but I hope this info is useful to you or someone.  For now, I need to make my mind up about going thru the hassle of an ER trip. *sigh*  One of those "I know I should, but I hate to deal with the 'hospitalists'" things." (great term, btw!)

Best to everyone!
Moore
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Avatar universal
Hey Al,

Just wondering how you're doing.  Drop us all a line and let us now how things are turning out (:  Best wishes (:
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Avatar universal
It would seem to me that since your chest pain/discomfort is always accompanied by high systolic BP it would be prudent to attempt to achieve better BP control. (Can't hurt/might help, right?) To that end, your exercising is commendable.  Are you watching your sodium intake?  If you are doing all that you can, perhaps you should ask your cardio to try an adjustment of your meds?
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Avatar universal
I don't know if you want to share your condition, but you seem to have a lot of information dealing with the heart.  I notice that you take a lot of medicines.  What were the stroke symptoms that you were dealing with when they put you into the hospital?  I have tried to post a comment, but I never seem to beable to get into the post.  I have a valve problem, plus the arteries.  They want me to do surgery because ischemia.
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Avatar universal
Oh Al,

I feel so awful for you.  You poor thing!  My heart just aches for you.  I am so very sorry to hear of this latest development.  So, they haven't said one way or the other if it was a stroke?  I'm sure they're keeping a close eye on your pituitary tumor.  Funny, I went for an MRI 3 years ago because my TSH was so low, almost untraceable and they said they were looking for a pituitary tumor.  Are they sure it's not pressing something it shouldn't be?  

I truly feel for you though.  I am hoping and praying that you find relief and the doctors put together the pieces for you.  Interestingly, I went to a neurologist as well for similar issues, and he said I had atypical migranes as well.  Mine always hit a spot on the front left side of my forehead.  I am dizzy pretty much most days of the week and have had facial numbness too.  How weird for you.  I was doing my own research into MS because I wanted to find some answers.  My husband said it seemed like I wanted MS, just goes to show how little he understands how crappy I've felt!  At least it would've been a clear diagnosis.  Wow, maybe it was an MS attack.  Do you have family history?  

Please take it easy and I'll be thinking of you as well.  Good luck with CCF then, hopefully they'll be more thorough and link some things together for you.  Take care and my sincerest wishes to you for good health (:
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Avatar universal
What test shows small vessel disease?  I have that along with the major arteries.  How do they know.  When I had the cath, they told me I had blockage in a branch off the LAD that could not be stented.  Is that small vessel disease? Do you know much about aortic stensis?  I am having a hard time be told sugery for 5 arteries plus the aortic valve.  
I can't imagine having all the things that you have to deal with all the time.  You are so knowledgeable.  I think that a stroke would be so scary.  It sounded like you had one.  I hope that you can find an answer to everything.  You are certainly wonderful to have on this post.  I hope you do not mind my asking you more questions.
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Avatar universal
Al Dente - given all of your health issues, you have an incredible sense of humor (and seem like an all around smart guy). More power to you dealing with the docs, and good luck.

My dad recently passed away (massive stroke) - he was 86 and did not suffer long, so it was a sad time but not tragic. The "Hospitalists" (is that what they are called?) at our hospital did take quite a bit of time with him, and I felt they had a decent bedside manner. I did, however, have to take a very proactive approach to arranging visits with his specialists, and coordinating his care. I'd hate to imagine what it would have been like if he had been alone.

On a lighter note, ever watch "House"? Bet we all wish we had a team like that around! Though I wouldn't want them breaking into my house :)
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Avatar universal
Wow, you are a train wreck (:  It must seem so unfair to you.  I hope you have good family you can fall back on because it must really be taking a toll on you.  

So, they're doing MRI's and such on your pituitary and spine?  At least they're looking in a different direction for you and hopefully something will connect.  

Personally, I don't care for MRI's (:  I don't like feeling enclosed, although the oh-so-helpful technician (who barely spoke English) told me to try and sleep!  Ya, good one!  Firstly my MRI lasted 80 minutes, I felt like I was in a coffin and the darn thing is so loud.  How is anyone supposed to sleep through all the banging/clanging?  Plus the contrast makes my heart race, which I already have problems with.  My dad claims he can sleep through all his MRI's though, and he's had many.  (He has a really rare issue with his sinus' where they've been infected so much that it ate away the bone in his forehead.  He had this huge lump on his forehead, he said he looks like a lop-sided frankenstein!  Well, he did actually.  He had this bizarre surgery at Duke where they peeled his face down, took fat from his stomach and basically made a fat sandwich with it.  They shoved it in forehead along with a titanium plate to replace the bone.  The good news was that it hadn't reached his brain but he's had this surgery 2 times and now the infections are back with a vengence.  It makes me worried because on top of this he has SVT and severe allergies.)  Anyhow, it's hard to be sick and see someone you care about sick.  

Can MS attacks still leave behind lingering effects?  How strange.  I hope your doctors are moving quickly to help you.  You know what, you can complain, you have every right to in my book!  Sure they're are sicker people out there, but you have a pretty nice little set of issues yourself!  And I love how the hospital said you seemed irritable.  That made me laugh.  Of course you were.  When I get just a normal migraine, I don't want to move, be talked to or even looked at!  I can only imagine how difficult it must be to still have it.  Mine last usually 2 days and I end up with bags of ice on my head to dull the throbbing.  Not fun is it?  

You must be so frustrated to be having all this.  I hope you can keep your spirits up.  It sounds like you trust your cardio doctors so that's good.  Hang in there and for what it's worth, you're still in my prayers too (:
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Avatar universal
Hey Al,

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 and non-cardiac chest pain.  I am wondering what the doctor's reply will be.  Have a great evening (:
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Avatar universal
I'm not sure how much help I will be, but I do get angina.  There are so many different kinds of symptoms for heart disease, and it is hard to know for sure what is the problem.  One symptom that usual happens with stable angina is symtoms when you are exerting yourself.  There are many websites that will list symptoms.  I will be glad to list them if you want me to or give you websites.  Unstable angina can happen at rest and one is told to get help.
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.
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74076 tn?1189755832
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.
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