Every sign except the MI itself?

[PED]

This my second question in 6 months, as such it will be my last.

In December I went to the ER with Chest pain. BP was high.  Chest x-ray, bloodwork, ecg, and nuclear stress ecg was reported clean.

However, since that time I have continued to have the following symptoms:

1.  Shooting pains in my arms (more left than right), shoulder, jaw, face, and entire chest cavity.

2.  Severe indigestion at times, including massive belching and nauesa, some coughing.

3.  3 more bouts of the central chest pressure. I will admit both were during stressful situations for me.

I've been evaluated for GERD (gi scope) and do have some reflux, but it's not severe and I am on max meds (80mg nexium, zantac at night).  They don't seem to help.

I'm on BP meds, and tried lipitor but got muscle cramps and just stopped it. I have high cholestorol (230, 145 ldl). BP is in the 140/80 range without meds. I can exercise without "classic" angina. I do at times get shooting pains, but never crushing, never short of breath. I can go over an hour at 80% or more of my HR and feel fine.  

Q's?

1. Regarding my above symptoms - They are all classic warning signs - however, when they talk about warning signs, are they usually more acute?  Mine have gone on for 4 months now.

2. Tough - What does angina "feel" like, location? Would my BP go up during angina spells if I had CAD?

3. When they talk about arm and jaw pain, is it shooting, or consant in nature?  Mine are shooting 98% of the time.

4. Other than to put my fears to rest, would any cardiolgist Cath me/64 slice ct?

Thanks

[CCF-M.D.-MJM]

Hello,

Sounds like you are having a tough go at this.  For one thing, if the nexium and zantac aren't helping, you could always stop them.  It sounds like gerd may not be your problem.

1. Regarding my above symptoms - They are all classic warning signs - however, when they talk about warning signs, are they usually more acute? Mine have gone on for 4 months now.

The signs you describe aren't exactly classic.  Shooting pains are usually not cardiac.  Cardiac pain does vary from person to person with seemingly more variation in women.  The classic cardiac symptoms are chest pain that increase with exertion -- you exercise routine is inconsistent with this.  It is true that cardiac pain can increase in stressful situations, but overall anxiety can cause a similar sensation as well.  I will admit that when you hear the classic case of angina, you are almost always right.  When you start getting more variation in the symptoms and there are some inconsistancies in your symptoms, it is not uncommon to find someone with no CAD but confusing symptoms that are difficult to you put your finger the exact cause.
  The symptoms can be very acute or they can slowly worsen over weeks to months.

2. Tough - What does angina "feel" like, location? Would my BP go up during angina spells if I had CAD?

Angina feels different to different people.  Classic angina is a fullness or pressure in the center of the chest that may radiate to the arms (usually left arm, sometimes right or both), jaw or neck.  It is very seldom sharp or shooting in nature. It is usually associated with physical exertion or stress, but does not have to be.  Blood pressure can go up with angina and it also can go down.  It depends on the vessel involved and the degree of stress in the individual.

3. When they talk about arm and jaw pain, is it shooting, or consant in nature? Mine are shooting 98% of the time.

It is almost never shooting.  It usually slowly increases.  Patients often tell me it is very difficult to describe when I ask them.

4. Other than to put my fears to rest, would any cardiolgist Cath me/64 slice ct?

That is a tough one without meeting  you and talking to you.  The answer is always yes.  People will use the techonology because it is there -- we probably over use it.  It is not a bad idea to do it to put someones fears to rest if they are really worried about it.  It is actually in the guidelines as an approved indication.

I hope this helps.  Good luck and thanks for posting.

[tickertock]

From my own experience and battery of tests , shootings are rarely cardiac in nature/origin or so I'm told, I'm not a doctor, but I've been told by my cradio and internist shooting pains tend to more nerve related or intermittent muscloskeletal inflammation. Good luck.

[PED]

Thanks.  35 year old male, 5'10, 205lbs.  Limited family history as my family is very small.  Had  a grandfather die in his 50's of a MI.  However, he was a heavy drinker and smoker.  I am neither. (don't smoke at all).

They did a nuclear ECG stress, and it was clean in December.

Other weird symptom is the back pain many report.

I know I haven't been having a MI for 4 months now on and off... as I've had the symptoms.  Just wondering if they are warning signs (should I push harder on docs), or real Angina.

[omega67]

Dear Ped,
         I have had a really bad problem with GERD and I have went to the doc and he also gave me nexium and he also gave me a generic for pepcid called fomatodine anyway I Think thats how you spell it.  But I also went in and had a stomach wrap done and it is awesome no more GERD not any I can eat what ever I want to and I have no problems, Before I was getting heartburn from milk it did not matter what I ate or drank it was really bad.  I also had some of those pains you are describing and the doc said it was from the GERD because my heart was fine.  You just have to keep trying new things until you find what works for you and your bodys chemistry.  anyway I hope maybe this will help I will keep you in my prayers God bless take care.
My email is ***@****

[DavesMom]

Hi,

Interesting post. I've been wondering whether what I've been experiencing over the past couple of months is angina. I've had approximately ten to twelve episodes of tightness/discomfort in the center of my chest that seems to goes straight through to my back. Lasts perhaps ten to twenty minutes. No other associated symptoms such as sweating, nausea or shortness of breath but it is very uncomfortable. I walk every day but these episodes never happen while exercising. They've happened in situations where I've been under some stress and also times when I've been completely relaxed.  

Had my physical in December and my doc said that my mechanical aortic valve (put in seven years ago) was clicking away loudly. BP and all blood work normal except for slightly elevated cholesterol. The echo I had last month was just fine.  

Since all tests have been normal I hate to seem like a paranoid alarmist and go running to my doctor. I'm not sure what GERD feels like (these episodes never happen soon after I eat) or I wonder if it's being caused by some sort of inflammation.

Would an EKG only be useful when I'm actually experiencing the discomfort?

Thanks and I look forward to reading the rest of the comments on this topic.  Cheers!

[LukeL]

The fact that exercise doesn't increase your chest pain is a good thing as this indciates your heart is getting enough oxygen. You may want to ask your doctor for some nitro pills or spray just incase you get your chest pains again, if the nitro doesn't help the odds of it being a cardiac problem are even lower.

With all the tests you have had your odds are very very low, I personally maybe would have a CT, or perferably an MRI (radiation exposure during a CT is too geat for a non necesary test IMO) to put your mind at rest. A cath study is too invasive for me but if it would put your mind at ease go for it.

You may also want to look into anti-anxiety medication and treatment and possibly even chriopratic problems.


Please note I am not a doctor and this is just my opinion please discuss anything with your doctor.

[Healthyself2]

Regardless you would be wise to bring get your lipid profile more healthy.  

You didn't mention your HDL, but my experience is that this is the best predictor of future coronary artery events.  

I had a similar lipid profile to yours with an HDL of 29 or 30.  When I had my first cath after an M.I. at 49, they discovered a "long standing" total occlusion of the M.I.  After two failed attempts to angioplasty that and other problems, I decided to live with the condition which has gone pretty well for almost 7 years.

I had been told twice that my ECG suggested that I had prior heart attacks, but I never sought hospitalization for them.  I remember laying in bed for most of 4 days when I was 33 with the same symptoms that I had for the M.I. at 49.  I also went skiiing in France one time and quit with pain after the first half day and just laid around my room (hotel was at 8,500') for 4 days with the same type of problem.

Over the years I had all kinds of chest pains, mostly sharp ones.  I used to beat my chest with my fist in an attempt to make them go away at times.

The heart attack felt much different with an intense and increasing aching under my sternum which eventually became almost unbearable.

Because of my blockages, although I am physically active, I will still experience angina under certain circumstances such as when I eat and then walk uphill.  As the doctor said it's more aching in the center of the chest, increasing with exersion.

On the other hand I think that shooting pains such as you have may be an indication of coronary artery disease.  Hell I used to run 10ks with a totally blocked artery.  Since my M.I. I've climbed mountains all day where I had difficulty keeping my heart rate below 130 because of the continuous physical demands. And that's with the totally blocked RCA and my ruptured plaque in my left main without any noticable experience of angina.  So just because you can sustain 80% of heart rate doesn't mean that you don't have significant coronary artery disease.

The bottom line is that no matter where you are at you should attain, and maintain long term, a perfect lipid profile if you want to arrest the disease.  You will most likely have to do that with drugs.  If your HDL is below 45 you are probably in trouble long term.  The only drug on the market to raise that right now is Niaspan, but better ones are coming.

Also loose weight, eat green stuff, reduce stress, walk 2-3 miles per day or swim and enjoy life.

Best Wishes

[PED]

Thanks all for your insights.  

I am struggling with this which is obvious,and trying to figure out how far to push doctors, without being labled a nutcase is tough.  I work in the medical field so I know enough to be dangerous...

My IM doc does not feel it is cardiac and I understand why.  My pains are shooting most of the time, when I have had the central chest pressure it has been after stressful situations.  I can exercise just fine.  I'm 35, don't smoke.  I'm about 15 lbs overweight, maybe 20 but work out a lot.

My Total Cholesterol is 230, I started a statin and had muscle cramps, in fact I also had a lot of GI distress.  My HDL is in the low 60's so that is good.

My bloodwork has been clean, everything within range.

I do have some anxiety, no question. I have a low dose of Xanax I take on occasion.  That however does not help with the chest pains either way.  I get shooting pains, and pinching type pains in my ribcage.

I'm on low doses of two blood pressure meds, an ACE, and a Calcium Channel blocker.

6 months ago, I was fine.  No meds, felt great.  

I'm scaling back on the acid reducers since they don't seem to help, but when I tried cold turkey - damn, I had a rebound effect.

I don't want to get cath'd if not needed.  What is tough is that if I were a cardiologist, I also would likely not cath me.

I'm trying to decide if I should push for the 64 slice CT, or another local place has a heart scan for 300 bucks.  It also uses CT, but isn't the 64 slice.  I don't believe it shows soft plaques.  But, it might be enough to ease my cardiac fears.  

Thanks all.  Only good thing is that over these last 6 months I've really eaten healthy and realized how important my family (kids, wife etc) are to me.

[Flycaster305]

Cardiac pain is so very difficult to identify as such.  I've had two heart attacks, I should know for sure what is and isn't cardiac pain... but I am fooled.  I have a couple of problems that cause chest discomfort, Ankylosing Spondelitis and Asthma.  During a stress test several months ago the test administrator suddenly asked me if I was having Angina pain.  Through clenched teeth I muttered, no, only some Asthma.  They stopped the tests, I was ushered straight to the hospital for two more stents!  Since then, every time I get some chest pain I pop a Nitro tablet.  I simply can't tell the difference.

Good luck to you.

[PED]

No, my PC is pretty good about things.  I think I'm going to push real hard to get the 64 slice 3-D heart scan.  If he won't refer, I may just go pay the cash to have one done.  I think it runs about 1200 bucks, which is a lot of money, but to get piece of mind back that whatever this ailment is, is not my heart might be more than worth it.

I am insanely gassy and belching all the time though, and when I can't do either... the chest pain and shooting pains get worse.

[woodruff]

"I'd take a cath over a shot in the toe anyday!"

Can't resist, Al:  What are you doing getting shots in your toes, anyhow?

[George8211]

I get shooting pains in my Chest and have also had in my Jaw, Shoulder, and Arms.  After running out of medical test for my Heart, I started to see a Chiropractor...  Turns out I have 2 disks that are slightly compressed that aggrivating nerves.  For the most part my regular adjustments have correted this problem.

Now that I know what it is... I pay closer attention to the pain and can feel that it is orginating from my back and coming around my ribs... to the center of my chest.

Just something to think about.