Exercise-induced Angina???

[unksoldr]

52 yo female, smoker, No history of heart disease. After 2 months of strength and cardio training at a gym experiences chest pain at 80% MHR(she thought gas pains). One week later diagnosed with pneumonia, doctor blames smoking, prescripted antibiotics. Patient returned complaining of shortness of breath and got a chest xray. Doctor reviewed chest xray and ordered a echo on heart. BP was also running high during this time, though patient has never had a high BP reading before and heart echo showed moderate tricuspid regur. Referred to cardiologist, during stress test chest pains at 90% MHR, stopped test and given nitro. Cardiologist does heart cath because he "needs to find the blockage!". Result...no blockages, pressures and ejection fraction normal. Doctor's only instructions, return in a year for another stress test!?!?!?!?! I'm assuming the diagnosis is exercise-induced angina and further conditioning will improve her MHR over time??? Doctor said safe to return to gym, but to start slow. Wouldn't a scrip for nitro be appropriate???

[CCF-M.D.-MJM]

Hello,

unksoldr -- does that stand for United Kindom soldier??  If so, kudos for serving your country.

These are tough cases.  Your doctor is right that it is ok to exercise and that she should slowly increase her exercise regimen.  It is reasonable to give nitro if it helps the pain.  I would also start a calcium channel blocker like long acting nifedipine or amlodipine.  If the chest pains continued, I would also consider adding an oral longer acting nitro pill like isordil

I am not sure if the mechanism here is "endothelial dysfunction" and failure to properly vasodilate with exertion or if it is spasm.  Either way, vasodilators are appropriate.  If endothelial dysfunction is a concern, I would also check her lipid profile and consider starting a state medication like atorvastatin or simvastatin as well.

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

[scag]

i just wanted to say that i think your post was written without much thought at all,and im not a doctor but i cant believe for the life of me that anxiety symptoms can be related to hear failure,and im sorry to hear about your friend but whatever medical facility did the testing and did not give proper care should be investigated but that doesnt happen very often at all,people are on this site to relay and talk about serious problems and the doctors are nice enough to give us some of their time,some people might now worry about your posting but i would urge everyone to consider the source and follow doctors orders
thanks
hope everyone is well :)

[unksoldr]

No, I am a retired disabled US veteran, 50 yrs old, male, a heart attack survivor(4yrs) and after 25 years in the VA system my opinion of the medical field is pretty low.LOL Especially, since a good friend who went to the ER with chest pains/shortness of breath and was told she was mental and having a panic/anxiety attack. Given a scrip for some sort of sedative! (BTW ladies, panic/anxiety attacks can be a serious symptom of heart failure) She died at the age of 43 in her sleep Thursday night 2 months after the ER visit and a week after another doctor noticed a abnormal ECG and referred her to a cardiologist. She won't be making that appointment but I'm sure the doctor will try to charge her for the missed appointment! I now chose my doctor by looking at his car, if he's driving a Jag,BMW,Mercedes,etc his biggest concern is your money, if instead he's driving around in a car similar to mine or yours(i.e. a beater)his biggest concern is more likely to be his patient's health. I do realize that this isn't always true but please remember one thing when you chose a doctor!!!! He is your EMPLOYEE, respect him for his knowledge, pay him well for good care but if he treats you as if he knows it all and you know nothing about the body you yourself live inside then you might want to stop payment on his last bill and start looking for a new doctor.

[suzzie1]

Hi Al, I see you are having your heart cath. this week!! I wish you well and will be hoping and praying that you get good results from it :).  I'd  also like to ask your opinion on something Al,(because I value it).. About 4.5 years ago I had an exercise stress test done and had to stop at just over 6 min due to chest pain and irr heartbeat, the doc said the test showed somekind of depression..about 3 years ago I had another exercise stress test done and the doc told me to stop because of whatever they saw my heart doing. They wouldnt let me leave the hsptl and called a more senior doc who admitted me right then (even though I was protesting that I had to go pick up my kids from school etc) he said there was no way he could let me leave the hsptl. I was in hsptl for a few days, given Dilzem and a beta blocker and allowed home. I know your not a doc, but was wondering what are your thoughts on this !! As you know from my other posts, things have gotten progressively worse year by year, this past 5 or 6 days has been quite rough with a lot of chest pain.....its tough going!!!!!

[unksoldr]

If your brain sees your oxygen levels getting to low, it can and will in some people fire off a fight/flight response. This response is a panic/anxiety attack, in a effort to improve the oxygen level the heart speeds up and your breathing rate incearses, both help to supply more oxygen to your brain. That is why panic/anxiety symptoms can be and are often associated with heart failure. BTW ya might want to read up on CHF, panic/anxiety attacks are a known symptom of Congestive Heart Failure. Giving sedatives to a person with CHF is basically killing her, no panic/anxiety attack, no incearse in oxygen level, patient passes out, heart struggles then stops!!!
My friend I asked about in my orignal post was completely left in the dark by her doctor. However, when I accompanied her to see him he was amiable,friendly, and informative. When I arrived to get her after the heart cath our only contact with him was on the phone. He seemed to have the attitude "Well, it's not her heart so, not my problem!!" He never gave a diagnosis!!! Never ordered any prscriptions as the doctor here suggested.

PS My mechanic knows way more about my car than I do but I don't respect or pay him if he can't diagnose and repair my car's problems.

[suzzie1]

Hi Al, Yes,I have an app with cardio on 19th Sept in Dublin (Capital of Ireland)its make or break for me on that day..iv GOT to get help from them or thats it caus I cant bear to think of the rest of my life feeling like this!! I know what you mean about the meds, if Im late with mine I know at about the 3 hour mark,I start to feel unwell so I make sure it doesnt happen very often. Tomorrow I will phone my local hsptl and request copies of my reports, and i will take your advice concerning my visit to cardio on 19th.
Thanks Al and the very best of luck with your heart cath. :0)

[unksoldr]

I've been a member of this board for over 4 years now. In Nov 2001, I had the flu but the car needed a water pump. I was on that day of the flu where you finally start to feel like your going to live through it. Therefore, I was outside in 0 degrees and a foot of snow working on the car in Fairbanks Alaska. I felt some pain in my left arm/hand, didn't really think much of it thought I had bruised the palm of my hand. I needed a part and while standing in the autoparts store, I realized I was having a heart attack. I patiently waited for the part, paid for it and went home and lay down after taking 3/325mg aspirins. I think I was just about asleep when someone knocked on the door and I awoke with renewed chest pain. It was at this time I decided to go to the hospital. Once at the hospital, they got a ECG which must have shown problems which indicated MI, so was giving TPA before being transferred from the Army hospital to the local one. After some blood tests during the night I was informed the next day that 'yes I had a heart attack!" and actually it appeared I had 2-3 small MI's according to the doctor. After I got out I was put on atenolol( I have never had high BP)which seemed reasonable. I must say though, atenolol has some wicked side effects not to mention it's effects on blood glucose and triglyceride levels. When my triglyceride levels went off scale I was put on Lopid(gemfibrisol, a proven carcinogen) and my fasting glucose slowly creeped up till I was diagnosed as insulin resistance. Next, I was put on a max dose of metformin with Avandia added. Finally, Zoccor(undocumented side effect-increased BP) was added to my meds. I've been taken off the atenolol and replaced it with lisinopril. Also, for the first 3 years after the heart attack I had a thallium stress test each year. Results showed no damage to my heart, no blockages and a 75% ejection fraction and I reached my MHR each time.
After 4 years, my blood glucose was under control if I watched how and what I ate, my BP was hitting -90/-60, to low for me, I can't function well with BP that low. My lipids were much improved but not prefect. The combined side effects of all these meds made life miserable. So, 3 months ago I quit all the meds!!! First and foremost, I refuse to take recommendations about my health from drug companies. High blood pressure can be bad, but as a person ages their BP slowly increases. 50 years ago doctors used the 100 rule, your age plus 100 for systolic and if your diastolic wasn't over 90-95 it was considered a normal BP. Telling a 50 year old man his BP needs to be under 120/80(or have the makers of BP meds got it dropped to 110/70 now??) is a bit of overkill. I have recorded 55 BP readings since Jan 06 and my avg BP is 104/69 and after a workout at the gym(30-40mins@80-95% MHRx3/week)my BP can drop to 90/60 and I don't feel dizzy, confused or fatigued anymore! Since the atenolol masked my true blood glucose level another drug company made some cash when I was diagnosed as insulin resistant. After 3 months with no metformin or Avandia the last fasting blood glucose I did was 84. I've found as long as I don't overeat or eat potatoes, white breads or rice my blood glucose is fine. I am eager to have my HcA1 checked at my next VA appointment. Now for cholesterol, Lopid has been proven to be a carcinogen in clinical studies especially with long-term usage and that alone is a very good reason not to take it. Zoccor if I"m remembering correctly stops the production in your body of a precursor to cholesterol. However, that precursor that Zoccor reduces is also used by every cell(even more so by brain cells) in your body to do their normal activities. Zoccor has also been mentioned as a possible carcinogen and lets not forget(at least for me) it elevates blood pressure. People with high cholesterol live to old ages as people with low cholesterol die of heart disease. The jury is still out on cholesterol, having low cholesterol doesn't mean you'll have no blockages and people with high cholesterol can have nice clean arteries. The human body evolved without doctors, many doctors would say "NO, they had witch doctors!!!", before they realize they are equating themselves with witch doctors.
I have great respect for good doctors, the ones that continue to learn during their careers, the ones that honestly care for the well-being of their patients. doctors that can and do explain things even to the dimmest of us. The mark of a good doctor doesn't hang on his office wall!!! The person most responsible for your health is you. If something is wrong, go see a doctor, they can help but don't expect them to fix you. My friend believed the healthcare providers and actually went to a mental health facility to get more of the meds the ER had given her. Only to die in her sleep from heart failure a few weeks later at the young age of 44. Even I never connected panic/anxiety attacks with heart disease, it was only after doing a little research that I found that tiny factoid. I very much regret that, even I didn't take her problem more seriously. Personally, if not taking the meds means I'll die in 10 years instead of 12, I'll take 10 years of feeling normal to 12 years of feeling like I'm going to die everyday!!!

[suzzie1]

Hi Al,  Im so pleased to hear your great news, you must be delighted. Well, whatever your doing, its working for you. Great to hear good positive news !!! It will give us all hope. Congrats 8)

[momto3girls]

Hi there Al,

Wow, I was so happy to hear about your positive cath!  I've been praying for you too.  Congratulations and hears to remaining positive and resolving your other health issues!  Keep up the good work and thanks for being such a great resource to this forum.  You're like a doctor in disguise (:  Best wishes to you!!!

Sincerely,
momto3girls