How often do tests need to be repeated?

[Toneman]

I'm a 49 year old male, have had off and on mild chest pains for over two years, had heart work ups twice over this time period in 2005 and 2006. Both work ups included nuclear stress tests and echos along with blood work, all normal. I work out every day, 45 minutes on a tread mill at my target heart rate of 125 to 135 BPM, no symptoms during exercise, I could go longer but my arthritic knees are not up to it. I am still 50 pounds overweight but have lost 50 pounds in the last year. My Rhuematologist says chest pain may be due to my RA in my intercostal joints. I have no other symptoms other than the occassional PVC. My blood pressure is controlled at 110/65 and by cholesterol is 165 although Tri's are high at 311, very low LDL at 53. I am on Benicar HCT 40/25 and Vytoren, no history of early heart disease in my family. Still have the same mild occasional chest pain as I have for over 2 years. Is it worth another visit to the cardiologist again this year to get checked out again or since nothing has changed just not bother until there's a change or new symptom? Could any of my RA meds be causing the pain, I'm on plaqeunil and celebrex.

Thanks,
Tony

[Forum-M.D.-MJM]

Hi Tony,
Congrat for treating your self right! That sounds like a great regimen and the 50 pounds  of weight loss is great.

Because of the this being an online forum, I don't feel comfortable telling someone with chest pain that they should see their doctor about it.  That conversation needs to be a bit more interactive than we can do here.  That being said, if you are exercising 45 minutes per day with no chest pain during exercise, there is almost no chance that this is ischemic (lack of blood flow to the heart) chest pain.

Plaquenil and celebrex are not known to cause chset pain by themselves, but as you have read, celebrex does increase your risk of cardiovascular events. That is when you have to decide if the slight increase is cardiac events is counterbalanced by your improved lifestyle with decreased RA pain.

I hope this helps.
Thanks for posting.

[ireneo]

This is a good question, one that's been on my mind off and on. Obviously I don't have the answer. I've had one echo done in 2000, none since then. However, I've had 3 catheter ablations during that time, the most recent was a couple years ago. Still have my heart murmur, still have arrhythmias. Sometimes I wonder if I'll ever have another echo. Just rambling. . . .

[Fionajnz]

This is how I have differentiated chest pain from rib pain.  If its chest pain, it tends to be more of a pressure and SOB issue, I had this when I had an allergic response to some IV iron, it just took my breath away, I flushed, my heart rate changed and it felt like I had a HUGE weight on my chest.  With costachondritis (joint rib pain)when you press the area it makes it locally worse, though the pain can cover more than just one finger tip size spot.  I had costachondritis due to other health issues, which changed my posture significantly, I had the chest pain checked out, but with that explanation I was able to figure out the difference relatively easily.

The intercostal muscles are the ones that basically connect your ribs together and they hurt when they are pulled, again though it tends to worsen the pain if you push on the area or twist, whereas chest pain tends to not be affected by pressing on the specific area, it kind of has a life of its own.

Hope that helps.

Hey, CONGRATULATIONS on the weight loss, you need to pat yourself on the back with that one.  Keep up the good work.

Fiona  

[tricializ]

You say you've had 3 ablations....Curious as to why you have had to have 3. I am having my first (and hopefully last?) one done in a week or so and I thought if they found the disturbance, and were able to reach it and ablate it that the problem would be solved.  So, I'm just curious.  Obviously I am nervous about this procedure mostly because they told me I wouldn't get sedation at al...not even something to calm me down unless absolutely necessary.  THAT freaks me out!  I think of all sorts of weird things that could happen like....What happens if you sneeze during the procedure?  Anyway, thanks for answering.  :)

[ireneo]

I can't imagine why they would do an ablation without any sedation. Running the catheters up is no problem. I had this fear that I would feel them snaking through my body and poking into my heart. Nope, nothing. During the first ablation they were very light with the meds so when the actual ablating was happening, it wasn't very comfortable. It felt like a big weight pressing on and through my chest. I suppose it would be bearable since it comes, then goes as they zap. But the person next to my head (anesthesia lady?) noticed my distress and gave me more meds. The next two times I went in they were great with the meds. Felt nothing, remember nothing. Why 3? I had a lot of activity going on in there. PSVT as well as some atrial flutter. Not what they expected. They thought they had it fixed but it came back. The second time they knew they didn't have it fixed so I went in a third time. That time it was greatly improved. I still have PVC's, PAC's (my heart hiccups) and PSVT but the tachy doesn't last so long - less than 15 minutes. The other day it jumped up to 191 but I was able to turn it off within 2 minutes with valsalva. Trust me - it's a great improvement over what I had before and I'm happy with that.

[tricializ]

Thanks for the info.  They said that they don't want to give me sedation because it can cause the heart to not do what they want in terms of finding the SVTs etc.  I am so hyper that the thought of lying still makes me crazy.  They said if I was really nervous they could give me a small dose of valium if I really thought it necessary.  (sort of shame you into not having anything).  My SVT runs are very very short (like only about 10-15 rapid beats at a time).  This is leading them to believe it is more Atrial Tachycardia instead of the re-entry one.  So, they might have trouble getting to it and having a successful ablation in the first place.  But, I guess noone knows until it's done.  I am curious as to what they will find.  Thanks again for your info and if there are any tips you wish to give....I'd be more than happy to hear them.
Tricia

[ireneo]

I see now why they want to hold back on the meds. Perhaps they could do the mapping of the errant signal while you're fully awake. All you'll feel is the quick heart beat and you already know how that feels. Once they have the spot located maybe they could give you a light sedation for the actual ablation.
The only suggestions I have (and they aren't really important): because they have to take away your clothes to place all the leads and run the catheters up I was allowed to wear socks into the cath lab. A small item for my sense of modesty. I also bought the craziest socks I could find just to cheer me up. The staff got a kick out of it too. Afterwards I wore soft boxer shorts since the incision sites will be a bit bruised and tender. So do take comfy pants to wear home, maybe boxers and sweat pants. Hope it all goes well, they find the problem and zap it away for you.