Is this cardiac or not? Doc not taking me seriously

[modublin2210]

I am a 34 y.o., 5'4", 112 female. Family history of heart problems. I have been to the ER 3 times in the past 3 weeks for heart attack like symptoms. Back in March I had a stress / treadmill nuclear test and everything was fine with my heart. I do have Mitral Valve Prolapse. Recently I have been having crushing chest pains, left arm pains, some jaw pains and some upper back/shoulder pains. Also shortness of breath. This doesn't happen on exertion, but sometimes. I do not work out but I do have a 2 year old. I do not have high Blood pressure of high cholesterol, but I do eat horrible and have always been pretty stressed out. At my visits to the ER all blood work, EKG's and chest xrays come back fine. I had a echocardiogram resting done today. I asked my doctor if he thought I could have blockage or heart disease and he just brushes me off saying no I really think it is your mitral valve. I have some days where I feel great and others where I feel like I am having a heart attack. I do get some palpitations. It happens a lot when I am sitting or trying to sleep. My question is could this be a blockage? He doesn't want to do an angiogram or heart cath because again he thinks it is just the Mitral valve causing this. Back when this happened in March they put me on beta blockers and I took them for awhile but stopped because I was feeling good and I am not a fan of medicine. Now 3 weeks and counting I am feeling miserable again and very scared I am going to have a heart attack home alone with my kid. I am back on betablocker and they gave me an anxiety medicine. Only 2 days of taking the beta blockers and one day with the anxiety medicine and I am still having this crushing chest pain, and left arm pain. I just am very frustrated that they won't do an angiogram on me. Any advice would be very helpful. Thanks

[erijon]

On the surface, it sounds like you've been checked out very well and it does not sound like heart disease. If you are still experiencing symptoms, then a cath is the only way to be 100% sure. You could have a CT but their accuracy is still being debated. In addition, most insurance companies won't cover their high cost when a nuclear stress test is normal. I suspect the reason your doctor is hesitant to do a cath is because he is weighing the potential of a positive finding to the risk of a cath. Given your age, gender and test results he most likely does not feel that the probability of finding anything significant is greater than the risk. Having said that, if you are having chest pain along with a family history, a cath may be the only way to get the reassurance you're looking for. You may want to get a second opinion from another cardilogist.

Good luck!

Jon

[Smiley2000]

If you had a blocked artery or high risk for heart attack, there would be ECG changes and your ECG didn't show anything, that is why they are reluctant to do a Cath on you.  I have heard of people suffering a stroke after an innocent Cath, so it is really not something you do if it is not proven to be necessary.

Mitral valve prolapse can also cause chest pains, but it is not dangerous.  Anxiety also causes chest pains.  I have been in Cardio ICU a lot and most of the patients that come to ICU with chest pains are then send for a Gastroscopy and come out with the diagnoses of Hiatal Hernia - mimics heart pains and can also explain your symtoms.

[ed34]

First of all, your symptoms do not seem to relate to stable angina. Maybe you are getting unstable angina for which not everyone responds to medication. If you have an angiogram, then you would have to have an artery spasm at that time for the doctor to see it, and most of the time this doesn't happen. There is nothing in angioplasty to cure that problem anyway. Personally I don't think you have any blockages. You need to sit down, relax and look at it in a logical way. The harder you work your heart, the more oxygen it requires to keep working properly. If there isn't enough oxygen due to a blockage then it will cause the heart to stress and release an enzyme called Troponin which will have been tested for in a blood test. So, the more you exert yourself, the more the discomforts should get but you say it isnt exercise related. It sounds like an anxiety problem and worrying about your heart doesn't help. Beta blockers can take a few days to adapt to. They change the limitations of your heart to prevent it from over working and your body needs to get used to these limits. Anxiety can bring on gastric problems and you will be surprised how similar these feel to heart problems and indeed many have been misdiagnosed as heart issues. If they fool doctors, then they can fool us. I wouldn't worry about an angiogram but I would have the cardiologist keep an eye on your MVP.

[modublin2210]

I also wanted to mention that I had a stress/treadmill test back in March with nuclear. I have also recently had an endoscope to check my stomach for other problems I was having which it was clear.  Today all of my pain has been under my left breast which I have never had it there before it is usually up high left side over my breast. I again started to get the pressure today and think I caused myself to have a panic attack. Also if it was a blockage why would I have days where I feel fine. I am just waiting on my doc to call with the results of my echo and might demand an angiogram just to put my mind at ease. I have been in so much pain today. Thanks for everyone who replied!

[erijon]

Have they checked your gallbladder yet? When I went through all the normal heart tests due to chest pain, mine were all normal as well. Turns out I had gallbladder disease, had it yanked out and all my symptoms went away. It can cause pain that is consistent with heart pain that radiates too.

Just a thought..............

Jon

[joanincarolina]

In this age of the dependence on tests to give final anwers, medicine can still be surprised about what things turn out to be. I would be surprised at your age if there were any blockage in your coronary arteries BUT you certainly are having signs of discomfort with shortness of breath and left sided chest pain that radiates. Remain calm, write down your signs and what you're doing when they occur and what causes them to stop. It may be MV related but you are either compounding signs with anxiety or perhaps you are experincing vasospastic angina from the small heart vessels. A Cath will not show this. All routine tests can be normal, including the gold standard heart cath. Talk to your doctor about this; you may be young but my friend in Ireland is just a bit older than you and has this. Symptoms are relieved with nitro or similar vasodilating medicines. Let me know. Joan in Carolina

[modublin2210]

Thanks for commenting. It is not my gallbladder as I had that removed some time ago. Joan I will ask my doc about this thank you!  Thanks again for everyone getting back to me. Puts some peace to my mind. :)

[modublin2210]

Ended up in the ER once again on Monday and they admitted me overnight to check for enzymes.  Ran EKG's, blood test over a 23 hour period. Everything came back fine once again. The entire time I was in there didn't feel too bad, felt okay last night then work up this morning being in pain again. The cardiologist said that I need to follow up with my cardiologist (who was out of town) in 2 weeks and if I am still having problems maybe might do a heart cath.  How can I not have pain then wake up with horrible pain?  I really feel this is a blockage and scares me that I am just sitting waiting to have a heart attack. What else could this be?  

[JanisLee]

When they've done blood tests, have they checked you my lipase and amylase counts? For pancreatitis?

[modublin2210]

Not sure about that.  That is a good question. They have not told me that. i know I had that tested about 3 months ago and it was fine because I was having serious digestive problems which resolved themselves.  I will call and find out :)