Mild Heart Attacks - Diagnosis

  I am a 34 year old female who has Aortic Stenosis.  I am due for an Angiogram on 6/3/98.  I have been told recently that I need to have my valve replaced.  On Sunday a.m., I had a dull chest pain, my arms were tingeling, was lightheaded and nauseated.  I did not call my cardiologist right away (because I was not near a phone).  By the time I reached a phone, the chest pain had subsided.  I felt that I should have called my cardiologist but was advised by my husband that if the pains were gone, it would be unneccessary to call - so I didn't.  I did call the next day however and was told in so many words that because I need a valve replacement I'm just overreacting to anything that feels abnormal in my body.  He did say that if it happened again, and lasted 5-10 minutes, to call him.  I don't feel like I'm overreacting.  I know my body and when there is something different going on.  In the past, I've had the tightness in the chest with the tingeling in the arms.  Because the symptoms go away, I never called 911 or my cardiologist at the time, however, I did report it at my next check-up.  Was told that it was just stress.  My question is this:  If you don't go to an emergency room right away to be tested for a mild heart attack, is there no way of telling if it actually happened?  Also, when I have the angiogram, will there be evidence there?  
---------------------------------------------------------------------------------------------------
Dear L.B.:
Severe aortic stenosis can cause chest pains.   At age 35 it is unlikely (though not impossible) that you have blockages in your coronary arteries, the usual cause of heart attacks.  The angiogram will determine definitively if you have coronary artery blockages.  In addition, an echocardiogram, which you have undoubtedly had as part of the work-up of aortic stenosis, would show whether you have had a major heart attack.  If you had a very small heart attack, it could conceivably be missed unless you went to the ER right away.  However, the few minutes of chest pain you had do not sound like a heart attack (not even a small one).
Good luck with your angiogram.
Information provided here is of a general nature.  Specific diagnoses and treatments can only be made by your doctor.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.