Should we be concerned? Possible Heart Issues

[jenf163]

My husband is 35 yrs old, and has been having a lot of chest pain recently.  Two weeks ago, he had an echo done to check the function of his heart, due to some past history.  The doctor called back with the results saying it came back abnormal.  His ejection fraction was 40-45% and there was some muscle damage to his heart.  She seemed very concerned and wanted him to see cardiologist.  This week, my husband experienced chest pain while he was at work.  Of course he ignored it, but was complaining of right arm pain the next day.  Of course this sounded bells off in my head.  On Wednesday night, he again experienced chest pain while at church.  I had noticed that his color was very gray looking, and I was about to ask if he was ok, when I noticed he was in severe pain.  Tears were rolling down his face and his eyes had rolled back into his head.  He was clammy to the touch.  He finally told me he was having chest pain.  We got him to the ER and they ran his blood test.  The troponin was normal but the CK MB was 654.  The ER doc was concerned but not certain if he had had a heart attack or not.  To make a long story short, he had a nuclear stress test done, that showed no blockages, but a lower ejection fraction.  The cardiologist at the hospital did not seem too concerned about it.  Said he needed to have another test done to determine why the ejection fraction in low.  Gave him nitro to take for the chest pain.  He still is experiencing chest pain off and on, (not as severe as Wed night, and he tires easily and is short of breath with any kind of exertion.  To me, this is not normal.  My husband had an episode like this 3 yrs ago, and since then he has never been the same.  We have had 3 different opinions on his heart, and we are not sure which person to believe.  My gut feeling is, there is something wrong.  This is not the same man I married almost 5 yrs ago.  Any thoughts?

[grendslori]

While I do agree for the most part with all of the other posters and Flycaster, one thing he does say I believe is incorrect. Thinned walls, not thickened walls, will cause the heart"s EF% to drop. Thinned walls result in CHF or Congestive Heart Failure which is a form of SYSTOLIC heart failure, while thick walls are a form of DIASTOLIC heart failure; this is not a form of CHF and therefore the EF%s are in the normal to high range. Patients with CHF have thinned walls which do not have the ability to pump blood out of the heart correctly. The chambers become enlarged as the walls become thinner and because not all of the blood can be pumped out of the chamber it tends to just slosh around in the chamber, increasing the size of that chamber. In patients with thick walls, the problem is not the actual pumping, in some cases, the pumping action is stronger than normal; the problem is with the relaxation of the chambers which interfers with the amount of blood filling the chambers; less blood gets in, less blood leaves the heart. These are both forms of different heart failures; the symptoms are basically the same: chest pain, lightheadedness, shortness of breath, pre-syncopy and syncopy.  

[Flycaster305]

I agree with the other posters, and ask for a heart Catherization and/or an event monitor and an echocardiogram.  Discomfort like your husband experienced needs to be examined.  40-45% ejection fraction seems very low for a young man.  If your husband's heart has been working to hard, the muscle thickens and changes the volume of of the heart chambers, leading to a lower EF.  Keep us posted.  

[grendslori]

You need toto see a cardiologist and as far as going back to the same ER, I wouldn't unless it is the ONLY ER in drivable distance. Any doctor who looks at an EKG and can't tell if a patient is having a heart attack....let's just say there is a problem ther....a BIG one! There are definite changes to the R-S-T segment on the EKG during a heart attack and those changes tend to last for several days, not something easily missed. Your husband could be having spasms which can be painful, sometimes they can be seen during a cath. The normal EF% is between 50-70 so your husband's EF%s aren't really that low, but someone still needs to explain why it is that low for someone his age. Usually this means the walls of the heart are too thin so they lack the ability to pump the heart correctly. The results can be chest pain, dizziness, shortness of breath, most normal things you would expect to see from a heart patient. Cold clammy sweat is not normal, especially with chest pain and shortness of breath. If you see your husband like this, you really should be calling for an ambulance; they have the equipment to handle his care and in situations like this, minutes can make a difference. Take care

[skydnsr]

I agree with you and ed34, your husband has something going on that somebody needs to get to the bottom of.  There has to be a reason why a 35 year-old man has an ejection fraction of only 40-45%.  The chest pains he is having are terrible, and nobody should be expected to have to put up with that.  Plus, on top of everything else, it is frightening.  

Your husband needs to be thoroughly evaluated.  The ER docs do just enough evaluation and treatment to get a person stablized so that he or she can vacate the bed and leave.  Literally, that is their goal:  to get you out of their ER alive and in no worse shape (hopefully better) than when you came in.  Generally, they tell you when they discharge you that you should follow up with your own doctor.  If your husband does not already have his own cardiologist, he needs one.  

Your husband needs continuity of care.  He needs the best cardiologist in the area to figure out what is wrong and help him.  Ask around and see who people think is a excellent cardiologist, and make an appointment for your husband to go in to see that doctor during office hours.  As a rule, that is when it is possible to get a doctor to think long term -- in his office during office hours, not in the ER.  Only by working with the same doctor over a period of time, can you systematically work through a process to get answers.  

If your husband does not have a primary care doctor, he needs one of those, too.  Keep us posted, and good luck.

[ed34]

So all they did was a blood test and a nuclear stress scan? That is not enough. A nuclear scan is really a backup scan to give more detail in problem areas already known. If he is getting pain, then the heart muscle is not necrotic, because once the tissue dies from lack of oxygen, there is no pain. If he is getting pain while sitting, then this is serious and should be addressed, and why they don't seem that concerned is beyond me. I had a nuclear scan back in 2007 after an angiogram was performed. I was getting pains on any form of exertion. The angiogram revealed 3 blocked arteries, yet the nuclear scan showed fantastic results and no problems. The reason is that I had opened a few collateral vessels, tiny bypass vessels on the heart which kept the tissue alive, but couldn't supply enough oxygen for exertion. Didn't they even run an echo scan?
If he is still getting pain I would go back to the ER and complain, demand something be done. Those pains are very uncomfortable. Perhaps he has unstable angina and one of his arteries is having spasms. Nitro sometimes works in such cases, but the best medication is calcium channel blockers. Spasms can just happen out of the blue and nobody understands why. I had spasms and after taking CCB for just a few weeks, they stopped. I then stopped the medication and they haven't returned. I think your gut feeling is right, and I think he needs more tests.