Still having pain

[Victoria]

A healthy and happy New Year to you Cardio Docs!

I have pain in my chest, jaw and arm.  I am been worked up twice with a stress echo, twice in one year.  I wore a holter during these episodes and it came back fine.  I am on Atenolol.  I have a few questions though.  

1.  Will Atenolol weaken my heart over time ? (years)  25 mg.  I take it for pvc's.
2.  Is the stress echo accurate in woman?  I am 34 and otherwise healthy?  I have had one regular stress test, an echocardiogram, and two stress echo's. (all within one year)
3.  Can panic or anxiety really cause these same symptoms? ( chest/arm pain too?)

Every time I go to the Er with these symptoms, my Ekg and enzymes are fine...Any clues?  My cardio says its  NOT  my heart, but it sure feels like it when the pain in my chest hurts.

Thanks and blessings. :)

[CCF CARDIO MD - DLB]

1. Definitely not. It is very safe for the heart.
2. Absolutely. The exercise treadmill EKG type of stress test is a bit less accurate in women. The stress echo is quite reliable in women (and men).
3. Yes, it can.

From everything that you have written, I am inclined to agree with your cardiologist. The risk of your having heart disease after all these normal tests is extremely small. Other more likely diagnoses include anxiety, heartburn, or chest wall muscle and joint pain.

[Diana Lynn]

Julie:

My heart goes out to you!  I, too, continue to suffer with chest pain (I'm 43 years old, F, married, 2 children/ 1 husband :-)).  It all began on March 5, 2000 for me, while walking on a nature trail I developed svt/palps/lightheadedness/sweating/something wrong feeling.  Had a sustained heartbeat of 180 while resting awaiting the ambulance.  During the first 24 hours of hospital, enzyme/ekg changes were noted and I immediately underwent a cath which showed normal coronary arteries.  I have pretty strong familial risk factors for cad.  I don't smoke, not overweight (a lifetime weightwatcher success story).  Anyway, for almost a year now, I've been battling chest pain - drs. saying its coronary artery spasm.  I'm taking Cardizem, Altace, Aspirin, Prilosec and Centrum Vitamin.  When needed, I use Nitro sublinguals and patches to get through the day.  I'm on my third cardiologist, others have simply said, "take your meds and i'll see you in a year".  No way will I stand for this.  I just recently had an echo stress test and am waiting for those results.  Now the drs. want me to have an endoscopy to determine what's going on with my stomach/esophagus.  I understand that problems with those areas can mimic cardiac pain.  I'm finding this hard to believe.  Would ST changes on an EKG be the result of something gastric? I don't know.  Anyway, the point I want to make is to say YOU'RE NOT ALONE!  Be proactive with your health.  Don't settle for anything less than what you believe is right for yourself.  It can be rather intimidating having drs. diagnose you.  Just remember, it's their OPINION, unless of course its pretty cut and dried.  At least in my case, its still rather gray.  Hang in there.  If you'd like to email me, feel free, ***@****.

[Lauro]

Diana, I agree with you wholeheartedly.  They say that women can have different symptoms than a man.  Why some doctors don't know this, is beyond me when it is listed in the papers and on TV, etc. etc.

I too, am in the same boat.  I carry my Nitro around with me.

I read somewhere that there is a test that docs can do to trigger a coronary artery spasm to see where the problem lays.  I am investigating this.

Good Luck To Both.

[Diana_Lynn]

To Becky:

Usually spasms are "tested" with a chemical injection when a cath is done.  I don't believe that was done during mine, but perhaps it was without any results.

While I was in the hospital, 3 out of the 4 Drs. felt I had experienced a "mild" heart attack.  One kept calling it an event.  Whatever it was has continued to haunt me.  Just over New Years weekend I was smack dab in the emergency room at a local hospital with uncontrollable chest pain.  Again ST changes in the EKG, fortunately no enzyme changes.  Cardiologist on call told me that he questions whether or not a mild heart attack ever occurred and told me to "stop looking at the heart as the problem or it will ruin your life".  What a compassionate guy!  While in the hospital they ran a lung scan (thought perhaps it was a blood clot) which turned up negative, ran a CT scan of my chest (thought perhaps a scary tumor somewhere) this also turned up negative.  I am planning on having a GI endoscopy done.  I'm not looking forward to this but I want to have everything checked out.  It's not normal to have to live with pain!

I currently am seeing a female cardiologist at a large teaching hospital where I live.  I truly believe that women aren't taken seriously when it comes to our health and it's up to us to find the right physicians who can work with us.  I know this was a very sexist statement, but I don't care.  This is my life we're talking about.  

Hang in there!  I pray for all of us that God will find it in his mercy to show us the answers...

[Victoria]

I currently am seeing a female cardiologist at a large teaching hospital where I live. I truly believe that women aren't taken seriously when it comes to our health and it's up to us to find the right physicians who can work with us. I know this was a very sexist statement, but I don't care. This is my life we're talking about.

Hang in there! I pray for all of us that God will find it in his mercy to show us the answers...

****************************************************************

Yes, do rule out an ulcer and hernia, which can cause some of the same symptoms. Wear a Holter during these episodes and they will catch if your heart rhythm changes or ischemia occurs..

[Victoria]

I currently am seeing a female cardiologist at a large teaching hospital where I live. I truly believe that women aren't taken seriously when it comes to our health and it's up to us to find the right physicians who can work with us. I know this was a very sexist statement, but I don't care. This is my life we're talking about.

Hang in there! I pray for all of us that God will find it in his mercy to show us the answers...

****************************************************************

Yes, do rule out an ulcer and hernia, which can cause some of the same symptoms. Wear a Holter during these episodes and they will catch if your heart rhythm changes or ischemia occurs..

[Lauro]

Hello Diana and all.

I too am researching and trying to find a good female cardiologist in Houston.  We have the Texas Heart Institue Here with many many many cardiologists and my insurance covers this but the question is WHOM do I see that will take me seriously and give me peace of mind and respect  that "women" deserve.

I had another spell yesterday afternon while on the computer. My hubby called from the car phone and kept me on the line till he got home.

I know to some this may sound "dumb" but to *me* it doesn't, as I would be more petrified knowing I was in the wrong hands and not believed again. This causes me more anxiety.

There are some good doctors out there.  I just have to find one.  I heard that RN's know more about physicians, i.e. who is good and who is not as they work closely with them in clinical settings and see how they treat and handle the patient.

I see a gastroenterologist on Friday for my pains also. But, there are 2 types of pain, I am having.  One, I feel sure is cardiac related.

I pray a lot for guidance and often say, "This Too Shall Pass".

God Bless.............Becky

[christine m. smith]

Hi!

I have read several posts by women with undiagnosed cardiac problems (I am in that category also)stating they are looking for a good *female* cardiologist.  In my opinion being female does not make a cardiologist understand women's cardiac problems any better than a male cardiologist might. It was a female cardiologist who told me after I had a negative regular treadmill test that I did not have a cardiac problem and she saw no need for further investigation. She did not seem very understanding to me. When I had a sestamibi scan done next and it was positive my pcp referred me to this female cardiologist for a consult and I requested one of the other (male) cardiologists. Unfortunately he didn't seem to understand any better. Good communication and listening skills are necessary.
  
Chris

[Diana Lynn]

To Chris:

It sounds as though we're all being put through the wringer!  I guess my negativism regarding the male cardiologists shows through because this has been going on for me for almost a year.  Sorry, you haven't found someone who can give you some hope.  So far, my new cardio at least makes me feel like I'm not some crazed, emotionally distressed female.  Don't get me wrong, I'm not some dyed-in-the-wool feminist, just an unsatisfied patient looking for answers.

[someone who cares..Att: Becky]

I see a gastroenterologist on Friday for my pains also. But, there are 2 types of pain, I am having.

One, I feel sure is cardiac related.

What does it feel like?  

[beverly]

YOU MUST check your gallbladder.  I went through the same things you all are talking about and finally my new cardiologist had a simple ultrasound exray done of my gallbladder and found it terribly infected and full of gallstones.  After almost 10 months of terrible chest pains that responded to Nitro and 4 trips to the hospital in the middle of the night, they took my gallbladder out and my whole life changed!!  I do have CAD, mitral valve leak, left bundle branch block and Cardiomyopathy but now I am not in almost constant pain.  They did the Endoscopy first and found nothing.  Ask them to do ultrasound exray  of your gallbladder first.  If it is "HOT" then you don't have to go through the other.  I would NEVER have believed that this could be my problem, but I thank God everyday that the pain is gone.
Good Luck  Beverly  (***@****)

[christine m. smith]

Hi!

What you posted about your gall bladder being your problem is so interesting.  I am sure that is going to be very helpful to other readers.  I have been told that "esophageal problems" can cause pain similar to cardiac pain and that responds to nitro as well.
A friend of mine had several gall bladder attacks before being diagnosed and she was sure she was having a heart attack. However, in my case, my "exertional angina" is in my throat/neck/jaw/cheeks and occurs when I walk uphill or climb more than 2-3 flights of stairs. Occasionally I will get it with other types of exertion. I rarely get chest pain and if I do, it is more of a pressure than actual pain.  Can you see any way this type of pain could be from something like the esophagus or gall bladder?  

Chris

[christine m. smith]

Hi!

I understand what you mean. I believe the female cardiologist I saw was negligent when she didn't recommend more testing. The male did do the testing, but since there was nothing to fix and he didn't see me at serious risk of a "cardiac event" I feel he dismissed me. He has agreed to see me to continue with the nitrate prescription, so who knows what he will suggest in the future but when I asked him if I could have "microvascular angina" or "syndrome x" he said that was very hard to diagnose, he wasn't ready to label me with that and saw no need for further testing. Well, if he doesn't do any further testing how is he going to "label" me with anything? Is the liklihood of a  "serious cardiac event" the only thing that matters? Maybe I am being naive when I say that I believe him about this, but I still don't want to be in pain and I don't want to have to take nitrates indefinitely and not know why. Actually the best answer I got was from the Physician's Asst who was present at my second treadmill test. I said to him "if this one turns out negative I guess I just have to forget about this?" and he said something like "well, it may be negative, but if you are still having symptoms, you really can't just forget about them ".  

I'm glad you like the doctor you are seeing now. Good Luck.

Chris

[Diana Lynn]

To: Beverly

I've already had an gb ultrasound and gb function study.  Both have turned up normal, no evidence of stones.  I am, however, persuing a GI endoscopy in order for them to get a closer look.  To be honest with you, I'll be shocked if they find something there.  

[Diana Lynn]

To: Chris

My former cardiologists more or less have had the same attitude.  I truly believe they are "interventionists".  They do great work when you're in a crisis, but don't know how to handle patients like us when the diagnosis isn't clearly defined.  We're not the norm for them.  Haven't you looked around their waiting rooms - average age is 65+!  Although I have been told more and more younger patients are being seen.  I think its because we're more in-tuned to our bodies and aren't afraid to search for what's going on. With patients like us and not so clearly defined illnesses, we're giving them their run for their money. I know I certainly don't want to get to an acute stage of anything.  

The Dr. I'm seeing now is into Preventive Cardiology.  They usually like to see patients before they have their first heart attack and they work to help patients avoid a crisis.  I wish I had known about this before last March.  They look at the whole patient - nutrition, exercise, etc.  After my heart "event" I asked the old cardiologist about rehab and his answer to me was "I don't know of any programs, you might want to call around".  I don't call this support and I won't go back to him!  Perhaps the hospital in your area may have a Preventive Cardiology unit - its certainly worth looking into.

I like to consider myself one of those "dangerous patients", AN EDUCATED ONE!  I've often been asked if I work in the health profession, and no I don't.  If we don't look out for ourselves, who will?

Hang in there.... :-)

[Victoria]

I guess I just have to forget about this?" and he said something like "well, it may be negative, but if you are still having symptoms, you really can't just forget about them ".

I'm glad you like the doctor you are seeing now. Good Luck

          __________________________________

Hey Chris, how old are you again?  Have you worn a holter during these episodes?  Esophageal Spasm can cause and mimic angina down to the jaw and arm pain too.  I would ask for the Stress Echo, not just the treadmill...they look at your heart after exceeding a heartrate..go back on tghat treadmilll with NO HANDS again, with the Stress ECHO...insist insist insist...

[A friend]

Just a response after reading the messages here:

One thing I am struck by is the continuing to rely on this type of medical treatment when you keep getting the lack of results you're getting, not to mention the lack of compassion and simply not being believed...struck, but not without understanding.  I was where many of you were several years ago, going from doctor to doctor, and emergency room to emergency room with my pain and symptoms, always being told in the end that there was nothing physically wrong with me that they could find and that the problems were probably  psychological, but I learned this hard way that this was more about the limitations of allopathic/conventional medicine than about anything that had to do with me. Once I understood that, I was on my way to much better things, the least of which was getting my hope restored.  Specifically, my journey lead me to systems of medicine outside of the Western model -- which is the way we all, for our own good, need to learn how to view this: that our system of medicine is not the only system of medicine -- and my experiences since have been much more hopeful, informative and, most importantly, productive.  I have come so much farther than I was told I could ever go by almost all of my previous doctors -- and heartily believe my health will be completely restored in a natural and much gentler way.  I am sorry I can't get more detailed here, I must go (besides everyone has their own journey), but please consider, if nothing else, a change in your way of thinking.  Perhaps that is the best medicine at this time.

[Victoria]

. Once I understood that, I was on my way to much better things, the least of which was getting my hope restored. Specifically, my journey lead me to systems of medicine outside of the Western model -- which is the way we all, for our own good, need to learn how to view this: that our system of medicine is not the only system of medicine -- and my experiences since have been much more hopeful, informative and, most importantly, productive. I have come so much farther than I was told I could ever go by almost all of my previous doctors -- and heartily believe my health will be completely restored in a natural and much gentler way. I am sorry I can't get more detailed here, I must go

*******************Okay, you have said nothing could be found, but say you have come much farther than any of the Dr.s had hoped...do share...I guess I know your basically saying not to worry?  Is there some kind of Higher Healing you can share?  :)

[Lauro]

I was told recently by a gastro doc to MEDITATE and try YOGA for my contiuning chest pains and GERD and Hiatal Hernia Symptoms when Achifex/Prilosec and Prevacid did nothing to help me.

Instead I went to the drugstore and bought Zantac and Mylanta Extra Strength and these do help better till I can get into see a new doctor.

I am sure Yoga, etc, can help anyone whether you are in Mental or phsycial distress but if there is pathology to one's pains, a good doctor needs to be right in there too.

[Victoria]

I was told recently by a gastro doc to MEDITATE and try YOGA for my contiuning chest pains and GERD and Hiatal Hernia Symptoms when Achifex/Prilosec and Prevacid did nothing to help me.

Instead I went to the drugstore and bought Zantac and Mylanta Extra Strength and these do help better till I can get into see a new doctor.

---------------------How and where is your pain Marge?

[christine m. smith]

Hi!

The area where I live considers itself to be the "Heart Center" of our state. I had big expectations. You are right about intervention though-the doctors I saw did not seem very interested in my blood pressure or lipids. I consulted a noninvasive cardiologist on another forum (because its easier to ask questions, I like this forum and the doctors very much)  and he said I could very well have "syndrome x" and that those that do catheterizations have a hard time believing there is something wrong when the arteries are clear.  

Chris

[christine m. smith]

Hi!

I am 50 years old. My pcp told me a Holter monitor would not be useful for the type of problem I was having. (I asked him that after the first treadmill where I didn't have any symptoms. I knew I would have symptoms the next time I walked uphill and thought maybe I could record it on the Holter)

How is a stress echo different than a sestamibi nuclear scan?  I had that done and it was positive-it showed ischemia in the area of the left descending coronary artery during the exercise phase of the test, normal during the resting phase.  Another cardiologist on a forum told me that esophageal spasms can mimic cardiac pain but would not give an abnormal nuclear scan. Also, why would my esophagus spasm walking uphill and climbing stairs? If I had random pain I would be more inclined to think that could be the problem.

During the regular treadmill test and the sestamibi scan my EKG was normal with no ectopic activity at all. My blood pressure acted appropriately also. Ejection fraction was 72% which I understand is excellent. What else could a stress echo show?

Chris

[Lauro]

I too live in a State where we have a well known Heart center.

But, I have not been happy with the two physicians I have seen
so far.  I was apparently plain vanilla to them.

I think many are too busy to take time to listen well to the patient. Atleast this was my case.  One was an Interventional Cardio and the other travels and does not have time for followups.

I did like one but his staff was incompetent and made more mistakes than I care to mention.  Now, if he would fire some, this doctor would be Top Notch in my books.

My NYear's resolution is to locate a Good Cardio Doc.  He/She must come with a trail of several people recommending him/her via other patient satisfaction.   This doctor must also have a good staff that will take and return calls, write orders correctly and file appropriately with the Insurance company, using correct codes.

Am, I asking for too much here??? (-:

[A friend again]

Hi, no, I wasn't really talking about not worrying or a higher form of healing as much as maybe a different one (particularly if the one you've been using hasn't served you well after giving it plenty of chances)...  TCM (Traditional Chinese Medicine)and Ayurveda (the medical system from India)are two of your options, now more accessible to the average American than ever before. If you don't know much about them, try to find out more the next time you get on the net (I'll try to post a site or two ).  The thing that's important to know, though, is that there are other legitimate systems of medicine -- systems --out there, that have undergone their own process of developement and built a solid body of knowledge often over millenia, from which a number of us could possibly benefit.  It's a big world out there.  Medically speaking, we have been very insular, I think, and have been led to believe certain things about what is or is not possible, period (that's why I think someone thought I was talking about something often perceived as more spiritual or psychological rather than physical. Nope. The way I was hurting and the way it disrupted my life made me know there was something really wrong with my body, despite what any doctor said. Also, speaking of doctors, I agree with the person that said one should have a good one, particularly with problems that have been chronic.  Mine just happened to be a good doctor of Chinese medicine; a hundred years ago, it might have been a good Eclectic physician right here in the US of A -- either one, the medical establishment would probably not have approved.  But I have learned something: my loyalty is something to be earned. Bye for now).

[Diana Lynn to Chris]

Syndrome X is a new term for me, so I did some quick research. See Women.com. which is part of Prevention.com.  This condition is quite likely the result of out of whack insulin.  Who would have guessed! I don't know if the Drs. have checked my blood sugar but I'm certainly going to request a "fasting plasma glucose test" when I get back to the Drs.   My blood pressure has been quite a bit higher over the last year, just within the last month, they've put me on ALTACE and it's certainly bringing it down (yesterday 124/70, couldn't ask for anything better).  There's a possibility that high blood pressure is indicated as a marker for cardiovascular disease risk that usually turns up as part of X. Chris, do you have any of these markers?  This may not be my problem, but it certainly sounds like it's worth pursuing.  Thanks, Chris!  This forum just shows us that more heads are better than one!

[Diana Lynn to Chris]

Syndrome X is a new term for me, so I did some quick research. See Women.com. which is part of Prevention.com.  This condition is quite likely the result of out of whack insulin.  Who would have guessed! I don't know if the Drs. have checked my blood sugar but I'm certainly going to request a "fasting plasma glucose test" when I get back to the Drs.   My blood pressure has been quite a bit higher over the last year, just within the last month, they've put me on ALTACE and it's certainly bringing it down (yesterday 124/70, couldn't ask for anything better).  There's a possibility that high blood pressure is indicated as a marker for cardiovascular disease risk that usually turns up as part of X. Chris, do you have any of these markers?  This may not be my problem, but it certainly sounds like it's worth pursuing.  Thanks, Chris!  This forum just shows us that more heads are better than one!

[Diana Lynn to Chris]

Syndrome X is a new term for me, so I did some quick research. See Women.com. which is part of Prevention.com.  This condition is quite likely the result of out of whack insulin.  Who would have guessed! I don't know if the Drs. have checked my blood sugar but I'm certainly going to request a "fasting plasma glucose test" when I get back to the Drs.   My blood pressure has been quite a bit higher over the last year, just within the last month, they've put me on ALTACE and it's certainly bringing it down (yesterday 124/70, couldn't ask for anything better).  There's a possibility that high blood pressure is indicated as a marker for cardiovascular disease risk that usually turns up as part of X. Chris, do you have any of these markers?  This may not be my problem, but it certainly sounds like it's worth pursuing.  Thanks, Chris!  This forum just shows us that more heads are better than one!

[christine m. smith]

Hi Diana:

You're not going to believe this, but there are *two* disorders called "syndrome x". There is the cardiological syndrome x, also known as "microvascular angina" and the metabolic syndrome x, the disorder described in the article you refered me to at women.com The really confusing part is that it seems that the metabolic syndrome x can also have microvascular angina as part of it!  The metabolic disorder includes hypertension, elevated triglycerides, upper abdominal fat (the "apple" shape), insulin resistance/type II diabetes and heart disease.  I have to wonder if the two disorders are connected somehow.

Besides a fasting blood glucose you should also have a test called the hemoglobin A1C done. This measures your average blood glucose level over a period of a few months.  

I have most of the markers of metabolic syndrome x-hypertension, elevated triglycerides, apple shape. I don't know about the insulin/blood glucose levels. I'm waiting for the results of those tests. I don't have heart disease, according to the cardiac cath, but do have exertional angina.

There is a lot of controversy about what type of diet a person with this tendency should be on. It seems that high carbohydrates cause an increase of insulin in the blood and eventually the cells may become "resistant", leading to type II diabetes.   Insulin also causes the body to store fat. Some doctors on forums have told me that high carbohydrate diets are not good for women because it drives up the triglycerides and apparently in women, triglycerides are much more dangerous than they are in men. I get my lipids tested tomorrow after 6 weeks of a low to moderate fat, low to moderate carbo, moderate to high protein diet. Don't know how the test will come out but all I know is that a low fat, high carbohydrate diet did not work. My lipids did not improve much, nor did my weight.    

You really need to become a biochemist to understand all of this!

Chris

[Kathleen]

I just stumbled across this site when trying to help find some information for my sister who is presently in the cardiac intensive care unit at a loca hospital here in Minneapolis.  It certainly must be very frustrating to live with chronic/recurring chest pain and never have any clear answer!  That seems to be the path that my sister is going down now, as well.  

She is a 43 yr old obese, white smoker who has hypertension and insulin-controlled diabetes, so she certainly seems to have more than enough risk factors for heart disease.  However, her pain also seems to be an atypical presentation, in that Nitro does not help it, nor does excertion seem to exacerbate it.  It has occurred while she was sitting upright, and been releived when she layed down, and has also occurred while laying down and has been releived when sitting straight upright.  Morphine is all that seems to relieve it.  He enzymes are very slightly abnormal, and they say her EGK has not changed over 3 days, although it shows evidence of a questionable old M.I.  

They are going to perform an angiogram tomorrow, although we have not consented to angiography at this time.  If any of you have any ideas and/or insights you could lend, it would be most appreciated.  Good luck to all the rest of you too.

[Lauro]

There are 3 different types or degrees  of Hiatal hernias I was recently told.  One type can really play havoc and produce this type of discomfort.  After my doc told me about this, I researched on the internet.

Have they done an EGD and a Barium Swallow on your sister to rule this out?  I am not a doc and I am sure there are other tests that can help rule in/out this problem.  

I have this problem plus Gastroesophygeal Reflux and who knows what else this problem may be causing. i.e. like other secondary symptoms.   Sometimes the Nitro works immediatley for me and other times....nothing helps, but laying down and staying still.

There is also something called cardiac Spasms. I believe they talked about this here or in the "Search".  I "think" this has also been referred as Microvascualr Angina or Variant? Angina.

My best to your sister.  Please keep us posted.

[Tricia]

Hi Becky,

I too live in Houston.  If you find a female cardio doctor that you like, please let me know.  my email address is ***@****

Thanks.  Tricia