angina after heart attack

[janne]

Thank you for this great forum.
History: 39 yr old female, 15 pounds over weight, blood pressure fine, cholesterol fine, no other health problems, no family history of heart problems, smoker for past 7 years.
About 6 weeks ago I had a heart attack with 90% blockage LAD.  A stent was placed and I was put on blood pressure med, cholesterold med, plavix as well as a few other meds. About a week to 10 tens after the heart attack, I began having brief periods of shortness of breath.  Shortly after that, I began having the similar symptoms (but to a much lesser degree) that I had the day of the heart attack.  I have a sqeezing sensation almost like when food is stuck in one's throat and chest.  My left arm would tingle off and on.  None of this was painful, but my GP was concerned the stent was blocking.  Nitro spray helped, but only briefly.  The only thing that cleared the slight pressure feeling in my chest and unusual choking feeling was IV nitro. EKG was fine.  I have not heard results of treadmill stress test yet, but I assume it was fine.
I was released from the hospital with no diagnosis and put on the nitro patch (doesn't fix completely).
They did not want to do another angiogram as the cardiologist felt that it was not a stent blocking up because he said that never happens as a gradual thing, but only occurs suddenly. I honestly had the impression he felt it was in my head.
Any idea as to what would cause these chest and neck symptoms? GI tests ok. Can EKG and stress test be normal if something is wrong? Why at my age did I have a heart attack?
Thanks
Jann

[Cleveland Clinic]

Janne,

As you can see by the brisk response, there are alot of people that wonder, "why did I have a heart attack?"  The psychological impact is often just as long lasting as the physical. The answers are often unknown. One big focus of research here at the clinic is looking into the genetic components that explain why you get a heart attack at age 37 and some other people never get one.  While the genetic components are unknown, several risk factors such as smoking and cholesterol are, and you should be vigilent about them. Homocyteine has been controversial, but it plays some role, is easily modifiable and is worth checking.

The answer to your other question about chest pain is difficult. While people who experience pain after a heart attack sometimes have pain that is psychological in origin, that needs to be a diagnosis of exclusion. There are several ways a stent can reocclude.  One is the reccurrence of a blood clot in the stent. This usually happens in the first 30 days and is related to the stent causing a clot. The occurence of this is rare, especially if you took your plavix. It would reappear as another heart attack, probably with very similar symptoms to your original event.

The other way stents can cause pain is by narrowing down with a type of scar tissue. This usually occurs slowly over several months and appears as anginal symptoms with exertion.  These are usually reproduced and will get worse with exertion.  

The only 100% way to see what is happening would be another angiogram. However, depending where the stent is placed, some people will do a stress test to see if there are areas in the heart that arent recieving blood because of narrowing of the stent. You should inquire about the results of your test, but im assuming it was negative from your statements.  


hope this helps.

[Dr. Erik]

Many things can cause a heart attack in people at any age.Very over looked in today's medicine are Homocysteine levels which can damage the arterial linings and lead to heart attack and stroke. Also CRP (C-Reactive Protein) levels that are high cause inflamation (inflammation) and can cause unstable plaque to break away from an artery wall and block an already narrow artery causing a heart attack. Although scientists are getting the word out about measuring these blood levels as a regular practice in medicine. You should read up on how to lower these levels. Actually, half of all heart attack victims have normal cholesterol levels.

As far as your pain and tingling sensations. My father had a stent placed several years ago and still gets occasional pain in his chest and he's had EKG's and stress tests that were all normal. But it is possible for an EKG to not pick up a problem. Stress tests are more accurate, but also not 100%. A repeat catheterization would rule out new stenosis. It is possible that you have developed anxiety after your heart attack and that can certainly cause these symptoms.

[cardiac jack]

I'm a 35 M and had an MI in April.  You've probably done the research and found out that its not entirely clear why we had heart attacks.  I'm experiencing chest pain of apparently the "non-cardiac" variety.  GI tests are normal.  Since mine make me panicky, I'm approaching this from a mental health point of view.  I know its still kind of taboo, but we are at HUGE risk for anxiety, depression, etc. after a heart attack.  Keep up the good work on the physical, risk reduction side and don't ingnore the mental side.  Good Luck!

[Terry Lee]

I am sorry to hear about your problems.  I had a very similar situation but if you feel that you are having re-stenosis, please ask for a second opinion. I also had none of the traditional problems, ie high cholesteral, high BP, inactive, overweight.  I hope you have stopped your smoking because that can be a big factor in cardiac health.

My blockage was also in my LAD and I have since learned that everyone has some plaque in that artery.  I had a plaque rupture which caused the blockage but was lucky and didn't have a heart attack.

If you would like to talk somemore, please let me know and I will give you my e-mail address.  It is hard to find a women who has had the same problems (lucky us!)

Anyway, good luck and don't ignore your symptoms - keep pestering your Doctor till he gives you an answer or finds something to help.

Terry

[janne]

Thanks for the advice guys.  I had never heard of Homocysteine levels, but I will certainly do a little research on it.  As far as the anxiety goes, I did consider this myself.  Even when I was in the ER the day I had the heart attack, I told the cardiologist that I had been under a lot of stress the past few years and although I have never had one, I thought maybe I was just experiencing a panic/anxiety attack.  He didn't have the blood work back yet showing elevated enzymes, but his comment was, "you don't strike me as the panicky type and I do think this is a problem with your heart".  It sounds stupid, but I still have trouble believing I even had a heart attack in the first place. My g.p. just laughed at that saying I was still in denial.
I think everyone around me is more concerned about me having another heart attack than I am. I just want to go on with my life and get back to normal. When I started having the unusual throat/chest symptoms I didn't think it was a big deal, but it was on a routine visit to my g.p. that I mentioned it and before I knew it, I was back in the hospital and on IV nitro. While on the IV, I had no symptoms other than once while I was reading I could feel the choking/throat/pressure thing and mentioned it to the nurse as I was told to do and she discovered my IV had fallen out.
Personally I'd like to ignore it all because it's not painful, just a pain in the a**, but I also don't want to be stupid and ignore something and cause myself problems in the future.  It does not seem to necessarily be activity related other than when I hang laundry or I notice it while climbing stairs while carrying something, especially in the hot weather. But, sometimes it occurs at rest too. I guess I'll just wait and see what happens.  Thanks again for your comments.  Jann

[janne]

Thanks Terry. I just finished my other long winded post and saw yours. I would really appreciate receiving your email address.
Thanks again.
Jann

[Terry Lee]

It is ***@**** - I would love to hear from you.

Terry

[lainie]

At the age of 47 I had a heart attack followed by triple bypass.  Six months later one bypass failed and was "fixed" by 3 stents.  After the stents were placed the angio-seal used for the cath failed and I lost a major amount of blood , hence a huge internal bleed and a transfusion. Also, somewhere in there another heart attack. So now my problem is the chest pain which is a daily occurance which is diagnosed as chest wall pain , treated with vioxx. DOES NOT HELP  My questions is I also have the choking feeling in my throat and neck that is relieved by iv nitro and I have even had another cath done after a positive stress tests. Cath showed no change.  Nothing releives the pain and choking feeling. Any suggestions or ideas would be appreciated.

[janne]

Hi Laine
Wow, you've had a really tough time!  I can't say that the choking/squeezing throat thing is painful, but more of an annoyance.  So, as long as they tell me I'm okay, I'll just have to live with it.  I figure it's been about 7 weeks since my heart attack and the throat thing is more constant now in the past week or so, but certainly not more painful, so I'm not going to worry about it for now.
But, it sounds like your symptoms are much worse.  Have they given an explanation as to why you are feeling this?  If the vioxx isn't working, can they suggest something else?  I am a true believer in listening to your gut instinct.  If you feel there is something still wrong, go back to the doctor.  
I figure my instinct hasn't steered me wrong yet.  It took me awhile to realize I was having a heart attack, but I certainly figured it out before it was too late or before there was a lot of damage. So, I will ignore the symptoms I'm having now and count on my instinct to tell me they are getting bad enough that I should seek medical help.
Although it is true that many things are anxiety related and, understandably so, this happens frequently with people with heart problems, it is sad that often it is used as a diagnosis rather than a diagnosis of exclusion.
Hopefully things will work out for you. I feel lucky compared to what you've been through.
Best of luck.
Jann

[aggiedowns]

I read your comments with great interest.  My mother had quad heart bypass surgery one year ago (no heart attack but angiogram showed extensive blockage).  Since the surgery she has had 2 unexplained symptoms and seen numerous specialists who have not been able to diagnose the cause.  (1) Eye pain (like something is in her eyes all the time).  (2) Choking and the sensation that something is lodged in her throat, especially at night in bed.
She has been diagnosed with a small goiter but tests done at Johns Hopkins indicate this is not causing the choking problem.I am at a loss as to where to take her next to find the cause of these very annoying problems.
I had not considered until recently that choking and the heart could somehow be related.  I guess my next visit will be back to her cardiologist.  Thanks for any info.
aggiedowns

[K24Fork]

Was very interested in reading Janne's posts.  I had normal bp and cholesterol but mild discomfort for two weeks in left biceps.  Finally went and flunked my EKG and stress test.  Had stent insertion to unblock 90%-blocked artery on October 27th.  I'm on Plavix, Zocor, Aspirin, Lopressor and Nitro as needed.  Continue to get angina and that concerns me.  I had a bowl of cauliflower, of all things, and had a bout of angina.  Smoked before but have all but quit.  Eating well and doing the treadmill every day.  Wondering if more people out there are still experiencing angina and how many Nitro pills are they taking a day?  I don't know what is considered "normal" in these instances.  Any help would be appreciated.  I'm a 38 year old female and was not diagnosed as having a heart attack.  Just close enough.  Thanks!

[K24Fork]

Was very interested in reading Janne's posts.  I had normal bp and cholesterol but mild discomfort for two weeks in left biceps.  Finally went and flunked my EKG and stress test.  Had stent insertion to unblock 90%-blocked artery on October 27th.  I'm on Plavix, Zocor, Aspirin, Lopressor and Nitro as needed.  Continue to get angina and that concerns me.  I had a bowl of cauliflower, of all things, and had a bout of angina.  Smoked before but have all but quit.  Eating well and doing the treadmill every day.  Wondering if more people out there are still experiencing angina and how many Nitro pills are they taking a day?  I don't know what is considered "normal" in these instances.  Any help would be appreciated.  I'm a 38 year old female and was not diagnosed as having a heart attack.  Just close enough.  Thanks!