cardiac symptoms?

[Cosmobirdy]

Over the past 4 weeks I have had several episodes of chest pressure, with high back (central) and some shoulder pressure/pain.  I've had brief left jaw and neck pain during some of these episodes.  Sometimes I get nauseated, but not each time.  During these episodes, it feels like my heart skips a bit, and then when it resumes beating it makes me catch my breath.  The episodes are lasting longer, and during the most recent one it felt like my heart beat was erratic - pounding, skipping.  Prior to one episode, I suddenly felt exhausted, then came the nausea and then the chest pressure, back pressure and weird beats.  After these episodes, and usually for the next day as well, I feel like I've been hit by a truck - just wiped out.  I seem to have less zip in general since this all started.  I'm a 44 yr old female, health very good overall.  BP is good, cholesterol is good, not a smoker, not overweight.  I exercise about 3-4 times /week.  Currently on HRT (estrogen only) x 1 year or so for early menopause.  I finally went to my family doc and he was actually very concerned - I had assumed that it couldn't be my heart because of my overall good health and no real risk factors.  (Family history unimpressive except for my mom.  She has MVP and something else going on - they never allow her to finish her stress tests, but say she has only moderate plaque.)  My doc did an EKG and muttered something about an abnormal Q wave.  He was adament that I take this seriously (I'm not one to go to the doctor unless I absolutely have to), made me an appointment with a cardiologist (going tomorrow) and gave me nitro pills.  That got my attention.  Again was adament that I take them if I have these episodes. Could this actually be heart related?  What would an abnormal Q wave on my EKG signify?  As a child, I had multiple rounds of tetracycline due to severe asthma and numerous episodes of pneumonia - is that significant at all?  The upper back pressure is almost constant now, and my chest is uncomfortable most of the time, but not as much pressure as when I have an acute episode.  The episodes seem unrelated to eating or drinking and have occured while I've been up and about and while I've been resting.  Any thoughts or input would be greatly appreciated.  Thank you for your time...  

[Cosmobirdy]

Very interesting... thank you for the info.  I will try to find out more about the EKG's.  I spoke to my family doc today and he was not amused by the cardio's attitude.  He, too was appalled by some of the things he said to me, and totally understood why I had no confidence in further testing being done thru this guy.  I'm going to get a stress echo at a different place and we're going to start there.  He felt really bad at how it had turned out, and I know we'll get to the bottom of this.... :)  This forum is wonderful - so many helpful people with useful info... I really appreciate it.  Thanks!

Rita  

[KLeonard]

I am a 27 year old normally healthy female, not overweight, and have had very similar symptons as you have suggested. I was referred to a neurologist because when I get these episodes, I gave fainted in the past and get this head rush and jaw pain and naseau as well. It wasn't until I rounded up all of my ER charts for my neurology appt that I discovered 2 abnormal EKGs, both of which the ER docs told me came out normal. The abnormality was a prolonged QT, which is the q and t waves being too far apart. Do you have copies of your EKGs on hand? If so, check if your QTc is on there. Anything above about 470-480 I heard is a concern, you could go into cardiac arrest.
This may not be what it is or you may even be on the opposite end and have a low QTc interval, which could be fatal just as well. Not many docs know enough about Prolonged QT and because of that, they do not tell the patient. I have read several doc to doc forums on here tell each other they usually don't tell the patient if they find a prolonged qt because either a) they believe an EKG prolongs the qt and is inaccurate or b) they know it is fatal and do not want to be bombarded with questions when they do not know for sure and dont know enough about it to draw a conclusion. Pure laziness if they cant just refer you to a cardio for it.

Anyways, check your QTc out or call whomever gave you the EKG and ask for that number. Check out long qt syndrome on google and there is lots of info of symptoms and treatment.

[Cosmobirdy]

Truthfully, when these episodes have happened lately I've had no choice BUT to lie down.. :)  If the EKG doesn't really give that much info, wonder why the cardiologist used it as so much evidence that nothing was wrong?  The only tests he suggested were the stress test, echocardiogram, and 24 hour Holter monitor.  Is that a reasonable place to start?  I'm still waiting to hear from my family doc to see if I can follow things thru him for now - not real keen on going back to Mr. Personality the cardiologist.... today is actually the first day in a while where the discomofort hasn't been too bad.  Hadn't realized how much it was really bothering me till mid morning when it dawned on me suddenly that I wasn't in alot of pain... :)

[caregiver222]

I am concerned by the nausea and the left jaw pain which, as you know, are yellow flags for cardiogenic ischemia. Remember that the EKG merely manages electrical activity and does not give a good picture of what is actually going on. It is possible to be in cardiac arrest and have an acceptable EKG (electromechanical disassociation). There are tests that you need to have. I am sure you know what they are. Cardiad enzymes, blah, blah.  My guess is you don't have an infarct. An aberrent Q is sometimes a symptom of electrolyte imbalance. Irregular heartbeats can sometimes be cured by taking magnesium glycinate supplements. The problem with PVC's is that if they occur at the wrong time in the contraction sequence they can cause ventricular fibrillation. Fortunately this doesn't happen all that often and people often throw PVC's for decades.  This is my advice. Should you experiene symptoms again it is important to reduce the oxygen load. LIE DOWN AND REST! Often the problems are transient. Take care of yourself and get a good medical evaluation. You know the drill.

[Cosmobirdy]

Ya made me smile... thanks... :)  My husband went with me to the appt. (which seemed to really irritate this guy) so he heard everything too.  He's been concerned about me (bless his heart)  and wants me to still get all the tests done, even if "they will all be negative."  My husband knows I hardly ever complain or whine about stuff, especially health issues, and he's noticed that my energy level just isn't what it should be.  Everyone I talked to was horrified at the behavior of the staff and the doc, so I guess it wasn't just me being touchy... :)  Someone suggested having the tests ordered by my family doc, and then if there's anything abnormal I can follow up with a different cardiologist - so I think I'm going to investigate that option.  At this point, all these tests would be done right at the cardiology office where I had the bad experience.  Even if the staff perfoming these more specialized exams is thoroughly trained and knowledgeable, (assuming the clueless woman doing the EKG was an fluke), will the interpretation be fair and thorough since they will probably be read by this same doc?  Or will he approach them with the same attitude that he did me, give everything a cursory look at best, and just assume there's nothing wrong?  Don't get me wrong, I certainly don't want the tests to show anything abnormal, but by the same token, if there IS something going on, I'd hate for it to be missed because the doc already had some preconceived ideas, ya know?  I know you're a veteran of dealing with cardiologists, as are many of the wonderful people here - any thoughts of what I should do from here?  Or should I just take him at his word and assume there's nothing wrong and leave it all alone?  After all, bad attitude aside, he IS the specialist, right?  I don't want to be a big baby but I don't really want to take chances with my heart, either.... :)   Thanks again....

Rita    

[Jack54]

Do you know what they call a medical student that finishes last in his class?




























DOCTOR....

More to come on your experience later :)   So sorry :(

[Cosmobirdy]

Thanks.. :)  I think I will probably call my family doc (who I love) today and see what he says.  This cardiology group came highly recommended by him and several other folks who I checked with.  When I checked in for my appt, I told the girl at the desk that I was having alot of chest pressure and asked if I should take something for it or would it skew the results of any tests they might do.  She just looked at me blankly, said she didn't know, and gave me forms to fill out.  No more contact till they called me to the back about 15 minutes later.  I was amazed....  The MA who did my EKG had to have someone come in and help her - she clearly was not comfortable or experienced or whatever.  I'm an Ultrasound tech, and if we ever were so dismissive to patients, acted like we didn't know what we were doing, it would never fly.  I could understand the dismissive attitude if I was a chronic complainer who went to the doctor every time someone looked at me cross eyed.  But I'm the opposite - if I actually drag myself in, there's a problem and it's probably been going on for quite some time....

[Happy2girls]

Can you get another cardiologist?  I think it's really terrible that he blew you off.  Good luck to you.

[roe929]

man i really understand im so fed up with being told nothings wrong i could just cuss the doctors out  i just really hope someone finds out b4 its too late

[Cosmobirdy]

Saw the doc - he basically blew me off from the start... :)  Was having the pressure when I got there - BP was 140/95 and heart rate was 97.  Neither are ever high.  Could feel my heart pounding.  He said I was just nervous.  Mind you, I've worked in the medical field for almost 25 years - doctor's offices don't tend to get me too hopped up.  His first question to me was "Why are you here?"  They did another EKG, very quick.  He said I have "some small Q waves" and it's "probably just a normal variant."  Said the weird beats are premature contractions and "everyone has them" - but I might need meds to regulate that.  HUH??  Said I probably have MVP, but it's no big deal.  He's ordered an echo, a stress test and a 24 hr holter, but he thinks they will all be normal.  So I said why do them?  He said because we live in a country of lawyers and if I go home and drop dead someone will sue him.  Said there's a bunch of other things that can cause the same symptoms but nobody else will touch me till we rule out heart.  I certainly hope the cause will turn out to be something easier to rectify than cardiac problems, but I'm kind of frustrated with the dismissive attitude.  So I'll get the tests "that will probably all be negative" and we'll go from there.  Meanwhile, I'm sitting here with the pressure in my chest and back - go figure.... :)

Thanks again,
Rita    

[Cosmobirdy]

Thank you so much for your warm welcome and helpful information. :)  I really appreciate you taking the time to get back to me and share your knowledge.  But you didn't tell me what I wanted to hear, LOL!  I guess the Q wave explains why my doc had his concerned face on when he came in the room - and that's what bought me my very own bottle of nitro.  I do take aspirin every day, ever since they put me on the hormones.  Not real keen on having a stroke, ya know?  I found out last nite that they want to put a defibrillator in my Mom - so I guess she has some type of arrhythmia?  I go this afternoon to the cardiologist, so we'll see what he says.  At this point, it's been going on long enough that I want to know why I'm hurting and so tired - so we can fix the problem and I can move along.... :)  I'm a busy girl and used to being able to go, go, go.  It's frustrating to not have my usual energy, and the near constant discomfort is getting on my nerves.  The back pressure is stronger today for some reason, but the chest pressure isn't much different than usual.  I'll let ya know what the doc tells me - hopefully it was a mistake on the 1st EKG... I don't really have time to pencil in any serious heart problems.. :)  Thanks again..

Rita    

[Jack54]

Hello and welcome :) You sound very calm, level headed and ready to deal with whatever is going on. It does sound like your doctor is onto something. I am sorry to say that your symptoms really sound heart related. People can seem really healthy and have a heart attack due to coronary artery disease, or blockages in one or more of your coronary arteries. Your doc is very aware of this it seems.

Q waves indicate a heart attack or myocardial infarction (mi) as stated below, in some literature I googled up.

"Abnormal Q waves are a common finding early in the course of acute myocardial infarction. However, there is no evidence that abnormal Q waves are associated with less benefit in terms of reduction of infarct size after thrombolytic therapy."

This means to take that nitro when these pains come on! This medicine instantly dilates your coronary arteries (and all other arteries) which instantly increases the flow of blood to your heart muscle. It actually decreases the size of the blockage if it increases the diameter of your blocked artery. You also need to take an aspirin a day, if you can tolerate them. I myself cannot due to abuse of NSAIDs years ago, which caused stomach and small intestinal ulcers. The ulcers are gone but any NSAID causes bad ulcer pain.

There are also "non-Q wave mi's". They do not penetrate completely through the part of the myocardial tissue where the infarct occurs, I believe, or if I remember correctly.
I do not know about the pneumonia or heavy use of antibiotics as a child, being associated with coronary artery disease.

All said and done, even though your symptoms are ever so suspicious, and the abnormal Q wave showed on your EKG, your problem may still very well be due to something more innocuous. The EKG you had was probably not a 12 lead EKG, which you will get at your cardio appointment for sure. Let's hope your doc's equipment was wrong or the nurse was inexperienced. If the Q wave is for real it will always show up on an EKG, I believe. It means you have had a heart attack. Let's hope you haven't!

Good luck,

Jack