heart attack vs heart failure

[tickyticker]

just been released from hospital with dx pericarditis, echo did not show fluid but did show wall motion abnormality inferior and right posterior wall, ef 50%. no known heart attacks, but had chest pain on/off all year d/t thyroid problems(total thyroidectomy 5 yrs ago)-cannot get a good dose of synthroid, many times had chest pain, sob, arrhythmias, palpitations, racing hr 120-140, went to ER several times, EKG would show ST, with unspecific ST abnormality (ST depression), enzymes would be negative, nothing outrageous on cxr. Thyroid function studies would always be off the chart-tsh completely out of ranch either hypo or hyper....
Now resting, they want to do stress test in 2 weeks and go from there? They dont want to do cardiac cath as they say it doesnt look like I have blockages? Should I insist on one or wait for stress test? I'm worried I will go into heart failure?
Btw, I am a critical care nurse, so maybe a little paranoid as we always expect the worst, but have seen 20/30 something women go into complete heart failure and needing LVADs.
I have lots of cardiac issues in my family-dad needed 4 vessel bypass when he was 50 from MI.
Should I insist on Cath, or other tests more reliable, show whats actually going on???
Thanks

[gedankenkatze]

Hi,

1. You  have nowadays other examinations for detecting CAD, pericarditis, and cardiomyopathy.
2. CT scans excellently detect CAD. In your case, heart rate may be little bit too high. Some oral drug may be available. MRI, scintigraphy also are useful. Currently, many cardiologists prefer to do these non-invasive examination first, and they perform cath. for patients with equivolval diagnosis.
3. For pericarditis and cardiomyopathy, combination of CT and MRI is highly useful to detection. Cardiac catheterization may be needed in case of constrictive pericarditis with surgical indication.

Thank you.
  

[jrbon]

I would not dear to write this post to anyone, but since you are a nurse, here you have all my thinking.

Have you ever had a head scan looking for your pituitary gland? It is there  where the TSH gets produced.
By the way to adjust thyroid substitution medication there are cases where THS it is not reliable, you should get free T3 and T4 levels which are the hormones that the thyroid really produces.

How are your PTH levels? This is produced by parathyroids glands and if they did not pay good attention, they could have removed them in your thyroidectomy. The important point is that parathyroid hormone regulates the calcium in the whole body, which imbalance inside of the myocardium cells (not in the serum) can give some of the symptoms that you describe.

By any chance are you in the upper limit of glucose and waist perimeter? Any visual issues? Just thinking on possible Metabolic syndrome and/or small vessels blockages (Syndrome X).

Please, take all the above just as thoughts for you. Keep in mind that I am not a doctor just a cardiac patient.

Jesus

[erijon]

Insisting on a cath and finding a Cardiologist to perform an invasive, risky and unnecessary procedure are two different things. If there are no indications for a cath, I wouldn't push for one. Your symptoms really don't sound like CAD to me, but I'm not a doctor. I would personally wait to see what the stress test shows. Are you having a normal stress test or a nuclear stress test? The latter is 85% accurate overall, but will detect heart disease when present 97% of the time.

Good luck,

Jon