is chest pain cardiac related.

[jonesy70]

I have been to emergency on two separate occasions in recent weeks with chest pain, palpitations and anxiety. EKG and blood tests ruled out heart problems and diagnosis is GERD.  I am currently experiencing chest pain on the mid right sternum , back pain and burping a lot which is not being totally relieved by antacids or proton pump inhibitors.  I am very worried.  I have also recently had two week long event recorders which showed normal sinus rhythm even when I was experiencing chest pain.  I have previously been diagnosed with chronic oesphagitis and hiatus hernia. I do not want to rush off to emergency again, but could my symptoms be cardiac related.  The pain does ease a bit through walking around.  

[grendslori]

OMGosh, ed!!! I about flipped reading this last post....five months!!!? We generally have to wait MAYBE a week? In fact many of the cardiologist here have a stress test available in their office so if you have an appointment....they just go find out if the tech is available to do the test while you are there. If there is a concern and they don't have the availability, they will send you over to the hospital and have you "fit in" to the schedule there. WOW.....five months!! It's no wonder why people are hitting the concrete! You are one very lucky person, ed! Take care!

[ed34]

Unfortunately here the waiting time for a stress test is very long. I had to wait 5 months. They just do an ECG, then take a troponin test 12 hours later. If this is negative, they send you home with 'maybe' a stress test appointment for the future. In my local hospital, there is just one treadmill which is a joke for over half a million people in the local community.

[grendslori]

What you are saying in your first post could certainly happen, ed, but here the protical for someone having chest pain that is NOT EKG documented would be sent for a stress test of some kind because of the stress induced chest pain. That's pretty much a given. I was, quite frankly, surprised by your second post! On discharge here, at least for every hospital we have had to deal with (there have been many) the nurses have always gone over meds with us at discharge. Verapamil can do a number on a person; I took it and it put my heart rates up into the 180+ range......I wasn't on it long at all! Obviously heavenly Father had you here for a reason........to help educate all of the people that you do, including me! :)    

[ed34]

Just to say that I don't under rate ECG totally, it did save me once. I was given my bag of medication and discharged from the cardiac care unit in 2007 and when I arrived home I noticed a new medication. I knew I usually took Ramipril (ace inhibitor) 2.5mg but there was this new med, Verapamil and 240mg twice a day. I phoned the ward to ask and they said "We can't give you advice because you have been discharged". I took the 480mg on day 1 and wow did I feel light headed and rough. I went to my local Doctor and she did an ECG. It looked really strange, the ventricle spike was upside down. She got an ambulance and I was taken to the hospital. My blood pressure was taken and it was 65/31. They said "no wonder you feel dizzy". I was fighting to stay awake. I kept telling them it was the verapamil, but they just kept saying "can't be, you are not on that med". The hospital pharmacist came over when I was speaking to my cardiologist and said "let's be sensible about this. Where would a patient get the name of the medication from if he wasn't taking it". I got my wife to bring my meds in, and there they were. They were meant for an 80 year old man in the bed next to me, but ended up in my bag. I took action against the hospital, not accepting money, but demanding they put a system into place to stop this kind of mistake. They changed the system, where a nurse MUST go through the delivered meds, check them in front of the patient against their chart, and explain the meds to the patient.
So if I didn't have that ECG, I don't think I would have been here today :)

[ed34]

Heart attack can obviously happen at any time and without warning. There are many cases where people have been in a hospital, had an ECG which is normal and then released, only to have a heart attack soon after. Let me give you 2 possible scenarios.
1. A person goes to hospital with chest pains. Angina is different in everyone, some people feel it with a 40% blockage, while others have to wait until a 90% blockage. Our sensitivities seem different, and it will also be affected by the exertion level. Most ECG's are taken with a patient laying down and fully relaxed, which is really no good if the pain comes on with exertion. It is obviously going to look normal. So, say the patient has a 60 % blockage and feels fine while laying in your examination room. You take the ECG and it looks fine. The patient leaves and then obviously they could have a heart attack at any time. Even within minutes. If the plaque ruptures, it can block the vessel lower down. They could then form a clot at the rupture site, doubling the problem and likely causing death.
2. A patient feels chronic chest pains and is taken to hospital. In emergency the patient suddenly starts to feel better. The ECG looks great and no cause for the discomfort can be found. What has happened with this patient is they formed a total blockage, but collaterals opened to naturally bypass it. On this surface this patient looks in good health, but underneath they could have plaque everywhere. I think this is something which happened to me because I had a totally blocked LAD at the top, with collateral development. However, when my left circumflex blocked, it caused hell because this was the vessel feeding the LAD. It was a 95% blockage but it had the effect of shutting down some collaterals too.

[grendslori]

I wanted to say thank you for this later posting. When I was trained and during the time I worked as an EKG tech and supervisor we were always taught that the EKG DOES change during a heart attack. The primary downslope on the R-Wave takes a jump and breaks off looking like the lower half of an "h"  and that the height of that lower "hump" (for a lack of a better description) changes over the course of several days. I cannot tell you how many patients I have run EKGs on in the ER to see this on their EKGs along with doing the follow-up EKGs while they were in the hospital. I found, therefore, what you have written very interesting. As far as the person dying two days later of a heart attack after getting a clean bill of health, that's harder for me to swallow, shall we say, it sounds much more likely he died suddenly from an arrhythmia issue and not due to a heart attack at all. People can have completely clear arteries and still die suddenly due to an arrhythmia which I am sure you would be aware of as smart as you are. An arrhythmia will not show up on an EKG unless it is taking place at the time the EKG is actually being run. It can, sometimes, show a propensity for that to be an issue such as a person having several PVCs on the EKG or something like Long Q-T or a cardiomyopathy, which a person can actually have without that actually showing up. Again thank you for the posting! :)      

[jonesy70]

Thanks for your counsel. I ended up going to emergency. ECG, blood tests and spiral cat scan (not sure exactly what this is) were normal.  Blood pressure was elevated on arrival 160/90 but went down to 145/83 on leaving.   Diagnosis- most likely oesphagitis but I need to go to cardiologist to get blood pressure monitored over 24 hour period.

[ed34]

American Heart Association.

"The ECG does not always show the damage that is occurring, particularly if it involves the left side or back walls of the heart. In such cases, blood tests or other studies that can “image” the heart’s blood flow are used."

Patient co uk

"Also, not all heart attacks can be detected by ECG. Angina, a common heart disorder cannot usually be detected by a routine ECG"

Peer reviewer Dr Hannah Gronow, Author Dr Tim Kenny

There is increased accuracy with an EKG if there are previous printouts to refer to from the same patient so any changes can be seen. In 2007 I had a heart attack and was rushed into the cardiac care unit of my local hospital. ECG after ECG was taken, I assume to make a small historical record to see if changes were occurring, but nothing odd showed up. I was then being prepared to be transferred to a normal ward but my Troponin test came back as very elevated and I was rushed into the Cath lab to be stented. Several times through 2006 I went to the emergency due to really bad chest pains, but all they did was an ECG and no bloods. I was always discharged with a good heart. My blockage was in the Left Circumflex, round towards the rear/left of the left ventricle. I assume that because the electrical pathway for the ECG was well away from this area, that is the reason nothing was seen.

Personally I don't think the ECG is all it's cracked up to be. So many patients slip through this net, to shortly suffer after. I remember about four years ago, a famous Actor here in the UK wanted to emigrate to Spain for retirement. He had a full medical before going because he wanted to make sure he was fit. The report said that he had a clean bill of health and his ECG looked normal too. He was in spain for 2 days and he died of a heart attack.

[grendslori]

This does not sound heart related to me, but if you are that worried, it is always better to go back to the ER. One thing I can say is that an EKG Complex DOES change if a heart attack is going on so if you were having chest pains during an EKG/Holter monitoring and that was normal, you probably do not have too much to worry about in that department. Problems with the esophagus can lead someone into thinking they have heart related chest pain, especially with spasms. Walking around would not "ease up" heart related chest pain, in fact, it would make the pain worse as the heart tries to pump blood either through clogged arteries or outstripped veins and capillaries.

[ed34]

I have experienced lots of Angina and also a heart attack. Last year I called an ambulance because I felt symptoms very similar to those I had with a heart attack. Only this time, walking made no difference. I actually ran up and down my stairs and it made no difference, so I was very confused. I was under strict instructions by my Cardiologist and Doctor that if I feel chest pains, to ring an ambulance. The paramedics took an ECG and it was normal, but said it could be a non-stemi and I need blood tests at the hospital. At the hospital I explained my confusion to the cardiologist and my bloods came back normal. I was diagnosed with oesphagitis and I can tell you now, it feels 90% like heart problems. The only thing which helped the pain for a short period of time was Gaviscon. It took 3 weeks to clear up and in the whole of those 3 weeks I was still wondering if it could be my heart. A hiatus hernia could also be an issue if it's the sliding variety. If you lay down, it could be that your stomach is then protruding through the sphincter into your chest area. When you stand up, and walk around, gravity pulls it back down again.