is this cardiac?

[louis]

Hi, I,m a 36 year old male in good health and my cholesterol levels are fine. a few years ago an echo done at a local hospital showed a mild DCM but otherwise structurally sound heart. I saw a cardiologist who based on clinical exam doubted the diagnoses, but ran a battery of tests(EKG, Thallium stress test, chest X-ray, PET scan) which were all fine, and showed no ischemia. I have since seen Dr. Edmund Sonnenblick at Einstein Medical Center for a second opinion who ran his own tests and Echo, which was normal ( the most recent one on 6/2003) and he said he doubted the DCM ever existed, and to make sure I drive safely on the way home. However, during the course of the last four years, every now and then I'll get chest pains ( at least I think they are, I'm not sure what they're supposed to feel like ) As a result, to indulge me whenever I complain, my original cardiologist has been repeating Thallium stress tests pretty much every six months for the last 3 years which all come out fine, but i"m starting to get the feeling he thinks I'm nuts. This past Thursday I started to get chest pains again on and off for the last three days, and they're not necessarily brought on by exertion, and when i flex my chest muscles it will usually exacerbate the pain, which i think means they're not cardiac related. I know that stress tests sometimes give a false negative, but is it possible to get a false negative for five consecutive stress tests in a row done a few months apart?  The cardio. thinks i'm fine. I'm going nuts. Do I call my cardiologist again now, or a psychiatrist? thanks

[CCF-M.D.-RCJ]

Inky,

Thanks for the post.

Your story highlights why people need to see good internists.  Chest pain can be caused by many, many different conditions, most of which are not related to the heart.  Simple things such as heartburn or costochondritis are often the cause, but other non-heart related serious conditions can also be the source.  The problem with going directly to a cardiologist is that we specialize in the heart.  So many of us simply attempt to exclude the heart as a source of the problem, but don't provide any guidance as to what actually is the problem.  This is a less than ideal approach, and I don't condone it, but it happens.

So let me say that I believe you that you have chest pain, and there is still a small chance that the pain comes from the heart, but I would see an internist to help sort out your symptoms.

Hope that helps.

[HealThySelf]

I have a long term totally occluded RCA, a 70-90% ostial occlusion of the circumflex, and a large "cratered" plaque in my left main.  I'm told that's about it's bad as it gets.  The attending cardiologist at my last aborted attempt at angioplasty gave me a 40% chance of sudden death within 5 years (2 1/2 years ago).  He said that I probably wouldn't have the opportunity to dial 911 when it happens (not that I would anyway).  Of course they have always given me the hard sell for bypass surgery, and I regarded this as just another crude sales technique.

The funny thing is that I feel fine.  I hike about 35 miles a week with 10,000' of elevation gain.  Lately I've been hiking up about 3,500' vertical gain every other day, with no problems.  I'm sure that if we had a day in the mountains, I could kill the little fat cardiologist that gave me the dire prognosis.  I can feel a bit of limitation, but otherwise feel like, and am, a very healthy person.

I have had a heart attack in the past and know what that feels like.  In my case it was an intensifying aching in the center of the chest.  It was something like I never had before and I was pretty sure what it was.

But every once in a while I just get this stabbing pain over my heart.  Given my history and prognosis, I have to worry a bit about it, even though I know it's nothing like the heart attack that I had.  I begin to think maybe that little fat ******* was right.  Sometimes it hangs around for a few hours and hurts like hell.  Yet I can still go out and walk up a hill so I know it's not directly ischemia related.

Anyway there are a lot of strange chest pains that a person can get and most of them won't kill you.  Living with the real possibility, as I do, can make you bit more paranoid.  My philosophy is to enjoy my last day on the planet whenever that may be.  I think most likely in 30 or 40 years, but it could be today.  

Best Regards