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428185 tn?1203745389

Angina or heart attack or what?

Do good results from a stress/echo test, EKG and resting echocardiogram preclude angina or heart attack? I passed these tests, so I can't figure out this squeezing pain I get in my chest. First I thought it was heartburn because I have hiatal hernia, but it's not a burning pain at all, and neither Prilosec, Tums nor water helps. I get these maybe 3-4 times a year, but I've had 3 this year already. Last night was bad, it finally went away but it's back again but milder right now. It lasts for 5-15 minutes usually, but last night was much longer, and this morning I've had it now for the past half hour.

My doctor had prescribed nitroglycerin previously, but the attacks didn't last long enough for me to know if nitro works, since it's supposed to take 5 minutes or so to work. Last night I took one, and there was no improvement, so I took another, still no improvement but I did get a blinding migraine.

Though I have this hiatal hernia and have to take antacids or Prilosec occasionally, no doctor has suggested some kind of look-see at the hernia through a tube to see if anything else is wrong.

I'm 61, 6-2, 185, just muscle, don't drink, don't smoke, normal bp, live a good life...well, except for prostate cancer...but I began having these attacks a few years before I got the cancer diagnosis. I got the heart tests to get cleared for cancer surgery (which happened a week ago), and the cardiologist (and amateur psychologist) decided I have anxiety disorder because of the cancer, and that's causing the attacks, despite my telling him the attacks predate the cancer by years. Could anxiety, even before cancer, cause such pains?

What makes me anxious about the attacks is that my grandfather dropped dead of a sudden heart attack at the age I am now, and he was built the same as me and didn't smoke or drink either, and had no sign of heart disease.

Any clues out there? Thanks in advance.
10 Responses
428185 tn?1203745389
shoot - forgot to add the fact that the squeezing pains also occur in my jaw, right next to my ear, sometimes before the pain in my chest - and that's what makes me think it's not heartburn. No pain in the arms.
428185 tn?1203745389
Sheesh! Can't remember anything...the pains never come with exertion, only at rest, often when I'm sleeping, last night while watching TV.
406412 tn?1217441984
159619 tn?1538184537
Did I understand you to say the cardiac tests were last week? If so, believe the doctors, especially if the pains do not come on with exertion.

There are always cases where people pass all the tests with flying colors and drop dead of a heart attack the next day, it is possible. What you need to remember though is that the people that have normal test results and never have any further problems don't post so you hear much more about those that were unfortunate enough to experience a cardiac event after normal test results than from those that never have a cardiac event because they simply don't have a reason to post on the forum. Remember, the chance of a cardiac event after a normal nuclear stress tests with no other risk factors is less than two tenths of a percent per year for the next seven years, but there will always be exceptions.

I agree with Bob, it's your body and you know how you feel. If you have doubts about chest pain you should always get a second opinion. On more thing to consider however is that the more tests you have, the greater the chance of a false positive which will result in more invasive testing with some real risk of complications.

Good Luck!

428185 tn?1203745389
Thanks for the calm advice. It was the cancer surgery that was a week ago - well, I lost track of time because of it all; it was April 7. The heart tests were a week before that.

I agree re: unneeded tests. I think I'll just pass on tests for awhile and endure this pain. But there's no doubt it makes me concerned when I get it because it's so intense and nothing stops it but time, which seems to stretch out forever while I'm having the pain. I'm already prone to enough stress getting over surgery and hoping that the cancer is gone, with no clue to how I'm doing until I can get more blood tests and a biopsy in the months ahead.

I'd agree with Bob, too, if he hadn't said he'd suffered a sudden-death heart attack. Which of course makes me wonder how he's managing to post. Maybe I'm taking "sudden death" too literally.

Thanks again.

159619 tn?1538184537
No probem, I've been where you are and I know how easy it is to get worried. I let it drive me to complete cardiac workups with all the tests for three straight years before my cardiologist talked some sense into me when we went over last year's test results in August. After three years of totally notmal test results she just came out and told me it was not necessary any longer.

As far as Bob goes, I've read many of his posts and he seems to have a pretty good handle on what he's talking about. I think he is refering to a type of heart attack in which your heart either stops suddenly or goes into a type of V-tach from which there is no recovery unless you have help immediately. Both of these are dure to electrical problems with the heart and not usually due to CAD.

I hope everything works out for you!

428185 tn?1203745389
But Bob says his was due to complete blockage. Your tests can all be completely normal with all the things they're measuring - I could see my valves opening and closing - and still you have blocked arteries? Surely there's a way to show whether arteries are blocked - I think a CT scan shows this. Can you have normal cholesterol and triglycerides and still have blocked arteries? I don't see how that's possible.

Don't know if you're familiar with the story of Jim Fixx, who popularized running with his book "The Complete Book of Running". His father had died of a heart attack at age 42; Fixx died while running at age 52 - two of his heart arteries were almost completely blocked and a third was blocked 50 percent. He'd ignored his high cholesterol - 250 - for whatever reasons.

So it's possible to pass stress tests even with blocked arteries - well, up to a point, apparently. I did OK on the stress test, but still I feel kind of weak and weird climbing stairs, and this is recent - in the last 6 months or so - and I was getting very good at the long flights of stairs between the streets in my steep hillside neighborhood.

The pain bothers me a lot, obviously - this last episode continued the next day; it was almost like the pain from muscle strain or something. Of course I'd rather have it be psychosomatic than artery disease. When you pass the tests and told you're anxious, the doctors are saying that the pain is all in your mind, so it's hard to keep pressing the matter without looking like a hypochondriac. And I do realize that anxiety can  cause some very real-feeling symptoms. It's all very annoying because I really don't feel anxious in general, and in fact this pain causes me more anxiety than the uncertainty about whether my prostate cancer treatment worked.

At the same time, my episodes have scared my wife as well as me, and we have this complication: Three doctors over the last three years ignored my high PSA levels, did not recommend further testing or biopsies, said they were normal for my age or due to prostatitis or infection. So I learned to distrust doctors' dismissing my questions.

Well, as you can see, I'm just thinking aloud here, blathering on. Sometimes writing it out helps me figure out what I'm thinking. And I've gotta say that Google seems to track one's comments here in an uncanny way: I see two ads about blocked arteries right at the bottom of this page. Brother Google is watching us. Convenient, helpful, misleading, and scary all at once. Because of the ad "Dissolve Artery Blockages", which I clicked on, I looked up EDTA chelation therapy ($49 a month). But I don't even know if I have anything to chelate!

It's aggravating that until recently I didn't have to think about any of this stuff. I was in superior health (well, I thought I was) with a few aches and pains, in better shape than a lot of men half my age, could run and walk for miles, climb hundreds of stairs, surf for hours, clear brush, haul rocks from the river, make love, and now...

Thanks again for listening.


391561 tn?1227050815
Hello Bill, I'm Steve. I'm not sure if I missed something in your posts, but from what I've read, you certainly need a catheterization/ angiogram. They go in (typically) through leg (femoral artery), sometimes arm, wherein the Dr passes a catheter into your heart and gets angiogram of heart, particularly the coronary arteries. I believe it is the blockage of these arteries which causes chest pain/angina. Typically this would be from CAD (coronary artery disease).
  If there are blockages, Dr can perform bypass ( replace clogged arteries with veins harvested from legs, usually) or place stents in, opening artery to allow blood flow.
  From what your complaints, I do not feel that If it was I, I would not be comfortable without INSISTING upon a catheterization to indeed see if your coronary arteries are clear.
I am sorry to hear of your condition, and I wish you well.
Avatar universal
I had a drug induced stress test by the Cardiologist in July of 2006 to clear me for Surgery. I passed all tests. In January 2007 I had crushing chest pain with the onset of an acute Inferior MI. I was sent immediately to the Cath lab , found to have complete blockage of the LAD and 90 95  % of others. I wound up with a balloon pump, and emergency quadruple bypass and a stroke. I have overcome most of it and the vessels are doing well. I am facing major surgery on the 30th for non-union of the sternum

I would get someone to do a Cath. it is the gold standard and will see the blockages if they are there, unlike the non invasive tests that I certainly don't trust anymore.

Good luck

159619 tn?1538184537
Like I said, you will always have examples of people that suffer a cardiac event after passing all the tests, it happens. For every one person you hear about, based on the number of these tests that take place daily, there must be thousands that don't have any problems. It is your body and you know how you feel. If you have concerns by all means get a second opinion. My cardiologist refused to do a cath as my tests results were always good and when I tried to force the issue the insurance pushed back as well. A cath has a risk factor for complications so you and your cardiologist need to determine if your symptoms are an indication of a risk that is significant enough to warrant the risk of a cath. One other thought, symptoms caused by CAD don't normally go on for a long period of time without some sort of cardiac event. There can be a few weeks worth of symptoms prior to a heart attack, but generally symptoms that go on for many months or years are atypical for heart disease.

It sounds like with everything you have going n you should discuss all these possibilities to you cardiologist and make a decsion between the two of you on what to do next. When I was going through this I asked the same questions and did considerable research, which is sometimes more harmful than good! I not a doctor so I don't have all the answers, just passing along what I've been told and have read.

Good luck and let me know if I can help you out.

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