Trust me when I say you are not alone with this problem and it is very scary. It puts you in a difficult situation because you aren't sure what to do. It is very difficult to tell you for sure what is going on. you should feel comforted that you had a normal coronary angiogram last January. Angiograms tell you that there is not obstructive coronary artery disease. Angiograms do not lend insight into your endothelial cell function, the cellular lining on the inside of your coronary artery. There is a subset of people with angina like pain that have normal stress tests and normal angiogram that have angina like pain. Many of these people will have "endothelial dysfunction" -- meaning that there endothelials cells cause the vascular smooth muscle to constrict when it is supposed to relax. This can cause chest pain and EKG changes despite other normal tests. The diagnosis of this requires invasive testing and usually only at specialized centers. In general, we usually do not do this testing unless the diagnosis is really unclear. The treatment is nitrates and calcium channel blockers. We usually treat empirically and watch for benefit rather than doing invasive testing. The prognosis from chest pain from this cause is very good and should overly concern you.
We also know that people with anxiety can have angina like chest pain with other normal cardiac testing. It is possible to have one or both of these problems going on. The "vagal" or passing out symptoms you describe is often associated with anxiety. The word anxiety is often taken to mean that you are "crazy" or that you don't handle stress well, but this is often not the case. There is a wide variation to how we all respond to stress and our physiologic response is guided by our central nervous system, with only part of this being over our control. If your symptoms are from panic attacks or anxiety, often counselling or biofeedback will help control these events. It comes with recognizing the problem and being able to talk yourself down when your nervous system starts to get fired up. This can be diffucult and take time to learn, but I have seen it pay dividends if you are willing to try and this is the underlying cause.
I hope this helps answer your questions. Good luck and thanks for posting.
I made and error - My arm discomfort started on Weds. evening, by Thursday (Not Friday)....it radiated to the chest area. I felt bad on Thursday and went to my Dr. yesterday. I greatly appreciate your taking the time to answer my question. I'm petrififed that something is wrong and it's not being caught.
My apologies, I failed to add some general info. I am a 36 old female, on the thin side. One important question I wanted to ask and I ran out of room. I, for some reason, tend to get dehydrated easier than others (not the case in the ER per Dr). I faithfully drink Powerade......constantly. I have one with me at all times. I do not drink anything else......no water, no pop, no mild.......just powerade. Is this a bad thing to be doing. Could this be having some impact on my issues?
The fact that you are 36 years old makes coronary disease very unlikely. Statistically, more people will present with anxeity related chest pain then endothelial dysfunction. From our understanding now, people with endothelial function tend to be overweight, hypertensive, and diabetic or glucose intolerant. There may also be an increased risk for people with polycystic ovary disease or syndrome.
Thanks so much for your detailed and informative feedback. It is greatly appreciated!
Hi Stop Drinking the Powerade and see what happens, I went to the er a while back with a pulse of 174 and bp of 160 over 109 and had all kinds drinks that day with all kinds of sugar.
Do yourself a favor just drink water and Oj for a while.
Some people if they are just a bit dehydrated they can get angina.
Water water water. Not Powerade.
Also check out www.watercure.com
Thanks for your post. I often wondered if drinking strictly Powerade was bad. I mean I always, always drink this.....and nothing else.
I forgot to say.....all the bloodwork and EKG's were done in the ER Friday night.
Once again, thank you. Between what the Dr. said on here and what you have said, I feel more at ease. I have a 'mandatory' follow up (per the ER) with my doctor tomorrow. Hopefully we'll have some answers. Again, thanks so much!
Sending good thoughts your way for a good follow-up. Keep us posted! :)
Hi there. If you were having an esophageal spasm, the GI cocktail wouldn't do much to help your discomfort...which can feel frighteningly like cardiac pain complete with radiating pain and occasionally shortness of breath. I'm not saying you have this, just that if everything else is normal and the GI cocktail didn't help, you may want to try an esophagus-friendly diet and see what happens.
I've just recently gotten my esophageal spasms under control after over a YEAR of these horrid things. Gatorade and sports drinks were big no-nos for me, they would easily induce the spasms. Chocolate, peppermint, very warm beverages and too much sugar or garlic were also culprits, though everyone seems different in what they can or can't handle. If your workup is normal, I would try backing off the sports drinks and seeing if that helps. I drank nothing but water for months, then slowly introduced a couple glasses of skim milk a day - no juices. Recently I've added 4 oz of orange juice to my breakfast meal, but that's as brave as I'm getting for now!
The cold waves, I get those when I'm having an anxiety attack or if I am in a great deal of pain.
Hope you feel better soon.
Thanks for your post. I know you are very knowledgeable when it comes to the heart, I've seen your posts before. Maybe you can answer a few ?'s for me. I am still having the left shoulder, arm discomfort...with occasional chest / sternum burning or aching. I did have an angiogram in January. They did all the bloodwork and a few EKG's.....bloodwork fine, but one 'wave' on the EKG the Dr. said it could mean someone could have had a heart attack, but they believed this wasn't the case for me since I just had a normal angiogram. Could I have a blocked artery now even though I just had an angio. My blood pressure has always been 110's /70's......now its running in the 130's/140's over upper 90's. With of course on and off lightheadedness. Would the bloodwork show if I had CAD? Thanks in advance for answering. As I said, I see that you know your stuff about the heart......and I value your opinions as well as I do the Drs. I just ran out of room to ask the Dr. these ?'s. Thanks Anacyde!