SO CONFUSED. . .please help !!

[mickeysgirl61]

Thank you for taking time for my question. (While in Texas) Background:  44 yo female, total hyst., diabetic in control (Hba1c never over 6, never smoked or used alcohol.  In 2004 I had thought someone stabbed me in the back while I was climbing stairs to our apartment.  The pain got worse so I took my blood pressure (160/100. . never has been that high) so I went and chewed 5 baby aspirin and immediately headed to the hospital (we lived across the street from it so this all happened within 5 minutes)  When I got there and told them I was having a heart attack they ignored me and told me it was gallbladder problems.  I kept insisting loudly and they finally gave in (and hour later).  Hooked me up to an EKG and within seconds I was in the trauma room talking with a cardiologist.  Immediately they took me to the cath lab-once in a CCU room the doctor came in and said that he was baffeled.  No blockages, clear arteries, my cholestrol was 110, LDL 63, Tri. 53 and HDL 35 (the blood work was all done 2 weeks before this event by my regular doctor).  He said that I did have an ST elevation MI.  I was in CCU for 4 days and step down for 1.  Sent home on Coreg-this medicine caused fainting for the first 9 months I was on it, but the doctor didn't believe me and told me to find another doctor. He wanted me to drink 4-5 oz. of wine a night and I have never drank before. . because I wouldn't he got upset. Went to the other doctor and he said I didn't have a heart attack and put me on Norvasc with Coreg.  Did a stress test and it stated negative.  Have had holter monitors (30 day) and this is what it said on one of the strips:

Sinus rhythm, changes in QRS Morphology noted, SV ectopy noted, pairs, Rare PVC

When I asked the doctor what this meant, he said it was normal.  Normal ??  Doesn't sound like it to me. He wanted to run another 30 day and do another stress test and echo.  The insurance wouldn't pay for it so I couldn't have them done. . .he too told me if I didn't do the tests and pay for them myself, to go find another doctor.

I am SO confused as to all of this.  How, with the low cholestrol could this happen.  I have done everything right as far as I know. . .I am 25 lbs. overweight but working on it. No history of heart disease in the family (just most of us are diabetic. . had 2 sons close to 11 lbs)  Was a vegetarian but not now because of the diabetes.

(1)  Could you explain what the 30 monitor said "Sinus rhythm, changes in QRS Norphology noted, SV ectopy noted, pairs, Rare PVC"

(2)  What can I do to get my HDL up or is it so low because the total cholestrol is low?

(3)  I am having some burning chest pain after walking 2-3 minutes.  Could this be a blockage?

(4)  Can a cardiac cath be wrong ?  Could there be blockages that the doctor didn't see?

(5)  I have had to travel from Florida (where we live) to Denver to settle my father's estate. . .while there my blood pressure ran 149/94, Pulse 98, sugars around 200.  Normal here is 110/65, Pulse 74, and sugars in the 80-110 range.  What causes the rise and is it dangerous for me to be up there ?  

(6)  Does Coreg cause the feeling of not being able to keep up with exercise?  Like something is working against me, pulling back. . can't reach the heart max.?

I have been told that there was "minimal to no" damage but why do I seem to have problems with skipping, fatigue, burning chest pain.  I will be seeing a new doctor here in Florida in November-we just moved here and are waiting for insurance to kick in.  Thank you again for your input as I am totally confused !!  Yes I did, no I didn't, take this one, no take this one. . .you all get the idea !!!

Looking forward to hearing from you and others that may have had this kind of heart attack.

[Mels22]

Also, for the past couple days, I have had jaw/teeth pain sometimes going up my ear and my nose.  Does this sound cardiac?  I'm so worried.  I do grind my teeth and I suppose it could be TMJ or stress.  What do you think?  Many things I read online say to go to ER for jaw pain.  My question is, if I've been having the jaw pain for several days, if it were cardiac, I would be dead now right?  Doesn't jaw pain just start when having the heart attack.  I had a regular EKG on Tuesday - good BP and pulse.  Do you htink I should have it evaluated?  I've had normal stress test, echo, EKGs, blood work, etc.  Please just tell me, do you think its cardiac or anxiety or what?  I see my regular MD on Tuesday, should I wait til then or go to ER?  I would appreciate anyone's input!!!!!!!!!!!!  

ps - I'm now on 60 of prozac and 1 mg of ativan.  but why the teeth pains?

THANKS!!

[Mels22]

Hi Al,
So sorry to hear about your rough time with health issues!  How old are you if you don't mind my asking?  It started in your 20s???  Thats crazy, do you have lots of family history?  I have a question for you if you don't mind (you seem to be really smart)...
I am 25 - female - had a baby 6 months ago.  Since beginning of September, I have had chest pains, shoulder/arm pains, even some in my jaw.  I have been to 2 regular MDs, 2 cardiologists, a neurologist and have had chest x-rays, CT scan, MRI, 8 EKGs, blood work, thallium stress test, echo and all came back normal.  I still continue to battle my pains and have terrible indigestion/burping/bloating. I also get lots of headaches and feel horribly fatigued all the time.  I've had anxiety in the past - on prozac since I was 15.  I've had panic attacks but never for this long!  My docs say anxiety, GERD, and fibromyalgia but I'm just not convinced.  The prilosec seems to be helping some and they just put me on elavil which seems to make me more tired.  I don't know what to do! IT is disrupting my life.  I have no family history, my HDL and LDL are good, my BP is good.  THe only thing thats come back abnormal is my liver enzymes so we are retesting.  I need to be back to normal for my husband and baby.  My question is, do you think it could be cardiac?  All my family and doctors think its just acid reflux and anxiety.  What do you think?  The cardiologist says there are no more tests he can do except for cath and he doesn't want to do that with my family history and age and risk factors.  Let me know and I would appreciate any suggestions!
Thanks and good luck with your health!

[anacyde]

I totally understand where you're coming from.  My daughter is just turning three on 10/24 and my son will be 10 months on 10/26.  The thought of leaving them alone scares me.  I feel stronger now than I did before, and I think a lot of that has to do with getting back to being active.  I guess I feel like, if I can handle 40 minutes of kickboxing, an hour of rollerblading, and my Holter looked perfect while doing this...then I must be okay!  lol  I worked that monitor OUT!

Spent last night up until 2AM with esophageal spasms.  First in a long while.  I feel your pain, literally.

My GP says there are a few different tests that may be helpful in determining esophageal spasms - and yeah, one was the nasty little test Al Dente mentioned.  Thus far, I haven't gone.  Antacids and warm milk help my acute symptoms so I know that isn't cardiac.

I have a good feeling you'll be around to see your GRANDchildren ;)

[momto3girls]

Hey there (:

Thanks for your post, it was very sweet!  I hate worrying about whether my kids will be motherless.  It's a very paralyzing feeling, one that I know I have to fight down.  

Wow, you work-out hard!  I don't have the stamina for that, or should I say desire (:  Kudos to you though!  Sorry to hear about your esophagus spasms.  You poor thing!  I know I need to follow up with a gastro. dr.  I had an appt. in August but I ended up in NV because my sister had her 1st baby early.  Take care and best wishes to you and your family!

[momto3girls]

Wow, that really does not sound like fun!  Actually it sounds pretty gross to be honest.  Geez, it didn't take long did it?  Yuck.  You poor thing!  

I have a pretty horrible gag reflex (I choke on a tongue depressor for crying out loud) so I can just imagine the good time I'd have doing this test (:  Thanks for the advice.  I sure don't want to have that done to me, thank you very much!  Have a great rest of the weekend and take care.

momto3girls (:

[momto3girls]

Hi Anacyde,

Thanks for your insight!  That is quite the visual image your dad described (:  I know what you mean about the fun ER visits.  I've made several and I really am getting phobic about ever going again.  I hate hospitals!

It's so hard when you have little children and your heart is doing strange things and you're having chest squeezing, isn't it?  My thoughts always run wild during an episode and my greatest fear is leaving my children motherless and my husband alone.  My girls are still so little and I want to enjoy them.  I'm sure you must understand, having kids of your own (:  Anyhow, thanks again for the great descriptions.  It made a nice mental picture for me and I can definitely say that I've never had the spike in my chest, parked truck feeling!  Poor guy!  Take care and enjoy your Sunday.  Best wishes.

momto3girls

[anacyde]

Al Dente - you were a great help, that website was awesome :)  I had no symptoms at all, so I doubt it meant anything.  I have two cardiologists now, lol  My regular doctor took on another doctor in his practice.  They both review all of the testing, and neither were concerned, which eased my mind.  During my vigorous workout (yes, I do stay very active) there was nothing except my PACs, which appear to be adrenaline induced.  So, in light of my family history, I just keep up with my strict risk management.

Momto3 - As Al Dente mentions, nitro can "fix" an esophageal spasm.  A few years ago I went to the ER with horrible chest pain. I thought for sure I was dying.  The GI drink did nothing, so they gave me a nitro.  It worked.  Of course, a series of fun tests ensued.  All the cardiac ones were normal, and we discovered I had esophageal spasms.  Good times.  My dad always says the difference between his esophagus and heart pain are that the heart pain felt like a metal spike went through him and a truck parked on his chest - while the esophagus pain sort of feels like someone's blowing up a steel balloon from the inside of his chest and it's pushing out on everything around it.  I don't know if that helps, but it sure offers some interesting visuals, eh?  ;)

[momto3girls]

Thanks Al.  

Ya, it is the million dollar question isn't it?  Too bad someone out there cannot definitively answer it, huh?  Oh well.  It's so hard not to be concerned about funky chest pain.  I've read stuff all over the internet explaining what it could be but it seems to fall in both categories for me.  I did have one of those 3d heart scan slice thing this summer and it was clean though.  I realize a cardiac cath. would be more definitive but I really don't want to cross that bridge.

I was given nitro spray back in May during a very scary ambulance ride from the gym to the ER.  It really didn't make much difference in the chest pain and gave me one killer of a migraine, which I'm lucky enough to have several times a month on my own (:

I guess what I want is reassurance on whether what I'm feeling is simply esophageal squeezing or angina.  To make matters even more confusing, I do have fibromyalgia and costachondritis.  As I said, mine 99% of the time happens when I'm sitting and it's a brief, gentle squeezing.  It's never a squeezing pain, just like a gentle gripping.  It can happen several times a day and then not come again for 2 weeks.  It's just so darn frustrating.  I'm sure you'd agree given everything you've gone through (:  Anyhow, thanks for your time.  Good luck as you continue plowing ahead!  Take care.

momto3girls

[anacyde]

Thank you.  I thought maybe you could point me in the right direction.  It appears that ST changes can be caused by any vast number of things, including simple artifact from electrode issues.  If they're not worried, I'm not either, and I certainly won't speculate when there are so many possibilities ;)

[momto3girls]

Hi So Confused,

Good question about the hdl.  Mine is also low and I'm always on the look-out for a new way to raise it.  I've read too that niacin helps which is recommend by my cardiologist but I've yet to go on it.  I'm trying diet and exercise as well.  My dad has pretty low hdl too so my doctor is thinking it's genetic.  About the chest pain/burning after exercise...I had this too this past May at the gym and ended up being rushed to the ER!  Not too fun but clearly merited.  Anyhow, they ran all their little tests and said it wasn't my heart.  They think most likely it was acid.  Did yours burn up to your throat?  

Hi Al,

I hope you've been doing well and are finding relief from your angina.  I too had a quick question for you, if you don't mind (:  When I get the chest squeezing, it happens right in the center, lasts like 10 seconds and almost always occurs while I'm seated.  I know that you suffer from both angina and esophageal issues.  Does what I'm describing sound cardiac?  Sometimes I'll get acid after the squeezing but not always.  Anyhow, take care and best wishes continuing on my end for your health!

Sincerely,
momto3girls

[anacyde]

I'm going to temporarily hijack this thread ;) You probably know the answer to this.  What is the difference between an ST elevation and depression, and what is the significance of a short episode (5 minutes) like 30 minutes after exercise has concluded when there was no ST change during very vigorous activity with sustained HR around the 170 range?

This happened to me and I have a terrible family history.  My doctor shrugged it off, aside from asking what I was doing when it happened, but I didn't like it.  I figure something of clinical significance would have happened during the workout I was doing (attempting to induce PSVT, and failing) but that all looked perfect.

Reading this sort of wigged me out a little!

[CCF-M.D.-MJM]

Hello,

I am sorry to hear about your confusing recent history.

(1) Could you explain what the 30 monitor said "Sinus rhythm, changes in QRS Norphology noted, SV ectopy noted, pairs, Rare PVC"

I would need to see the study, but the results sound pretty normal.  Just about anyone that has a 30 day monitor will have pvcs, pacs.  I would not worry about these test results.

(2) What can I do to get my HDL up or is it so low because the total cholestrol is low?

Things that raise HDL include exercise, alcohol, low fat diet, statin medications, fenofibrate medications, medical formulations of niacin.  I would probably try the diet, exercise, and one drink per night route.

(3) I am having some burning chest pain after walking 2-3 minutes. Could this be a blockage?

If you had clean coronary arteries on your cath, it is not do to a blockage.

(4) Can a cardiac cath be wrong ? Could there be blockages that the doctor didn't see?

Can be, but this is very unlikely.  It is possible that the cells that line your coronary arteries are not regulating the dilation of your coronaries as well as they should -- endothelial dysfunction.  This can cause chest pains or arterial spasms in the setting of normal appearing arteries on cath.  Elevated blood sugars and hypertension  go along with a diagnosis of endohelial dysfunction.


(5) I have had to travel from Florida (where we live) to Denver to settle my father's estate. . .while there my blood pressure ran 149/94, Pulse 98, sugars around 200. Normal here is 110/65, Pulse 74, and sugars in the 80-110 range. What causes the rise and is it dangerous for me to be up there ?

It is possible.  this should be followed over time and if it doesn't improve soon, medical therapy to control your blood pressure and blood sugar is indicated.

(6) Does Coreg cause the feeling of not being able to keep up with exercise? Like something is working against me, pulling back. . can't reach the heart max.?


It can make people feel tired or sluggish.


I hope this answers your questions.  Good luck and thanks for posting.

[Senia]

Yes, sometimes everything does not show on a cardiac cath.  I had a cath, which showed no blockages.  I then went to a cardiologist specializing in womens' heart problems.  She has diagnosed me with coronary artery spasms.  I am currently taking Norvasc 10mg, Inderal 20mg and nitro as needed for chest pain. I still get chest pain at times, but I have not had to go to the ER lately. I hope this is some help to you and good luck finding out what is causing your problem.  I know it took me quite a while with my situation.