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Symptoms over past two weeks started with two episodes of mod CP, sweating

56 year old women who was active, and physically strong has decreasing activity over past year due to exhaustion. PMH HTN (controlled), mild asthma, restless legs,and new migraines (onset with menopause (hemiplegic/ocular). Propranolol helped migraines, could not tolerate because of asthma. Meds: Norvasc 10mg, asa 81mg,levothyrozine, occasional HCTZ 12.5mg. Several years ago could hike up to 6 miles in the desert AZ and in Mountains MT. Sx: nausea, CP (squeezing) radiate to neck and left arm (off and on), heartburn regardless of intake, severe weakness (usually can lift 60 pound bag dogfood, unable to lift 20 pounds without resting, severe sweating. EKG at times showed t wave inversion, "LAD--widow maker" mentioned by one ED doc. Some QTc prolongation, brief 480-500. Near syncopal event with CP walking up an incline 400 feet. Rest did not help. NTG helps after a couple tabs, then MS resolved for a couple of hours. In hospital: EKG showed some ST chang, briefly, then normal, neg trops (serial), negative lexiscan, negative echo (per MD). SInce home from hospital woke up two times 2am, 330 am nausea, heartburn , left CP squeezing, sweating, not wanitng ot go to ED as was told must be depressed or something, not cardiac. Have been active, athletic, weight lilfter/runner, etc--extremely frustrated and afraid. Was told CT angio is 100% accurate. Asked about Thyroid, was told medically impossible to be thyroid if TSH is normal (.79)
1 Responses
Avatar universal
Firstly, your using a lot of medical abbreviations, I'm assuming RN?

2nd, thyroid would probably more diffuse issues.

3rd cta angiogram is about 80 sensitive and cag is like 90.

Have you had perfusion testing?

Have you have stress echocardiogram?

Have you have a lhc and rhc simulataniously?

Can you go over your meds again?





5 Comments
Yes, I am a RN. I am trying to pull all this together as I am being told it is depression or anxiety. I am not depressed and this is causing anxiety.

Thanks for your response!

Agree if it were thyroid I would probably have other symptoms

One of the things that really scared me is the comment from the ED doc he is admitting me because of changes in the anterior leads. I did not see any of my hospital EKGs, and am not an expert by any means, just the basics, but the "widow maker" is an anterior MI.

I do have a copy of the EKG from my PCPs office with flipped t waves in V2, V3, V4. Brady 52,
PR 177,
QRS 96
QT/ QTc 471/451
P-R-T axes 11  15  28

Thanks for the percentages on CTA and CAG

Regular echo, not stress

I have not had a heart cath. Both the hospitalist and my PCP told me it is unnecessary.

I am going to pick up my records tomorrow from the hospital, ECHO, Stress Test, EKG, the things I can not see on my online chart.

I was told to get back to exercising, no need to slow down even if I get some chest pain--this scares me.

I did ride my bike today 12 miles  (easy ride) with husband, no chest pain, felt OK, but have had some chest pain for about 3 minutes about an hour after the ride.

Chest pain is MCL to slightly left of MCL, starts somewhat piercing, then squeezing sensation, has stayed in the chest at times. Other times goes up to left neck, feel full in the ear on the left side, and to the top, left shoulder. Other sx: sweating, lightheaded, nausea, heartburn, and of course, concern and fear.

I have also been told it is menopause, so was given sertraline script.

Meds:

ASA 81 mg daily (have factor V Leiden--heterozygous)
Norvasc 10 mg daily (was 5mg, had been on propranolol for migraines, stopped 5/20) and Norvasc increased to 10 mg.
BP controlled.
Levothyroxine .075 daily
Requip 3 mg daily, restless legs
HCTZ 12.5 several times a week prn
Allegra 180 mg prn
New atorvastatin, 40 mg Chol 218. My only abnormal lab. Normal: CBC, CMP, TSH.  Trop topped at .019

I see a cardiologist on Friday June 1.  

Thanks
Fellow nurse :)...

I've been sick for over 3 years.  Started when I was 25 am 29 now.

Learned a lot more being sick than a nurse lol.

Firstly, you'd be shocked at what can get misdiagnosed.

All my issues started with 3 bilateral pe's missed via 2 ctas.  Finally, 3rd scan did the charm, by the time they saw them they were huge.

The pressure in the pv, caused a small pfo that I had blow open into am 8 mm asd.

The asd was only found thanks to me and my husband rereading echos ( as you know we are not trained to do that lol).

Than the asd got closed my ra and rv enlarge.  Normal pa pressures.  So there is another L to R shunt.  And can't breath.  Chest hurts all day.  And I just turned 29.

In medicine they focus so much on the most common conditions.  So, maybe you don't have significant blockage ( which again it's very possible tests were misread or poor age quality, my original pe's).  But you could have so many reasons for your issues...

Coronary artery fistula causing steal
Torturous coronary artery
Misdiagnosed asd
Lv hypertrophy or dilation from high bp( ala after load)

Rv enlargemert, pah, pvh

Etc etc etc.

Imo you have not had nearly a fully thorough workup!

I believe you need to seek treatment elsewhere asap!

What coast are you on?

And feel free to pm me.
I agree. I am seeing a new cardiologist tomorrow.  So far I keep being told I have depression and anxiety!  They seem to completely miss that I was really strong just a year ago.  In fact 9 months ago my husband and I packed up, moved and emptied a 26 foot u haul in 100 degree weather without an issue. We hauled all the furniture etc. We are a young 56. Now I suddenly feel 80!  Something is wrong.  I use to get energy from working out, now I get so so exhausted I have to rest several hours. I hope to have some answers or at least a plan by tomorrow. My doctor told me to ignore the chest pain and work through it, since it is obviously not cardiac related. At this point in time, I do nothing strenuous without people around me as I worry I will have an acute episode or worse a full blown MI/cardiac arrest.
Thanks for writing. I am so sorry you have gone through all of this, keep in touch.
Will do, you as well.  I also have great teams I've found over the years... So if this new one is no good please let me know.  I have good recommendations.

Keep on going.  If you feel there is something wrong there is!  

Cath today. Leaving for hospital in half hour. Nervous, but glad, since I have CP daily. Thanks for your comments!
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