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Old 10-31-2004, 02:09 PM   #1
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Mickeycaregiver HB User
Unhappy Angina or something else?

My Mother has just had a pacemaker put into her heart. She went into the hospital with chest pain that she described as a burning sensation that covered the chest area and up into the neck which was much more than just an uncomfortable feeling. after admitting her and hooking her up to a monitor it was discovered that she had some significant heart interruption. Her heart would stop for long periods of time. She was transferred to a heart hospital where she had the pacemaker put into her heart. I was under the mistaken impression that the burning in the chest would cease. It has not. When I mentioned this to the Cardiologist, he said no, it would do nothing for that symptom, which he said was angina. I might add that this conversation took place as the Doctor was on his way out and we were actually on the sidewalk detaining him. My point is, he was in a hurry and made the statement on the run. At present I am giving Mom pain medication which does seem to relieve the symptoms somewhat. I am looking for someone who has had personnel experience with a burning sensation in the upper chest going up the neck. Nitro did not relieve this symptom, even after three tablets under the tongue. (given by the nurses in the hospital) Mother had an Aortic Valve Replacement in 1999. She has experienced the symptoms in varying degrees since that time and has in the last six months gotten more frequent and more intense. I am anxious that we are missing something.

 
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Old 11-01-2004, 09:09 AM   #2
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Re: Angina or something else?

I feel like your Mother's doctors are missing something! I don't know your Mom's age, but if she is older, then you must be more persistent with her doctors. My experience with elderly people and medical treatment is a sad one. I think doctors want to give up too fast on the elderly. It sounds crazy, I know, but I have witnessed it 2 times.

Look at your Mother's history! Aortic valve replacement in 1999. How much damage did the deffective aortic valve do to her heart, before it was replaced? This may have damaged the electrical pathways in her heart, that caused the need for a pacemaker (do a search on all the affects of a malfunctioning aortic valve). Records, records, records my friend. Get a cardiologist to take a look at the big picture of ALL your Mother's past treatments/records.

I cannot believe that the nurses gave her 3 doses of nitro, which didn't relieve the angina, and nothing more was done to check for coronary artery blockages. It may well be that the doctors do not believe she is healthy enough to have a cardiac catheterization at this time, but if so, they should have told you this.

I would be willing to bet that she has had at least 1 cardiac catheterization, which is still on record somewhere, that would give the docs an idea of any coronary artery blockages. Coronary artery blockages cause angina, and the description of your Mother's pain, sounds exactly like angina.

If your Mother is experiencing true angina, it is because the muscles of her heart are not receiving enough blood due to blockages (this can lead to a heart attack). It could also be due to coronary artery spasms (but not likely, due to the statistics). Does this pain occur while she is at rest, or while she is exerting herself? Does she have other symptoms, such as shortness of breath, or nausea when the angina occurs?

So sorry about the lack of time the doc had for you, but this is not uncommon, as you probably know. Best of good health to your Mom.

 
Old 11-01-2004, 10:01 PM   #3
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Smile Re: Angina or something else?

Thank you for your reply. Yes, you are right on, Mother is 87 and I too am worried that no one is all that committed to "fixing" her heart problems. Mother's surgeon did take a look at the condition of her arteries before the valve replacement and told us that her arteries were in great shape, no blockages, "clean as a whistle" were his exact words. However, Mother, who was a dedicated fast walker, (three miles every day), never recovered enough to do her daily walking exercise after the surgery. She began to complain of a burning sensation in her chest and radiating into the neck. It was maybe once or twice a week and most often when she was sleeping. then she began to have the symptoms during the day also. She has not had nausea with the pain and she has it when she bends over with some shortness of breath but she also has it "come-on" for no apparent reason, such as while she is sitting watching TV. She also began to have thick white, cottony phlem come up in her throat. Sometimes several times a day but mostly at night. She also began to have serious pain in her right leg from the hip to the knee anytime she was up walking, even just inside the house. To make a long story short she started experiencing the chest pain more and more frequently and more intense until it was almost constant which took us to the hospital.

I found this website out of desperation to try and find answers to symptoms that I believe are being disregarded. I am concerned that she may have an infection that has been slowly working on the sac around her heart for the last 3 plus years. I may be way off base, but while she was in the hospital taking IV antibiotics she did not have the burning, but it returned within 12 hours of arriving home.

I have given her pain meds (Hydroco/APAP 5-500) for the burning with some success but not much. Just today I gave her 400mg of Ibupropen and it seemed to give her more relief. However, reading over her pamplet on the drug Coumadin (given after the pacemaker surgery) it lists Ibupropen as one of almost every other pain reliever that you should not take while taking Coumadin. I think that the burning indicates inflammation, but I'm not a doctor. Does Angina present itself as a burning pain or a crushing or both or what??? My Mother is not wimpy, when she says it's bad, you can bet it is serious.

Sorry to go on and on, but it feels really good to just be telling this to someone who is listening. Your comments are greatly appreciated.

thanks for responding.

 
Old 11-02-2004, 03:13 AM   #4
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Re: Angina or something else?

Mickey,

The "burning" sensation is classic angina pain. I never had any of the "crushing pressure" that is often mentioned but rather 10 years of BURN on FAST exertion (heavy was never a problem- I'm very strong.)
My burn would exten up to the jaw and when really bad radiate into both upper arms.

Whether or not she has a classic "plaque blocking an artery" kind of angina, or whether she has some problem with that valve is something for the cardiologists to decide. Whatever the cause, the burning is ischemic angina from poor bllood flow to a portion of her heart.

She needs another angiogram if anything further is to be done, but I'm sure they don't want to get too invasive at her age.. Drugs that might help a lot are the beta blocker and the calcium-channel blocker families. Giving NSAID analgesics for this kind of pains is BAD medicine all 'round.

I too am surprised that the nitro didn't help your mom, but they didn't help my mother much with the same symptoms either. I personally have never tried nitro except for sex kicks years ago, so I don't know first hand how well it works for angina (except that it caused banging headaches.)

Last edited by zip2play; 11-02-2004 at 03:14 AM.

 
Old 11-02-2004, 05:06 AM   #5
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Jack51 HB User
Re: Angina or something else?

Quote:
She has not had nausea with the pain and she has it when she bends over with some shortness of breath but she also has it "come-on" for no apparent reason, such as while she is sitting watching TV. She also began to have thick white, cottony phlem come up in her throat. Sometimes several times a day but mostly at night.
A "frothy" phlem is a symptom of pulmonary edema, or fluid on the lungs. So is the shortness of breath. These are telltale symptoms for sure. This could occur due to failure of the right side of her heart, which circulates blood through the lungs. Does she appear to have fluid retention in any of her extremities? Has she limited her sodium intake, and is she on any type of diuretic? Has her potassium been checked?

 
Old 11-03-2004, 09:55 PM   #6
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Re: Angina or something else?

Mom has no noticeable fluid retention, meaning no swollen ankles, etc. She has long limited sodium in her diet. I don't know if her potassium has been checked recently.

I had to take her in to see her GP yesterday. The symptoms are becoming more frequent. He was at a loss. He said he did not know what was causing the burning in her chest. He asked her if the pain seem to be superficial or deep in her chest. She said it seemed to come from the surface, skin deep. He said he did not believe it was from the heart valve. I asked about the possibility of an infection and he doesn't think so. You can imagine the anxiety this is causing Mom. Her nerves are shot. Her Doctor gave her lorezapam (reluctantly due to risk of falling) to try, one at bedtime to see if it would help her to get some much needed rest. It worked, at least it worked last night, and she felt better today until about 2 PM. Then it all started again. It lasted about two hours and then slacked off. After dinner she has some slight nausea, didn't throw up but felt sick, she did that last night also.

 
Old 11-05-2004, 07:46 PM   #7
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Re: Angina or something else?

The Cardiologist's assistant explained to me that Mom's upper chamber of her heart filled with blood, then a healthy heart would squeeze the blood out into the lower chamber, only Mom's heart just kinda fluttered and that the Coumadin would thin her blood and make it easier for her heart to push the blood into the lower chamber. At least that is how I remember the conversation. Why don't doctors write this stuff down so they can give the patient the information to look over and digest in the comfort of their own home? How many people can remember accurately what is said to them in a hospital with the interruptions and chaos that is around? Maybe that is just an excuse of mine, instead of admitting that I am getting older and can't keep things as straight as I'd like....

Mom was suffering from Tackycardia and Bradycardia. She was on Toprol to prevent her bloodpressure from going too high, but since she was suffering from both Tacky and Brady the treatment for the high pressure was making it go too low and cause her heart to stop, especially during the night. Thus the necessity for the pacemaker.

She left the hospital with Amiodarone 200MG three times a day to help with the heart rythmn for two weeks then reducing to once daily, Metoprolol 50MG replacing the Toprol to keep her bloodpressure stable, Coumadin 4MG to thin her blood. Her GP had to make some adjustments yesterday when I took her in because of the intensity of the burning pain in her chest. Her blood was too thin and he reduced the Amiodarone to once a day. He also gave me his blessing to give Mom one Lorezapam o.5MG at bedtime and if she experiences the pain during the day I can give her 1/2 tablet at that time.

Mom's GP told me he did not know what the burning is from but does not think she has Angina. We go back in a week if not before.

 
Old 11-06-2004, 11:18 AM   #8
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zip2play HB User
Re: Angina or something else?

Mickey...

First off, a GP should NOT be involved with your mother any more....this is out of his league!

"Suffering from tachycardia and bradycardia" strikes me as bizarre.

For sure, she is taking too many drugs.

She needs a full workup with an expert cardiologist...piling drug upon drug is NOT the way to handle this!

(Lorazepam is a horror for the elderly...it made my mother almost suicidal!) Try diazapam!

 
Old 11-06-2004, 07:23 PM   #9
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Mickeycaregiver HB User
Re: Angina or something else?

Zip, I know she should be seeing her Cardiologist, but he is 2 hours away. He is the one who put her on all the drugs (except for the Lorezapam) and when I called his office to set up a follow-up visit after the surgery his office called me back and said he did not need to see her for three months, just told me to be sure and have her protem checked weekly to adjust the coumadin as needed.

I noticed that about 30 minutes after Mom eats she starts to burp, maybe 3 or 4 times, then the pain begins. I gave her Tums today and either the Tums gave her some relief or it just happened that the pain started going away. I
read some info that Jack51 gave someone about it taking a lot of blood to digest food and a weak heart that can't pump sufficient blood can cause these symptoms. At least I think it was Jack,,,,forgive me Jack if I'm misquoting you.

So tonight I gave her soup and crackers (easier to digest) followed by a little vanilla ice cream just before bed. 30 minutes before her meal I gave her two tablespoons of Mylanta. So far no pain.

After the week we have had I am sure I need to find a Cardiologist who has time to treat patients who need them.

 
Old 11-08-2004, 03:41 PM   #10
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Re: Angina or something else?

Mickey:

Just a suggestion.

It sounds to me as if pericarditis (inflammation of the sac surrounding the heart) is a strong possibility that should be checked out. As the Cleveland Clinic Heart Advisor puts it (of pericarditis), "Its signature symptom is pain radiating to the back of the shoulder or neck".

With valve replacement or any open heart surgery, viral or bacterial infection of the pericardium is a possibility. There are other causes for pericarditis, including idiopathic (of undeterminable origin). And it takes about four weeks after surgery to develop.

I hope you find the source of the pain. It doesn't sound like angina to me, but I'm certainly no doctor.

Regards,
Bill

 
Old 11-09-2004, 10:44 AM   #11
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Mickeycaregiver HB User
Re: Angina or something else?

Thanks for your response Bill. I continue to look for any clues that might help Mom. She is becoming more depressed about her condition and pain can do that to you pretty quickly.

I have called her Cardiologist (the one who did the pacemaker surgery & treated her in 2000 when she had the Aortic Valve put in) he is 2 hrs. away and his office transfers all calls to a voice mail to leave messages. Neither he or his office have called back. He comes to our town once a week and I am trying to get an appointment for her to see him, but can't get his office to call me back.

In the last two days I have given her Tums &/or Mylanta when the burning pain begins and she has seemed to get some relief from that....it remains a mystery though, she has this pain many times right after arising in the morning, and frequently after she eats which points toward acid indigestion, but seems too severe for that.

She also seems to be growing weaker, she says her legs just feel so weak, like they can't hold her. It is so fustrating for me not to be able to help her and not knowing for sure what her symptoms mean. I know she needs to see a Cardiologist but at present her GP is the only one I can get her in to see. He is doing his best, although he says he don't know what is causing the pain.

This is such a hateful situation.

 
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