Hello. I apologize in advance for the length of this post but perhaps it will provide the necessary information in helping me understand this.
To begin with, I come from a family with a STRONG and longstanding history of heart disease. My father had the first of his four heart attacks at the age of 36. The symptoms he experienced prior to the first attack were much like mine are (although I haven't had a heart attack yet).
When I was about 30, I started developing a pressure in my chest that came and went. At the time, I never paid much attention. Then I started developing an extreme shortness of breath. Then over time, the pressure in my chest and shortness of breath seemed to come on more with exertion although not all of the time. After being called "crazy" by a miriade of doctors, I finally got to see a cardiologist who didn't patronize me. By the end, I had an angiogram which indicated things were "fine".
That was 3 years ago and things have not gotten any better. In fact, they are worse. The angina (as I believe it to be), is unstable. I take nitroglycerin which does help for the most part. Finally I went to see another physician who didn't quite believe the angina theory but still went ahead and prescribed metoprolol (50mg daily). It worked wonders!! I never felt better except when I overexert (shovelling heavy snow etc.) and then I have to take a nitroglycerin as well.
The bottom line is that these doctors believe my chest pain/pressure, shortness of breath etc. is anxiety driven. I admit that I am a very anxious person but I am not convinced that this is all in my head.
I would appreciate any input anyone may have regarding this. Thank you in advance.
Since I have a strong family history and have had to live with heart disease at a young age (MI at 35, 4 years ago), I am interested to hear more about your symptoms.
Do you notice that the discomfort increases with movement and/or exercise. How is your general physical health with respect to bp, weight, diabetes, and what kind of diet are you following? Exercise?
There are some things we cannot control and many others that we can. I didn't have to live with angina very long--the MI came 1.5 mos after I first experienced the discomfort that I only later learned was angina.
As for the angiogram, I don't know what to tell you. I have shown back up at the hospital 3 days after my 2nd stent and thought for sure that I felt angina. (Bottom line-if you think it is angina, its best to keep pushing for additional intervention).
Thank you very much for responding to my post. In general, the discomfort does increase with excertion - but such varied forms of excertion such as climbing a short flight of stairs or walking across the yard. Other times, it doesn't really seem to bother too badly. However, I experience terrible bouts of syncope when the discomfort gets too bad. My blood pressure, contrary to my dad's for example, is quite low - usually running 100/60. With metoprolol, it hasn't gotten any lower but my heart rate is down to 72 bpm. I don't have diabetes although my dad does. I have low blood sugar. I had a follicular adenoma removed in the left lobe of my thyroid last January which was benign but was assured that my thyroid was functioning properly - thereby ruling out hyperthyroidism.
As for my diet, I have made some serious modifications since my cholestrol level is through the roof with the LDL's seriously outweighing the HDL's.
I am trying to live my life as healthy as possible now with diet, exercise etc. but the stress level is something that I do have a hard time controlling.
My dad's sister, who passed away at 59 a couple of years ago, experienced the same thing in her thirties and by the time she was in her early forties she had a nearly complete blockage. I cannot dismiss all of these things nor can I expect that I will drop dead any minute from a MI but I can't help but feel terrified.
The cardiologist suggested that I see a psychiatrist first then he would run a whole battery of tests again.
Once again, thank you for writing. I hope to hear back from you.
I read your post, I am alittle discouraged with Drs. that put patients on metropol, and hand out nitro, without a diagnosis of heart desease. But you need to follow up with another Cardio dr. and have them give you a stress test, if you not able to walk at a rapid pace for about 8 to ten minutes they have a test which is chemically induced to give them the same results, just alittle bit more expensive. I went to Dr. with Chest pain, back pain, at times so excrusiating that I wanted someone to just shoot me. They did not find anything wrong with me, told me I had an old back injury, and stress. Months later, I had my first MI, two stents installed, a month after that I had my second MI, and two more stents. I am not trying to scare you, but you do need to find out whether or not you have blockage, if you do that is quite fixable. I will tell you that stress plays a very important role in your health, and obviously your drs have told you this. You should take your blood pressure and record it at least three times a day for a week or two, and bring this with you to your visit. Remember the rule with your nitro, if you have pain, take one under your tongue, wait 4 to 5 mins, if the pain is still there, take your second nitro, if you are still having pain 4 - 5 min after the second one, take your third and call 911. Better to be safe than sorry. I am alot older than you, and my heart is not healthy, and my blockage is non operatable, I still think I will live a long life, because I do not let stress follow me around. I would suggest to you, you might ask your Dr. about putting you on zoloft, its a anti-depressant. it takes about three weeks to enter you system but it sure relieves stress. Since the Zoloft, I have had very few times I have had to use my nitro, in fact haven't had a nitro in two weeks, before the zoloft, I was taking nitro almost everyday, sometimes twice a day. I will say that since my MI's I look at everyday as a blessing from god, and everything is so much more important when I see it, I have time to smell the roses like never before. Keep the faith hope this has helped you.
treetop brought up many good points in his response. If you were given nitro, then there should be a diagnosis of angina. If so, then you can at least justify periodic checkups to check for blockage. Coming back to something treetop reminded me of--when I had my first stress test (Thallium, followed by Technicium) and administered adenosine--I could really tell that I could barely go 3 min without breathing heavy. I did not feel the angina, but the occluded arteries were definitely resulting in decreased exercise capacity.
Angiograms can usually catch most blockages, better so than a stress test with radionuclides. However, that doesn't mean that it is foolproof, and you should certainly still be wary of your symptoms. Again, treetop stated this but if you think you detect angina, start with th nitro and if it doesn't alleviate the pain, defintely head to the ER. I couldn't state it better than what he said: "Better safe than sorry." I have been to the ER 4 times. The first after an MI, the second 3 mos later when I needed a stent in a 2nd artery, and then two false alarms within the next 3 months. It takes a while for the anxiety to subside. Since then (2002), no more anxiety, no more angina, even when running 5-15K races at full speed.
Anyway, the reason I asked about the low blood glucose was because sometimes an individual can be hyperinsulemic, prior to the onset of type 2. Also, I developed diabetes in 2000 and believe that the hyperinsulemic and hyperglycemic condition greately hastened my path to an MI at age 35 in 2002. Since I reversed the weight, my lipoproteins have vastly improved and diabetic symptoms have vanished. Actually, though, the diabetes at least is far further benefited by my exercise compared to my weight...another topic for another time
I understand about the stress being rough. I don't have any solution there. I finally gave in and tried Paxil after trip #4 to the ER in 2002, but came back off after 3 days of taking it. The anxiety I felt on day 3 was excruciating to me. So, I discontinued it, visited my GP and thanked him for "teaching me what anxiety is really like." Since then, no more meds and no more anxiousness over my plight.
As for the psychiatrist, that seems a bit harsh to say to you. I am shaking my head on that one and wondereing how willing your cardiologist would be to sign a document proclaiming that you are clear of heart disease and stake his/her reputation on it. One course is to find another cardiologist because the outcome here was not satisfactory in solving valid concerns about your health.
I just walked in the house and got a message from Saskatchewan Mental Health to give them a call back because my cardiologist had sent over a referral to see one of the psychiatrists there. I guess I should be seen in a month.
Like my GP had stated before, it was amazing that nitro was prescribed without a definitive diagnosis of angina but that is what he did.
My dad sees a different cardiologist in the same city so I'm going to try and get a referral to see him for a second opinion. I'm sure that it can't hurt. My dad even has a hard time wrapping his head around this one. If you are prescribed nitro and metoprolol, there must be a reason...a cardiac reason. Surely to God, they don't prescribe those types of medications for a case of the nerves.
Here's some new data for the females -- results of a lengthy study of about 1,000 women came out just the other day. It's called the Women's Ischemia Syndrome Evaluation (WISE) study and involves women with chest pains and other cardiovascular symptoms but who have shown no evidence of a blockage during angiogram.
Apparently this is more common that experts thought, and the tests to determine this "coronary microvascular syndrome" are "nuclear SPECT" and, even better, the so-called "provocative coronary testing, a stress test in which an adenosine injection mimics the effects of exercising on a treadmill.
From what I have read for years, treadmill testing in women frequently is a failure as women can't complete the test but are often quite healthy. Treadmill is more effective in diagnosing men with heart disease but not in women.
If coronary microvascular syndrome is detected by one of these other tests, not angiogram, which is not the gold standard in women as previously thought but is still the case with men, treatment is usually beta blockers and ACE inhibitors to lower blood pressure and statins to lower cholesterol, and the dietary supplement L-arginine which is a modest vessel dilator found in some foods like nuts, fish, etc..
Recognition of the syndrome is very recent so there has not been time to do trials of the treatments and experts say they need more data..
You can read more about this by Googling "Women's Ischemia Syndrome Evaluation" and clicking on lots of the sites. They all essentially report the same thing and it's all new within the past couple of days.
I myself have high total cholesterol but very high HDL, which is good, and have had a few pains here and there and do have a benign arrythmia with PVCs, but the cardiologist says I'm fine. Well, I had the EBCT test to check for calcium in heart arteries to be sure I didn't need statins, and the doc at the heart center said there was no way I needed a statin because of my ZERO calcium score on the EBCT which is as good as it can get.
I did fail a standard stress echo a couple of years ago because I was so out of breath I thought I'd die. They said then that I was fine, just really out of shape and should lose a little weight. I KNOW I'd fail that test again if I took it today, however, and can't help wondering if it's the "out of shape" aspect or hidden heart disease.
Evidently as women we have very different reactions to some of these tests and I guess we must all go and demand every test available since now we know even the "gold standard" angiogram isn't perfect in diagnosing women. Hmphhh -- this is SO maddening!
Good luck to all -- and let's stop letting ourselves get pushed into believing we all just need tranquilizers for anxiety -- there is probably more female heart disease and less anxiety than these docs think.
It really seems you have angina since it responds so well to nitroglycerine and beta-blockade, the commonest drug treatment protocols for angina. Now the problem is getting it diagnosed.
Cheer Up, I believe, is onto some cutting edge threory about microcirculation...we will hear MUCH more about it as more is learned. My first exposure to it was viewing my own angiogram where I saw a spiderweb of gossamery vessels to the point of a graying blur which showed my blood circulation around a complete RCA blockage with every heartbeat and pulse of dye...I'm talking perhaps THOUSANDS of teeny vessels.
Second thinking about it came from Dean Ornish's book on curing heart disease through a VERY VERY low fat diet. He says there is evidence that huge fat infusions that may LOOK like they are doing no damage to the heart's vessels are actually clogging this microcirculation dangerously. If we think about how the cardiac cells are fed, it isn't directly through the relatively large blood vessels that we see on an agiogram but rather by the microscopic arterioles that thread everywhere throughout the heart...probably miles of them some barely a few cells thick. And these are generally ignored because they haven't the technology to either see them properly of "cure what ails them."
I think some form of nuclear stress testing is necessary to determine if you are getting nourishment to your entire heart...even though the microcirculation might again be missed.
The other REAL possibility is that one or more of your heart's major vessels is spasming shut but it didn't spasm during the semi sedated angiogram. Not unlikely. ANother angiogram BY ANOTHER CARDIOLOGIST at a different facility might be wise.
How FRUSTRATED you must feel at the mere mention of the word "psychiatrist"