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Heart or esophagus spasm?

Male, 57, smoker, daily red wine, overweight. Normal BP, no diabetes. Had ablations 2 years ago to fix PVCs (all good). Had Angio 3 years ago to explore, DR said he could drive a truck thru my veins. Have a bit of GERD lately but nothing thats not manageable.         Had an episode sunday night that landed me in ER. Had EXTREME squeezing in center of chest, radiating outward in all directions, shortness of breath, cold sweat, nauseous. Paramedics applied Nitro, it helped right away. EKG looked normal, x-ray normal, CT w/Iodine normal except for  calcified plaque in left anterior descending artery...no dimensions or percentages provided (I assume if it was bad enough they would have given numbers and given me a stent). Enzyme test negative. Conclusion: Could be Esophagus spasm, but follow up with cardiologist. Please offer an opinion before I see my cardio DR.
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Avatar universal
OK went to have my stress echo. Passed with flying colors. Started with BP 104/70  went to 178/84. BPM 150 - yikes that was tough. My legs couldn't keep up and it was tough breathing but I did very well. The doc signed off on my heart - she feels it is perfect. Ejection 64%. So looks like my issue was indeed an esophagus spasm. The protonix seems to have made a big impact I feel great, but I may need to switch to something different since I get massive headaches from it. If anything changes I'll post here. For now, looks like I'll live a little longer. Thanks all for listening and commenting.
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976897 tn?1379167602
That's good, it really is an important test. They are meant to repeat it after 12 hours because until that amount of time has past, the results are generally negative. If it repeats as negative, then great but it is certainly best to know. It's good that they are attacking the possibilities from both sides, that is professional. I think it would be wise to add an extra pillow to reduce acid flow into the esophagus. This really helps if it is the problem. Thank you for keeping us informed and I hope you continue to do so.
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Avatar universal
OK so went to my cardiologist. I asked point blank - since she did my angio 3 years ago, is it possible I could develop a clog so soon?...she really doubts it based on my low cholesterol levels and other factors. She feels my episode is most likely an esophagus spasm, but to be sure I'm taking a stress/echo on Wednesday. As far as the calcified plaque on the CT, it doesn't prove that the plaque is on the inside...so inconclusive. She also put me on protonix (sp?) to get a head start on the acid reflux issue if that ends up being the root cause. Also ordered a bunch of blood work. So will keep you posted. I didn't know the enzyme test could linger for 2 weeks, so I'll call to add that to the tests she ordered. Thanks for the tip.
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976897 tn?1379167602
You could still have a repeat blood test now, because Troponin remains elevated for up to 2 weeks. Please keep us informed with your progress and what they establish. It's good that you are asking questions but not so good you are scared. Saying that I know it is scary as I have had more than one heart attack. It's just that obviously the more anxious you get, the more your heart will be affected if this is the issue.
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Avatar universal
The blood test was only at the 4 hour mark unfortunately. So far it hasn't returned full blown but I do have issues, most may be in my head cause now I'm scared of my own shadow. Seems when I smoke I feel aching in my shoulder and neck - I know ....DON'T SMOKE. I cut down, only had 5 yesterday. Eating very healthy, no wine, no caffeine. I feel anxious as all hell but I think considering, that is to be expected. I'm sooooo tired.
By the way I got the CD of the Catscan, made a copy for myself. After viewing it I cannot understand how they can see anything regarding plaque buildup. Now I see why there were no numbers associated with the reading. So yes, I agree with you that it is inconclusive and requires more testing.
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976897 tn?1379167602
I apologise, just notice your blood test was negative. I assume they repeated the test after another 12 hours? because it can take that long to get into the blood stream. I am interested though in whether you have felt anything since then.
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976897 tn?1379167602
If there is no evidence of blood flow restriction, then it is likely to be ok. All the cardiologists I've had (7 now) have all said how they don't like using CT scans. Firstly the radiation level is much higher than an angiogram and secondly they nearly all result in an angiogram to do further investigation. Since the GTN, has the pain ever returned? Did you have a troponin blood test and what was the result?  
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Avatar universal
Agreed it is tricky. OK this will sound bad, but it is what it is. I was listening to some music while having a 2nd glass of wine and of course...smoking. When the paramedics came and gave me nitro, end to end it was maybe 20 minutes. I had not eaten for a few hours - but had spicy seafood friday night, chinese saturday, leftovers of those on sunday. This being very different, I eat mostly organic and very healthy.      So what you are saying is the CT with iodine doesn't provide "how much is it restricted?" The doc in ER led me to believe it does if it is significant, since it was not specified its probably small. True/not true?
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976897 tn?1379167602
This is a tricky one because the symptoms are so very similar. When the Esophagus inflames, it can rub on the Vagus nerve causing all kinds of symptoms. The Vagus nerve affects nearly all the organs in your body, including the heart and can make you feel nauseous as well as give high levels of pain. A CT scan isn't great, it gives a general idea, but the best test by far is an angiogram. You need to know how badly the Left Anterior Descending is restricted. The negative enzyme test can be a good sign though but not necessarily conclusive. It just really means it wasn't a heart attack but the blood flow may have been sufficient to give pains (Angina). You don't mention how long the pains lasted before you took GTN. Also, do the pains coincide with eating? do they occur like 10 mins after consuming food?
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