I am a female, 57 years old, 250 lbs. 2 years ago I had taken my first dose of Effexor and withing 5 hours had severe burning in my chest through to my shoulder blades. B/P was 210/100. 2nd Troponin showed 0.05. EKG and Angiogram came back normal. TSH came back elevated. Recently I went to the Emergency room. My blood pressure was 245/142. BNP 337, TSH 6.67, T4 LOW, 1st Troponin 0.05, 2nd 0.09. 1 week later I had a Nuclear Stress test, Could you explain this to me?
The ECG showed 1 mm ST depression in the inferior and lateral leads with rare
PVCs. The raw nuclear images showed liver dome elevation aligned with the
distal half of the inferior wall and the entire apex. The processed images
showed some apical thinning and distal anterior apical attenuation but no
diagnostic defects. The processed images reported a sum stress core of 7
supine which dropped to 0 prone SUM rest score of 17 and a sum difference
score of 0. There were no wall motion or wall thickening abnormalities with
left ventricular ejection 77% and TID of 0.92.
1. Negative treadmill exercise MIBI cardiac perfusion study by imaging but
with borderline ST changes and chest heaviness and poor exertion tolerance
limited by hypertensive reaction with an intermediate score suggesting 1 to 3%
risk of major adverse cardiovascular event in the coming year.
2. There were no wall motion or wall thickening abnormalities, left
ventricular ejection fraction 77%.
3. Normal dilatation index does not add support to the possibility of global
And what is this LIVER DOME thing?
The two hospitalists I saw and the Cardiologist at the hospital all took down different histories from me (I told them all the same thing) and all gave different suggestions of how to handle this. All of them insisted it was not a Heart attack but was a Troponin Elevation, UGH! One believed I skipped Blood pressure meds, I did NOT. One believed I had an esophageal Spasm? Really?
I do have a PCP and am having a follow up TSH done that will be 6 weeks from having started Synthroid again.