Angina all the time now, should I go to ER????

[Daizy300]

Hi, am very worried, it seems that I have angina most of the time now.  Pain in the jaw, pinching under the breast bone, referred pain in the back, underneath the shoulder, whoozy, lightheaded, can't walk.  Would ANGINA show on EKGs?  and if there is angina, all the time, what does that mean?  what is the treatment?  There is a suspected heart attack about two weeks ago, and EKG showed possible ischemia, please hellllp.  Should I go to ER now?

[kenkeith]

QUOTE: All doctors I see say an EKG is not reliable, that machines vary, iinterpretations, etc ... and does not even show heart attacks sometimes, angina, but sometimes can show!!  

>>>>>That seems to be the medical communities' postion.

QUOTE: When you had the blockages, would the angina be consistent on exertion?  Would it happen each time you exerted yourself, or sometimes?  

It seems it is not consistent with degree of exertion. Other conditions may be a factor with exertion such as a heavy meal, weather, stressful event, concomitant medical problems that may be active/inactive, medication, etc.

I understand your frustration, but you seem to be getting a perspective with your reading,etc.  Take care.

[Daizy300]

Ken, what if there is no blockage, but transient ischemia attack,
and what if  it does not happen during the angiogram?  What then?  Will I be diagnosed with GERD too?  You see, it happens at rest, if I am tired, not enough sleep, etc...

All doctors I see say an EKG is not reliable, that machines vary, iinterpretations, etc ... and does not even show heart attacks sometimes, angina, but sometimes can show!!  

When you had the blockages, would the angina be consistent on exertion?  Would it happen each time you exerted yourself, or sometimes?  

What I mean to say here, having an angio is MAJOR, I have mitochondrial dysfunction, and, I can't even have dental work. Tthe contrast dye will cause adverse reactions, some of which can be life threatening, (for me).  Even a tiny minor surgery a few years ago, to implant a loop device (recording heart arrythmias) ended with me be totally weaken, bedridden for over a year along with other symptoms.

Hence, the reluctance.  I have to weigh the risks and benefits carefully.  An angio is also a snapshot of what is happening to the heart at that time, unless there are blockages?  I have to read in more detail the value of an angio if there are no blockages.

All I can say at this point, is that six years ago, a scan revealed three areas of calcifications on the circumflex of the heart.  Several echos  showed LVF, systolic and dyastolic dysfunction consistently till 2008.  Then despite the severe symptoms of heart failure, and echo was "normal."  A few days ago, an echo showed only diastolic dystolic dysfuction!!  I am told now, that different machines and different interpretations and bla bla bla.  Meanwhile, my BNP is slightly elevated at 400 ref range of 0-127 (in the UK, it used to be 0-100, but with financial restraints, most of reference ranges for many diagnosis have been altered).  Yet, swelling of feet and ankles, odema, breathlessness, lightheadness, and severe weakness and lack of stamina!!

I also read in scientific journals, that it is possible to have some type of heart failure, with a normal echo.  Its all very difficult and complex for some, not all.

I am at a loss here ...

Two weeks ago or so, I had all the symptoms of a heart attack, EKG showed possible ischemia etc... CK was high, troponin normal.  Yesterday, CK was normal, and troponin borderline normal, aghhhh

I wish it was simple :-(

[Flycaster305]

EKG's are today's medical professionals and indicator.  If it shows a ST increase of two mm or more, it get's their attention.  Angiograms are considered the gold standard for determining artery blockages.  During the procedure, they will be able to make pressure tests that will be very accurate and you can rule in or out a number of conditions.  I've had  eight of these procedures, they are minimally invasive.  In five of the eight procedures, I've had stents inserted that relieved my symptoms of angina and breathlessness, I've got eight stents as a result.  One of the procedures simply opened up my RCA artery, another confirmed I had nothing happening, and a GERD symptoms was diagnosed as the cause of my discomfort.  

If nothing is seen, then there are no blockages, and during the procedure other tests will indicate your overall heart health.  It's a win/win situation you have been offered.  I'd take it in a New York Minute.

Keep us posted.

[Daizy300]

Just came back from ER.  Troponin and CK were borderline normal. Doc said he has no idea what is causing it.  I am seeing a private cardio on Saturday, and will take my EKGs.  

But then, if it is not caused by a blockage, how on earth will they diagnose the cause of it?  Angio might or might not reveal the cause ...  Aghhhh

In anycase, EKGs don't always pick up angina, although, two weeks it did, well, it said possible ischemia.  Doctors often tell me that it is difficult to diagnose heart diseases, sometimes it is straightforward sometimes not.

Here where we have socialized medicine, they usually wait till you are near death's door before doing something.  

I have been like this for over two weeks now, and all the cardio said, is that I should have an angio.  This is not good enough.  It nothing is seen, what then???

They dismissed the abnormal EKG last weeks, just as when I had poor-R wave progression. I was feeling really ill then too .

Thanks for your input.

[kenkeith]

Yes, angina (pain related to lack of blood flow to the heart cells) can be picked up by an EKG if angina is related to occluded vessels. Angina can be caused by other medical issues not related ischemia such as anemia....a condition in which the body doesn't get enough oxygen due to insufficient red blood cells and that would not be seen on an EKG.

You should see a doctor as soon as possible to rule out any heart cell damage that may be reversed if treated on a timely basis.  If your chest pain is related to ischemia of coronary vessels, that pain is an indication the cells are not receiving enough oxygen and will begin to fail to adequately contract to pump blood.