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Forum Name: Ischemic Heart Disease

Question: Frequent Heart Attack Symptoms


 donaldgmartin - Sun Jun 03, 2007 10:48 am

Age: 53
Sex: Male
Past Diagnoses: See below
Past Surgeries: None
Family History None
Current Medication: 25 mg Atenolol,10 mg Amlodipine “Norvask”, 10 mg Lipitor, .5 mg Clonazepam.

Over the last several years I have been admitted to the emergency room several times with heart attack symptoms. On these occasions diagnostic testing has ranged from blood tests for enzymes and x-rays to a cardiac cauterization. My PCP keeps on top of this problem and recently noticed that my EKG was showing a slow recovery. I was sent back to my cardiologist who I have a great deal of faith in and he performed an echocardiogram and Thallium stress test once again. At the beginning of the test the EKG monitor registered a V2 level warning however, as my heart rate climbed to 135 BPM “4.5 MPH 13 Degree Incline” the level normalized. My echocardiogram showed that my heart was very strong. These attacks continue off and on yet all I know is that the testing shows no damage to the heart or occlusion of the arteries. It seems that my cardiologist feels that I am in no danger and mentioned that the EKG can be misleading and that the echocardiogram and Thallium stress were the best source of information: Can you add any additional explanations for my condition. Blood Preasure is controlled " 134 / 76 today"
 John Kenyon, CNA - Mon Jun 11, 2007 1:20 am

User avatar Hello - The more intrusive/invasive tests you've had constitute the gold standard for diagnosis of cardiovascular disease, so between an angiogram (I believe you meant catheterization where you wrote "cauterization"?) and the thallium scan/stress test do exclude cornonary artery stenosis causing ischemia.

Further, it is very true that resting 12-lead EKGs, while exteremely useful, can also produce no-specific or even sometimes outright misleading information.

You haven't described the symptoms which have led you to show up at the ER with presumptive heart attack symptoms, and I would really like to know more about them. In the meantime I can offer one possible explanation for your problem, assuming the symptoms you describe actually are consistent with an incipient coronary event, and that is this: there is a third possibility which lies between panic attacks and occult heart disease: Printzmetal's angina, a form of coronary artery spasm. This is not always associated with coronary artery blockage and can occur in otherwise perfectly normal hearts. One coronary artery will, intermittently (and sometimes with great predictability, but not always) go into spasm. When this happens the classic symptoms of heart attack usually appear, along with the classic clinical signs such as ST elevation on the EKG. However, within 20 minutes the symptoms subside and the EKG abnormalities, if seen at all, tend to go away. The patient and doctors are left frustrated. This is only one possible explanation for what's been happening to you, and if the episodes you've endured have been associated wtih periods of unusual emotional stress this could be the answer. It is possible to diagnose this condition by provocative testing during an angiogram by introducting a drug into the suspect artery which will cause a susceptible artery to reproduce the spasm. If this test (ergonovine is usually the drug used to provoke spasm) then the condition is treated medically. But first we need to look more closely at the clinical picture of your episodes and see if we can find some even simpler explanation.

Please, if you care to, share some of the details of the events which have caused you to seek help at the ER. The more details you can provide the better.

I await further information.
 mrworried - Tue May 12, 2009 5:06 am

Hello, please help.
I am 30 and am having sharp pains in the heart. For about 5 hours a day I am getting mild palpitations that feel like that are coming from just under my heart.

The stabbing pains usually occur while Im sleeping, they wake me up with about 10 seconds of stabbing, then they vanish.

I went to the hospital and they put me on some machine for 5 minutes that monitored my heart beats (ECG or something). That report came up fine, nothing showing.

Please help if you can offer any feedback as to what this might be.
Thank you for your time.

Mr.Worried

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