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Forum Name: Valvular Heart Diseases

Question: Where is the stopping point for heart tests?


 BillyW - Sat Aug 25, 2007 10:10 am

Hello,

Im a 25 y/o white male that's in "okay" shape. Im about 5'11, big boned, 250 lbs., and I suffer from some kind of severe vertigo that seems to be positionally related.

I have lived a hectic life style in the past. I used to smoke a lot of marijuana, experimented with cocaine to the point of feeling like I was going to die, did mushrooms.....and other stuff.
Please do not shake your head at that, in reality, out of a lot of people I have been around, I wasn't that bad of a "party animal". When it came to drugs, other than marijuana, most people were usually doing more than me.

However, I have been away from that lifestyle for 3 years now.

I do not smoke, drink, or even eat unhealthy or consume cola's and junk food.

I have been having chest pains for a while now. I do know that its closely related to anxiety, which I struggle with, but I also have Hypertension. My Hypertension is something I usually can't control, because sometimes I can take it and it will be close to normal, and at other times it can be 150/105. I've even seen it at 145/112 before.
Yes, my monitor is working correctly.

However, when I go to the doctors, they say I have a normal resting blood pressure thats just "a little high".

I've had a few ECG's, 2 echo-cardiograhms 2 years apart, a treadmill stress test....
HOWEVER, I still have left sided chest pain that seems to be right in my breast bone. In comes on especially in periods of stress (as my BP is very high), or after I've eaten a large meal.
But its not limited to those circumstances.....I can have it first thing in the morning when I wake up, or hen Im laying down reading a book at night time.

The pain is usually felt on the left side, and doesn't feel like a burning, but more like a sharp, twisting, cutting pain. I sometimes feel pains like that in my arm, around my elbow, and in my shoulder. I don't really feel them in my neck, although my neck feels like is just "blocked up" sometimes, like my pulse or blood can't get through and is straining.

The doctors say Im fine......but my heart can give me some really weird responses. Usually after walking a long distance really fast, I feel tightness in my chest.
But I always compensate by breathing deep.

When I studied martial arts, I learned the effectiveness of breathing deep. So I always breathe ddep, but it doesn't seem to help. Sometimes it feels as if it makes my heart beat double, or skip.

The doctors say Im fine. They said on my first echo that I had "a little leak that everyone has". Okay, I was 200 lbs then, in great shape, I didn't worry too much about it.
THen when I went just a month ago, the nurse doing it said "looks like your arteries are thickening up some....you have trouble with HBP?" and I said "yeah".....but when the doctor looked at it, he, and another doctor said the numbers were just "slightly elevated".

My question is.......would it be beneficial and lifesaving to my health if I got a cath done? Because Im getting mixed up results from all these tests, yet Im still having chest pains.
Chest pains that seem to have NO origin....they just come and go when they want to.

And it seems as if a baby asprin usually eases my chest pains within a few minutes of taking it.


Something beneficial to note: Ive struggled with weight my whole life. When I was 17, I weighed 280 lbs. Ive also been very inactive my whole life....
I didn't play sports, I haven't always had a job, I dropped out of school.
And pressure situations like jobs and school seems to make my chest a lot tighter.

When I envision the pains Im having....it feels like behind my chest plate, somebody is cutting a line that leads into my arm. And I feel little stabbing points at places in my arm.

So in the end point, my question is what tests are sufficient for showing artery disease and heart problems?


Also, doesn't the heart have many electrical malfunctions that doctors cannot yet detect and figure out?

How safe statistically is the cath?
And can my head be elevated, because I suffer from vertigo when laying flat?
 John Kenyon, CNA - Thu Sep 06, 2007 10:41 pm

User avatar Hello - Lots going on here, but maybe not as much as at first it appears. Let's break it down.

First, the weight problem: you are well aware of it, and have been in "great shape" in the recent past, so what you really need to do now as a life-saving measure is to get back into "great shape" and stay there. That's a fact. I know you know this, but I'd be remiss to not hammer it home. It's Number One. You may not feel you "eat unhealthy", but if you eat enough to maintain your current mass, that's not healthy enough.

Second, while I certainly won't shake my head at your past drug use, I will at the reasoning used by you to minimize the importance of it. Using relativism to minimize something problematic is dishonest. If you traveled in really fast company that doesn't mean what you were doing was just fine. Ever hear of Len Bias? First time, last time. One never knows. Don't go back down that road.

Now then, regarding the current complaints: the blood pressure of any individual will vary quite a bit during the course of a day. Yours would be likely to be slightly elevated at least, due to your weight vs. height. It is probably your relative youth that has kept doctors from treating this. Keep checking it, to be sure, but don't obsess over it. Look for spikes or sustained, marked increases, and if you find either, bring this to the attention of your doctor. Losing the 50 lbs you've put on would undoubtedly bring down the BP markedly and reduce a lot of other risk factors.

The pain in your chest: While it is in an unfortunate location, and while it does seem to occur in more than one place along the classic nerve pathway, the description of the character of the pain suggests something other than cardiac disease, most likely either Tietz' Syndrome (costochondritis) or some other musculo-skeletal irritation. If it were reproducible through exercise in a consistent way (and especially during a stress test) then it might warrant an angiogram, but that is an invasive procedure which must have its risks weighed against its benefits. Right now I doubt many doctors would want to go this route unless there was a lot more corroborating evidence suggesting a heart problem. While the risks are small, they are very real. If you don't have any classic signs or symptoms (and it seems you don't) then it would be foolish to waste the resources and take on the (very small but very real) risks associated with a cath.

Your statement that you often feel the pain when lying down or when reading in bed strongly suggest some sort of orthopedic rather than cardiac origin. An antiinflammatory agent such as ibuprofin (Advil) could well relieve it or even make it go away. The fact that one baby aspirin seems to relieve it is strongly suggestive of a somatic disorder (a form of anxiety) since a single baby aspirin would not relieve heart-related pain and is only recommended for people as a preventive maintainance measure.

The deep breathing, without proper yogic training, can lead to irritated chest wall structures, and it can also cause one's heart to fire off the occasional premature beat. It's probably better to not rely too much on the practice, except insofar as it affords you some sense of relief. It may be causing your chest pain!

I hope this all doesn't come across as negative, as what I am going for here is a wake up call to you regarding selective attention to issues. I'll repeat: you do not sound as though you have heart disease, although you no doubt will if you continue to maintain your current BMI; your blood pressure is probably tolerable right now, but in time, for the same reason, could become chronically and significantly elevated. Those both can be altered dramatically by a determined weight loss and fitness program.

The jump from vague symptoms to wanting an angiogram is not unusual among anxious patients, especially those with cardiac concerns. Try and gear back your expectations as to what can be "found" and what you'd actually want to "find." There is an algorithm that should be followed, which would lead to an appropriate train of diagnostic procedures. You're not yet at the point where many doctors would even consider a heart cath.

The anxiety problem is a biggie and needs to be worked through, as it can adversely affect your health and most of all your quality of life. The same holds true, on a purely physical level, for your weight. Those two things, once under good control, may well cause all the other complaints and concerns to disappear.

My best to you. Please do stay in touch.

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