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Forum Name: Ischemic Heart Disease

Question: Cardiac Ischemia - Should I go to an Emergency Room?


 Healthy1 - Sun Jan 06, 2008 2:45 pm

Age 40, Non-Smoker/Non-Drinker, Non Exercising, Slightly Overweight (5'11" - 195 lbs) - Family history of heart problems and high blood pressure.

Had a shoulder injury(or so I thought) at work. Did not report it because of how negatively work looks at - on the job injuries. Pain was a dull aching pain, varying in location from my left chest to left arm and left inner back. Injury happened approx.7 weeks ago. I nursed the injury thru to the Holidays, using my left arm as little as possible. (Very stressful, very physical factory type work) Went to a (GP) General Practioner Dr. 4 weeks later when I had time off due to the Holidays.

Upon my suggestion, the Dr. sent me for a Exercise Stress Test(no injection - just ECG and Exercise) and blood work. The specialist reading the test let my GP know that the test showed Cardiac Ischemia. The blood work showed high cholesterol:

Cholesterol 221 mg/DL
Triglycerides 193 mg/DL
HDL Cholesterol 40 mg/DL
LDL Cholesterol 142 mg/DL

The GP doesn't think that I had a heart attack, he said that he still thinks that it seems to be a shoulder problem, even though we can't find any area of direct pain. However, he did put me on Cartia XT 120 mg (Cardizem) to lower my blood pressure and gave me Nitroglycerin to take if the pain gets worse. He also said to take a baby aspirin (81mg) every day. He said that my blood pressure was high.

Under the medication(Cardizem and aspirin) my blood pressure is:
149/95 with a heart rate of 59.

I tried to get my GP to do additional tests (possible xray or some sort of injection stress test), he did not send me for these because he still thinks it's possibly shoulder and the fact that he has set me up to see a Cardiologist about 4 weeks from my first appt. with him. I moved up this appt the most I could, it is still two weeks away.

My main question is:
Am I possibly doing more damage to my heart every day, by not being on true heart medication if I suffered a heart attack? (the dull/aching pain has been the same since the day it started occasionally it does increase but then returns to the same aching state.)

Should I go to the Emergency Room instantly?

The blood work shows about 20 different values that were measured. Besides the high cholesterol shown above, a few other values showed high.

SGPT/ALT 84
BILI, Total 1.6

My GP said don't worry about these values, so I'm not as concerned with these values. Although I did read something on the internet where high figures for these can indicate liver disease or cancer. So secondly,

How important are these values?

Thank you for your time, consideration and experience. Any addl. info. would be greatly appreciated.
 Healthy1 - Sun Feb 03, 2008 2:52 pm

The previous message is an old message that I thought was rejected by this forum. I posted a message after this, titled - Do SGPT/Bili values relate to Cardiac Ischemia? It asks some of the same questions that were in my first message. I just had a heart catherization done four days ago after many other tests. After the procedure, the doctor told my wife that he has ruled out a life threatening condition, but I still am not able to get an answer if my arm/shoulder pain is heart related. Many different tests were done, but the results from these tests almost seem to be a secret. I have a hard time getting answers thru my cardiologist office. Many times, I'll get a nurse that will say write down your questions and the doctor will address them at the next visit. I don't know if the office is piecing together the big picture or what?

Side Note: GP wanted me to go on a Low Fat/Low Cholesterol diet, which I did for the most part follow. It did improve all my cholesterol values to high average values with my main cholesterol being reduced from 221 to about 176 in about 6 weeks.

I am just kind of venting here, but my main question to the cardiologist is if my pain is heart related or not. After denial a while back, I was convinced that it was related to my heart.(From all the pieces, it just seemed to make sense. Failed Nuclear Stress Test- Cardiac Ischemia, relief from chest pain after using a Nitro Patch) After the catherization the Dr. commented to my wife that - he(meaning me) is doing good and he mentioned something about 10-20% platelets. I don't know exactly what this meant, but it sounds better than the blockage that I had expected to hear. My main frustration is in wanting to have some answers or feel some results. I might follow up with more info. in another message here after I recover a bit more from the catherization. (sore hip due to probably being on my feet too much yesterday.) My next visit to the cardiologist is now 3 weeks away. I assume that because this date is so far off that there isn't anything urgent going on with respect to the heart. Currently, it has been over eleven weeks since the start of the pain.
 John Kenyon, CNA - Wed Jul 09, 2008 3:20 pm

User avatar Hello Healthy1 -

Hopefully this finds you well and having gotten some answers. I have read both your posts, and of course it seems you have run into that "horrible coincidence" situation wherein there is a likely musculoskeletal injury (work-related) which could have happened at the exact same time as an insult to the heart muscle. However, the symptoms don't match up exactly with the findings, so your doctors are hedging their bets on a definite diagnosis and trying to reduce your risk level.

The main symptoms, the ache in the shoulder and adjacent area, would initially be suspicious, given your level of cardiac risk (more about that in a bit). However, if the discomfort has been relatively constant without progressing or going away, this lessens the likelihood of it being heart-related and more likely orthopedic in nature. Of course, manipulation of the affected shoulder, and range-of-motion testing, should at least elicit some joint or muscle pain. If it doesn't, this makes the diagnosis more difficult. Have you had any imaging studies of the shoulder and also the thoracic outlet on the affected side? I ask because you could be suffering from a simple mechanical injury, but at the same time this caused your doctors to discover that you were, at the time, at fairly high risk for a future cardicac event. It doesn't seem you have had a heart attack as yet, so that's all to the good. You have also lowered your risk a good deal by simple diet and exercise, which is very impressive and earns you tons of points for taking your health seriously!

The SGPT/ALT 84 and BILI, Total 1.6 values are fine, but not germane to your heart's health. The lipid panel was and, early on, troponin and CK enzyme levels might have been helpful. Your blood pressure is (or was as of your post) still too high, but not enough to set off any flashing lights or buzzers. An upward adjustment of your BP medication may have been in order, and by now may have been ordered. You probably should also be on a beta blocker of some sort, since you did exhibit some ischemia on your stress test. It is not clear, however, whether this was clinically significant or not (one can have minimal ischemia, which is suggestive but not diagnostic, or one can have clinically significant ischemia, which is diagnostic). The follow up post mentions the heart catheterization, which is pretty much the "gold standard" right now for determining the degree, if any, of heart disease. The report your doctor gave to your wife was definitely vague and I can understand your frustration. What you can read into this, however, is that while the doctor may have seen some narrowing in one or more locations, they apparently didn't warrant any sort of intervention, or that would have been done right there and then most likely. I suspect what he saw was evidence of disease, but not to the extent that it met the criteria for immediate invasive correction (such as angioplasty, with or without stent placement). I suspect as well that your doctor wants to follow you as you continue to improve on your very good diet-change results and other lifestyle changes (stress management, regular aerobic exercise, etc.). The "10-20% platelets" was possibly a misunderstanding of "10-20 % plaque buildup", which is made up, in part, of blood platelets along with calcium and cholesterol. If that is the case, it would indicate some heart disease but nothing immediately life-threatening. The measure used to justify invasive measures is usually greater than 50% and sometimes 50-70%. Less than a 50% blockage is usually treated with diet, exercise, and cholesterol-lowering medications.

As to the question of whether or not you are "damaging your heart" by continuing your normal activities, the answer would be a qualified "no." Usually if your heart is functioning and does not have a problem which warrants immediate intervention, then you won't damage it by doing normal activities. However, so long as you are deemed to be at increased risk of a cardiac event, your risk during exertion also increases beyond that of someone with no heart disease.

For all these reasons, and especially that infuriating shoulder ache with no apparent associated tissue or bone injury, plus your definite risk factors, your doctor is right to follow you carefully, but being conservative and considerate of your needs overall. I would expect the followup visit you had scheduled probably clarified a lot of these things for you, and I hope this writing finds you in good health and enjoying some peace of mind as well as relief from the shoulder pain, whatever may have been causing it. You've done extremely well at reducing your risk, and you've cooperated with your doctor very well, so you are doing all the right things and hopefully by now you have reduced your risk and improved your overall health a great deal.

I hope you will update us shortly and that all is well.

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