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Forum Name: Cardiology Symptoms

Question: Chest Pain Incident but normal EKG and labs


 statg - Fri Nov 14, 2008 3:24 pm

I had an incident 2 weeks ago with chest discomfort/pressure/tightness and had some occasional nausea/dizziness. On the 1st day, the feeling lasted all day until I went to bed. It seemed to stop during sleep and for about an hour when I got up. Then it started again. At the end of the 2nd day, I went to a medical aid unit. They did an EKG, which was normal but referred me to the ER. The ER did another EKG along with one set of blood tests and an x-ray. All were normal and they discharged me instructing me to get a stress test that week. For various beaurocratic reasons I have not gotten it yet but will next week. The symptoms have mostly subsided. I am 44, overweight (BMI = 33); no history of CAD but do take meds for reflux. I don't smoke or drink.

Do the tests I had in the ER rule out a heart attack? If the stress test (nuclear imaging with treadmill) is normal will that rule it out? Did I make a mistake by not insisting on the stress test immediately?

Thanks in advance,
 John Kenyon, CNA - Wed Nov 19, 2008 10:53 pm

User avatar Hello -

The ER tests rule out an incipient myocardial infarction (heart attack, MI), but do not rule out heart disease, which can, in turn, eventually causes a heart attack. A stress test, especially if done with a nuclear scan, can rule out heart disease with roughly 95 per cent accuracy. If the test were to come out positive for coronary heart disease (CAD) there is a slightly greater chance for a false positive, which only increases the need, in those cases, for an angiogram to determine precisely if there is any significant blockage.

Given your episode, it is quite appropriate that you have the stress test. If there had been a more suggestive finding with the EKG and/or blood work, ER staff would have recommended a more urgent stress test. You were stable at the time, so that's not an unusual approach, to just refer for stress test, since there is sufficient question as to whether or not you have any significant heart disease. I do hope you'll have the test soon, however, just to be certain what is going on. It may well be GI related, and that would be fine, but you do need to know what's up.

I hope this is helpful to you. Please follow up with us as needed. Good luck to you.

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