Constant back pain after enlarged heart diagnosis

[neyr]

My mother, now 48, had a minor heart attack nearly three years ago. She was not overweight, nor did she have high cholesterol or hypertension. She was treated and released. Ever since then she has complained of constant fatigue and a constant pain, in her back, between her shoulder blades. Subsequent EKGs came out normal. A few months ago she experienced an incredible amount of pain in her chest, felt faint but did not go to the hospital. During those months she has been going to sleeping around twelve or so hours a day but still wakes up fatigued. She went to her cardiologist and had an EKG done. The office called her back and claimed everything was fine except for some plaque buildup. A few days later her family doctor called her and said her heart is enlarged (left side) and questioned why her cardiologist did not find this in the EKG. He prescribed lisinopril. She claims to be feeling better, no more pressure on her chest or chest pain, but still has constant pain between her shoulder blades and on her left shoulder blade, that subsides when she lies down but persists after being in a standing or sitting position for what anyone would consider a normal or moderate amoutn of time. She thinks it could be related to work (she is a CNA) but I disagree.
I am literally at wit's end. I worry to a ridiculous disagree about her condition and her cardiologist not catching her enlarged heart terrifies me. She is going for a sleep study tonight and I demanded she ask her doctor about congestive heart failure and all of her persistent symptoms.
I guess my question or questions are: is she experiencing congestive heart failure? what more can be done in terms of treatment or therapy?
should she see another cardiologist?
could she be experiencing the beginnings of another heart attack?
Help.

[John Kenyon, CNA]

Hi there -

Your mother is experiencing some very suggestive symptoms, both of probable ischemia due to some coronary artery disease (that "plaque buildup" her cardiolgist didn't seem very concerned about, even though she's already had one myocardial infarction -- MI), and possibly of congestive heart failure (CHF) as well. While the latter is one possibility -- and with an enlarged left ventricle it is fairly likely -- the pain is not even especially atypical (women often experience heart pain in more diffuse and atypical ways and areas) and should be a red flag especially in someone with a prior MI.

The cardiologist's cavalier assessment (he knows she has some "plaque buidup" because of having looked at an EKG?) and failure to make the connection between established heart disease (which he apparently acknowleges, but hasn't tested for adequately) and new chest pain (any thoracic pain suspected of being caused by heart disease may be called "chest pain" as shorthand for cardiac pain) really concerns me. Your mother's fatigue and need for extra sleep could be due to something else, but with that apparently enlarged left ventricle it's probably at least in part due to CHF, which should be treated. She also needs to have an angiogram (even if she had one during her original heart attack) to determine the extent of her disease and to help put together a treatment plan. She should probably be on a beta blocker at least, and if she's in CHF there are more choices in terms of which beta blocker, as some work better for this than the usual ones.

I hope this is helpful to you. I'm very glad your mother has you as an advocate. It's important, especially since medical people are often the most likely to deny a serious problem because of their work ethic. Please do continue to encourage her to get this fully worked up. Something is definitely wrong. What it is and to what extent it's wrong is all that's left to determine. Then it can be treated.

Good luck to the both of you, and please follow up with us here.