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Heart Attack or Indigestion?
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ACerulean posted:
I posted about this in a separate forum post, but I felt that this might warrant a post of its own. Yesterday evening I experienced pains that radiated across my chest, shortness of breath, pounding/hammering/racing heart, and cold sweats. This occurred while I was at rest and with no physical provocation. It also came on suddenly. I spoke with a physician from my healthcare provider over the phone who told me that there was no way what so ever that an eighteen year old could have a heart attack. I then spoke to my primary care physician today and she told me that I would have to undergo a 30 day event monitor and a stress echo as well as having there be the possibility of the necessity of a cardiac cath. I don't believe that what I experienced was an MI, but I do fear that it might have been an episode of unstable angina. Is that even possible at my age? Am I overreacting about what is no more than a case of indigestion or a panic attack? I am more than a little worried, but I fear that this worry might be the cause of it all. I have experienced exercise induced chest pain and I have undergone multiple chest x-rays, multiple ekgs, multiple echocardiograms, and multiple treadmill stress tests.I don't really know what to do other than rush to the ER if it happens again. Please help me.

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cardiostarusa1 responded:
Hi:

......"who told me that there was no way what so ever that an eighteen year old could have a heart attack."

It's considered rare in those of that age, but unfortunately, it can and does happen.

Some examples, as reported in the worldwide media from time-to time are, coronary artery spasm (CAS), a transient or brief constriction or transient or brief closure of a coronary artery, occurring typically, but not 100% always at rest, which has various causes, that includes cigarette smoking, prescription and illegal drugs (e.g., cocaine).

Spontaneous coronary artery dissection (SCAD, a tear or rip), coronary artery aneurysm (CAA, an area of ballooning out), coronary artery ectasia (CAE, an abnormal enlargement of the coronary artery), myocardial bridging (a part of a coronary artery tunneling under heart muscle, a congenital condition, one is born with it) and pathogen-induced (PI).

......"and she told me that I would have to undergo a 30 day event monitor and a stress echo as well as having there be the possibility of the necessity of a cardiac cath."

While the event monitor and stress echo (can reveal problems only when the heart is put under a load) sounds reasonable,
even though you said that you have had multiple echocardiograms, at ANY AGE, invasive X-ray angiography (angiogram, heart catheterization, carries risks and the possibility of complications, some unforeseen) is typically considered/performed ONLY if deemed absolutely positvely necessary.

......"but I do fear that it might have been an episode of unstable angina."

"Is that even possible at my age?"

Well, anything medical is seemingly possible (though sometimes improbable) today.

"Am I overreacting about what is no more than a case of indigestion or a panic attack"

Not necessarily. You know your body best.

Best of luck down the road of life. Live long and prosper.

Take care,

CardioStar*

WebMD member (since 8/99)



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ACerulean replied to cardiostarusa1's response:
Thank you so much for your quick response Cardiostar. I am going to be undergoing a stress echo like I said and that might just be enough to prove that it is simply anxiety.
 
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cardiostarusa1 replied to ACerulean's response:
You're welcome.

Take good care,

CardioStar*


[br>


[br>-[br>
 
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ACerulean replied to cardiostarusa1's response:
I just went in for my stress echo today and was told by the cardiologist that my heart is in perfect condition and that everything was normal. I was able to finish the test, but it was extremely difficult. I have yet to see if I will continue to experience the symptoms. I have tried omeprazole magnesium and it has done nothing. I hope to try an anti anxiety medication to see if that helps.
 
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cardiostarusa1 replied to ACerulean's response:
Thanks for the update.

CardioStar*

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It's your future......be there.
 
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deadmanwalking57 replied to ACerulean's response:
ACerulean:

Please describe your diet for a typical month, and ALL your day to day today activities. Despite the test results, try a multi-month diet and lifestyle change to see if it makes a difference in what you are experiencing.

I was told chest pain was minor anxiety after 5 minutes of light chest pain that occurred in the doctor's office, because an EKG showed nothing wrong.

Three weeks later I had massive unstable angina, went to ER, had an angiogram, followed by emergency triple bypass surgery. I had blockages of 99%, 99% and 80% of the three main coronary arteries. Staff was amazed I had made it to the hospital in time for surgery, and not died on the way.

I was also extremely fit at the time.

Your body is warning you that something is wrong. Do something about it, more than asking doctors questions.

DMW
 
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ACerulean replied to deadmanwalking57's response:
I eat a diet that is high in saturated fats, calories, sodium, and sugar. I understand that I really need to change that because the doctor just told me that. I plan to cut out all the foods that are high in these sorts of things. I think that the doctor may very well be correct and that it is just anxiety because the stress test showed no blockages on the EKG and the echo cardiogram came back normal.
 
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deadmanwalking57 replied to ACerulean's response:
I had two stress tests in three years that also showed showed nothing, the last one 10 months prior to my bypass surgery.

Those tests merely show if all the heart tissue functions normally, not whether or not you have blockages.

You should not believe you can have dairy, or avocados, or nuts, with the exception of pistachios. And you should add pomegranates to your diet, or the juice.

Exercise only at a pace that causes NO chest pain or shortness of breath. Behave as if you had the surgery already, and maybe you won't need it.
 
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ACerulean replied to deadmanwalking57's response:
Do you think I should push for an cardiac cath if I continue to experience the pains or just leave it there because they did a stress echo and it came back normal?
 
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deadmanwalking57 replied to ACerulean's response:
The doctor will argue age as making the heart cath 99% unlikely to find anything.

This is where you have to be really, really realistic, and totally honest about anxiety. My doctor also told me my two initial chest pain incidents were anxiety, without even trying to determine if I was concerned enough about anything to warrant anxiety. I asked him what I was anxious about, and he said, 'I don't know, its your anxiety." No basis what so ever. He might as well have said he thought I could learn to levitate and transport myself to other planets. Same level of accuracy. I had no anxiety at the time. Its still rare, and does not bring on any chest pain. My chest pain is almost ways totally random, unless I eat food with even a normal amount of fat. That will bring on strong chest pain within 24 hours, sometimes in as little as 4 hours. In one incident, the angina lasted two hours before subsiding.

So think about the incidents of chest pain, major and minor, you have had. As many as you can recall. Write down the day, date, and time of the incident, what you had been doing near that time, or what you had been watching, thinking, or worrying about. Events like this are traumatic, so they register more strongly in our memory.

Do the same for incidents of shortness of breath (SOB). My only incidents prior to bypass surgery occurred when I had a heart valve problem occur. With one, I was constantly short of breath if I even walked for about two weeks. With the other, if I did any exercise for more than a minute. That was from an infection, and took many months to heal. These were within four years of my emergency bypass surgery. I had echo stress tests with both, and the doctors saw no hint of blockages or abnormal heart performance.

So its no surprise they gave you essentially inappropriate tests to check for blockages. They did the same for me when I was 47, and 52.

Do your journalling and analysis. If the angina or SOB has an anxiety basis, you really will be able to figure it out. If the incidents came up out of the blue while asleep or exercising, doing physical work of some kind, or involved in an intense movie or video game, or argument with someone, then in my opinion, non-medical, but of my own experience, it is not stress.

Take a week or so to CALMLY assemble your history on this. Re-read it for accuracy, as if it is another person, not you.

There are alternatives to bypass surgery for most people. One, is one or more stents, but identifying locations still requires an angiogram. The non-medical alternative involves severe lifestyle and diet changes I have mentioned and I have been living SINCE bypass surgery. But if in a life threatening situation based on severity, it can be too little too late.

At this point you need determination, not anxiety. You are now your own dispassionate caretaker. If you will die soon, its what you set yourself up for, so no point being upset about it. If you won't die soon, don't be a baby crying about nothing, or Chicken Little saying the sky is falling when it is not.

Part of the lifestyle change, is to avoid things that bring on chest pain or shortness of breath. For the first YEAR or two, that would include action movies or thrillers, intense video games, active sports, even arguments with other people.

Eating an extremely health conscious diet, heavy on dark color fruits and berries, whole grain breads and cereals, non fatty fish, no red meat. No fat on poultry, no oils or mayonaise, pistachios as nuts, a few other nuts now and then. Dark chocolate is ok. No dairy, no ice cream.

Or try some of those things, maybe they will bring on chest pain. But they may also worsen your blockages if you have any, and you won't feel it for awhile.

Do ask your doctor about your HDL and LDL numbers. You have a target to bring the ratio of those as low as you can. Mine at time of surgery was 4 to 1. Now it is 1.7. It had been 1.2 for five years.

Go change your life.
 
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deadmanwalking57 replied to ACerulean's response:
By the way, with a careful fitness program after bypass surgery, I can enjoy almost any activity as long as I do not get cold. That brings on shortness of breath almost instantly.

Walking, hiking, rowing, volleyball, baseball, basketball. But I have to be careful watching sports to not get too excited. That can jack my blood pressure, not a good thing.
 
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deadmanwalking57 responded:
Describe exactly the exercise induced chest pain.

An MI, is pain that does not go away, and could involve partial heart muscle death as a result of an unrelieved blockage.

Unstable angina comes from no apparent reason, lasts from a few seconds to 10-15 minutes. Can be mild to as strong as a major heart attack. It is frequently a spasm in a partially blocked artery. Being able to breathe slowly and lie down can relieve it. Sometimes it goes away on its own. When frequent, it is serious cause for concern, as it may precede a total blockage causing a major heart attack.

A German research study found that fatal heart attacks are generally preceded by pain or discomfort for 2 to 10 hours, which the person ignored. The information was gathered from witnesses to the fatal heart attacks.
 
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ACerulean replied to deadmanwalking57's response:
Thank you very much for all your help in responding to my questions like this and reassuring me that I am most likely experiencing anxiety. The pains I experience usually come on gradually as I work harder and harder and don't go away until I cease all exercise at which point they go away after at most five minutes. These pains did not get worse if I breathed in and could not be replicated by pressing on the chest. I actually did journal the chest pains at one point and aside from about three incidents in which the pain came on from extreme stress, these were solely exercise induced pains. I will however journal the pains again so that I have something to read over and really determine if I am just getting worked up over anxiety. Once again thank you for your quick responses and for humoring me like this.
 
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ACerulean replied to deadmanwalking57's response:
I want to know if you think I should push for a nuclear stress test or a coronary cath based on the fact that I experience exercise induced pains. The pains in question are a dull achy pain that is localized to behind my sternum. I also get short of breath when I experience these pains. The pains come on after 30 or so minutes of light exercise or as little as 10 minutes of moderate to heavy exercise. The pains go away as soon as I rest for 1-5 minutes.


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