Chest pains

[twizzle]

I had the stress ECG yesterday - made it to 13:50, estimated VO2Max of 59, no funny problems noted. So, whatever the burning sensation in the chest is when I slow down after a full-effort long hill climb, it's not heart related. And, despite years of really bad diet, looks like I haven't buggered the heart... that they can tell, anyway.

Old and Rusty - the stress ECG is basically to pick up narrowing of the arteries and other dysfunction, but if you have plaque in the artery wall which ruptures and allows a blood clot to form... no test for that.

[Aushiker]

I had the stress ECG yesterday - made it to 13:50, estimated VO2Max of 59, no funny problems noted. So, whatever the burning sensation in the chest is when I slow down after a full-effort long hill climb, it's not heart related.

Hi

Based on my own personal experience, that is not a conclusion I would draw so quickly. It took an angiography to find that I actually did have narrowing of an artery (stress test results did not show any issues) and a holster monitor test to show I need a pace maker (stress test showed no issues and continues to do so).

Regards
Andrew

[sogood]

Good reply Aushiker. Negative stress test does not exclude underlying coronary disease but a positive result is much clinical relevant. As a minimum, keep an eye on it and review if the symptom persists.

[wombatK]

I had the stress ECG yesterday - made it to 13:50, estimated VO2Max of 59, no funny problems noted. So, whatever the burning sensation in the chest is when I slow down after a full-effort long hill climb, it's not heart related. And, despite years of really bad diet, looks like I haven't buggered the heart... that they can tell, anyway.

Old and Rusty - the stress ECG is basically to pick up narrowing of the arteries and other dysfunction, but if you have plaque in the artery wall which ruptures and allows a blood clot to form... no test for that.

Well the gold standard test for finding narrowed arteries is an angiography via catherterization. But that's pretty invasive.

There are digital imaging techniques like this http://www.sydneyxraybondi.com.au/Conte ... maging.seo
but there might not be a medicare rebate for it - could cost around $600 out of your pocket, which might be prohibitive given your family responsibilities. Doctors running these centers have been trying to get it listed, as it's much cheaper on the public purse if the result shows no problems - my info is a couple of years old.

And as Andrew points out, there are other troubles which need different tests like the holter monitors, and other nuclear scans combined with exercise tests.

Cheers

[vitualis]

CT coronary angiography is IMHO an unproven test modality and its place in the diagnostic work up of chest pain is unclear. This is why it does not have a Medicare rebate and it is unlikely to get one unless the evidence base changes. Arguably, the gold standard test for someone at intermediate risk is a myocardial perfusion scan (or a stress echocardiogram though this is rather operator dependent).

One of the dilemmas with CT angiography is that if you detect what appears to be a significant lesion but have a negative stress echocardiogram or myocardial perfusion scan, it is unclear what is the next step. Angiography? Watch and wait? Medical therapy?

Someone who has a POSITIVE stress echo or myocardial perfusion scan should always have a "real" coronary angiogram anyway, which renders CT angiography redundant.

Regards.

[PHL]

There are digital imaging techniques like this http://www.sydneyxraybondi.com.au/Conte ... maging.seo
but there might not be a medicare rebate for it - could cost around $600 out of your pocket, which might be prohibitive given your family responsibilities. Doctors running these centers have been trying to get it listed, as it's much cheaper on the public purse if the result shows no problems - my info is a couple of years old.

Can give you false positives; a doctor friend had one done out of interest, which showed significant plaques. Was rushed for a dye angiogram, which was normal.

On top of that, the radiation dose for a full body CT (which is what is often offered) is not insignificant, even with the new machines.

[vitualis]

Admittedly, the best CT coronary angiogram machines done by experienced operators can do adequate images with quite a low radiation dose. However, yes, full body CT scans give a massive radiation dose for little benefit; somewhere of the order of 3 years worth of background radiation in one hit.

Regards.

[Colin_T]

Hi twizzle

I'm in the same boat as you. I had a number of resting ECG with no problems. I had an ECG stress test, which was apparently great and showed no problems. I had an ultrasound of my ticker shortly after that and that did show a problem. Perhaps ask your doc to send you off for an ultrasound of your heart.
Besides all that I am now on medication to stop clots (aspirin) and reduce my cholesterol (Crestor) and am waiting to go into hospital for further testing. No private health insurance for me so it’s gonna be a while before I get in

In the mean time perhaps try reducing cholesterol and fat intake in your diet and get more tests done.

[twizzle]

Cholesterol etc., all comes back normal. The only time I've had problems is when doing a massive hill climb effort (ie 10+ minutes at VO2Max level outputs), and at the point of slowing down I get a burning sensation like lactic build up that lasts for less than a minute. Never happens in races (where I've pushed to the point of exercise induced asthma), and didn't happen in the 14 minute hill time trial I did around the same time either... but seeing as the doctor I mentioned it to had no idea, it seemed to be a reasonable idea to get a stress ECG just to see if anything showed up. Despite being a fat ba$tard with a gut, I still managed to push to a level that they reckon they only see once or twice a year.

[Colin_T]

My cholesterol was fine too and my other tests (blood, etc) were all perfect. The doc reckoned I was in perfect health. I sure as heck didn't feel perfect and still don't. I even had counselling for anxiety because the doc thought that might have been the problem. It didn't help, I'm still a nut
Just keep getting tests done until they find something. Most tests should be covered by Medicare and you need to find out why your getting pain, even if it is only on rare occasions. My pain only occured once in a while but systematically became more frequent.

[Colin_T]

I thought I was a gonna tonight. I was walking my dogs at the park and a couple of other dogs came racing down a hill towards us going off their head. They were barking and growling and freaked me right out. I yelled at the owner to grab his dogs but he ignored me. I yelled again and then I got chest pain. My blood pressure went straight up and my adrenalin was flowing and I thought, well this is it, I'm gonna die on the bloody park.
Obviously I didn't coz I'm here now but I didn't think I was going to survive tonight. I either got eaten by a couple of dogs or die of a heart attack. It was a bit of a scary one. I think I need to invest in a mobile phone & some pepper spray in case I have to dial 000 while I'm lying on the ground getting mauled

[twizzle]

Ho hum, digestive system has spacked again so I can't sleep.

So Colin_T - what did your problem turn out to be? And what did you have to do to set it off? I thought for sure I would have triggered something on my last TT when I went absolutely flat out in the last minute and pushed my HR from a previous best of 184 up to 193 BPM... but nothing.

[Colin_T]

Ho hum, digestive system has spacked again so I can't sleep.

So Colin_T - what did your problem turn out to be? And what did you have to do to set it off?

hey, someone else with an upset tummy, welcome to the club
The latest test on my ticker was an ultrasound, which showed a leaky valve, (which we knew about) but it also showed that the wall on one side of my heart is not working properly. It is also enlarged. The doc reckons it is caused by a blockage and has stuck me on blood thinners and anti cholesterol pills.
All I need to do to set off my chest pains is walk fast, cycle more than 20kph, or get threatened or attacked by a dog. Then BAM, I've got the pain

[twizzle]

Ho hum, digestive system has spacked again so I can't sleep.

So Colin_T - what did your problem turn out to be? And what did you have to do to set it off?

hey, someone else with an upset tummy, welcome to the club
The latest test on my ticker was an ultrasound, which showed a leaky valve, (which we knew about) but it also showed that the wall on one side of my heart is not working properly. It is also enlarged. The doc reckons it is caused by a blockage and has stuck me on blood thinners and anti cholesterol pills.
All I need to do to set off my chest pains is walk fast, cycle more than 20kph, or get threatened or attacked by a dog. Then BAM, I've got the pain

I guess my few incidents months ago isn't too bad them.

Yes, the joys of a stuffed digestive system. I'm generating impressive quantities of wind out of both ends, but the bloated stomach triggers vasovagal stuff... normally it happens daytime and I just have adrenaline rushes and occasional almost-fainting moments. But at night time, I startle at the point of falling asleep, which makes it very hard to get back to sleep if I wake up. I caught a stomach bug a couple of weeks ago, which seems to have buggered up the production of digestive enzymes in the small intestine again, which causes the impressive gas generation. I haven't had it this badly since it first happened back in 2005. I'd been pretty much O.K. the last few days, but I stupidly went out to lunch with someone yesterday and now I'm really suffering - no carbs for me for a few days.

[Colin_T]

I have similar problems when I eat anything starch/ carbohydrate based. I reckon I have a massive candida infection in my intestine caused by too many anti-biotics. The docs don't reckon you can get that but who knows. Probiotics and yoghurt don't help and if I eat bread, cereal, rice, corn, etc, I puff up like a balloon and could probably blow balloons up all night when I'm sleeping (just a touch of wind). I found taking garlic oil helps and I pop 4 or 5 garlic oil capsules about 15minutes before I eat anything with carbohydrates in. Then I don't bloat up as much. The garlic oil also settles my stomach and helps stop me throwing up in the morning.

[twizzle]

I have similar problems when I eat anything starch/ carbohydrate based. I reckon I have a massive candida infection in my intestine caused by too many anti-biotics. The docs don't reckon you can get that but who knows. Probiotics and yoghurt don't help and if I eat bread, cereal, rice, corn, etc, I puff up like a balloon and could probably blow balloons up all night when I'm sleeping (just a touch of wind). I found taking garlic oil helps and I pop 4 or 5 garlic oil capsules about 15minutes before I eat anything with carbohydrates in. Then I don't bloat up as much. The garlic oil also settles my stomach and helps stop me throwing up in the morning.

Bingo! You have buggered up your disaccharide enzyme production. Try the "Specific Carbohydrate Diet". The book is called "Breaking the Vicious Cycle" by Elaine Gottschall (dec.). Dymocks can supply it in Australia, about $45 shipped. My new copy turned up in the mail today, my original from 2006 got loaned out and I can't remember who to. There are also some diet basics on the web page.

[wombatK]

Hi Colin,

Scary incident in the park. Did you have your nitrate medication ? That's one step before calling 000 in such circumstances (see Heart Foundation recommendations in my earlier post). So even before making sure you have a mobile phone with you, carrying the nitrate tabs or spray with you should be on your to-do list. It can make a big difference in the extent of irreversible damage if a blockage has occurred.

Good you're still with us, but it sounds like you have got something nasty going on when a bit of aggro in the park can give you such grief. Sooner you can get an angiogram done, the better I would think. Maybe time to see what your GP's opinion is now.

With regard to the digestive issues, do you get much fibre in your diet ? ABC's catalyst last night reported some interesting research showing the mechanism which links lack of fibre to many auto-immune diseases like diabetes, irritable bowel syndrome, allergies etc.,. The rise in incidence of these diseases has correlated strongly with the fall in fibre in our diets, and now there is evidence of the physiological mechanism as well as the statistical correlation.

Twizzle's on-bike exercise test is pretty severe, so maybe he can be a bit more relaxed about what follow-up he does. GP's advice of course should be his best guidance.

Cheers

[cooperplace]

for nickobec, are you cycling again now?

I have chest pains and pain in the underside of my upper left arm (between elbow & armpit) whenever I first do any exercise. I have spoken to my GP about it and she says my ticker is fine. But each time I go out for a jog or when I first start cycling and pushing it a bit, I get the pain in the middle of my chest, and numbness in my arm. I might have to go see another doc.

Yo never think about stuff like this when you're young, but as you get older you think about it more and more

get another opinion. Ask to be sent to a cardiologist. Now.

[twizzle]

for nickobec, are you cycling again now?

I have chest pains and pain in the underside of my upper left arm (between elbow & armpit) whenever I first do any exercise. I have spoken to my GP about it and she says my ticker is fine. But each time I go out for a jog or when I first start cycling and pushing it a bit, I get the pain in the middle of my chest, and numbness in my arm. I might have to go see another doc.

Yo never think about stuff like this when you're young, but as you get older you think about it more and more

get another opinion. Ask to be sent to a cardiologist. Now.

That was a long time ago. Look up a few posts (or click here).

[Colin_T]

Scary incident in the park. Did you have your nitrate medication ?

With regard to the digestive issues, do you get much fibre in your diet ?

Hi WombatK
nope, I didn't have my nitrate medication with me.

I used to have lots of fibre in my diet but reduced it last year due to the insides playing up. The fibre (plant matter in the form of fruit & vegetables, yes they are bad for you ) was actually making the insides worse. I have been eating fruit again over the last few months but I'm still not able to tolerate frozen mixed veges. And before anyone asks, they're not frozen when I eat them