Heart Cath or not??

I am new here and hoping maybe someone can relate to what i have been going through and have some advice of what I should do next. I have been sick for over a month now. Pressure and heaviness in center of chest, pain in left side of chest, left shoulder, between shoulder blades, left side of neck, left arm, as well as numbness at times in arm, nausea, fatigue, weakness and dizziness. It got so bad 3 weeks ago that I went to the e.r and was admitted. They put the nitro patch on and it took the pain and pressure away. EKG and echocardiogram were normal though. They discharged me and said maybe something with my stomach, my back or just stress. I have had endoscopy, back and neck mri, chest ct scan and stress test done since then, all of which are normal. I know something is not normal though! I went from being a very busy, very active, 36 yr old mother of 3, to being someone who can barely get out of bed most days. I switched cardiologists and like the one I have now much better. He thinks it is not likely my heart, but is not dismissive about it as the other one was. He said the only way to know for sure is a cardiac cath. At first, I was so relieved he was going to do it. Then I became more and more worried about getting it done. I know it is very routine and relatively safe. But I also know that when something bad happens during or after it, it can be very bad and even deadly. My husband thinks I am crazy. My family does not think I should have the test. They feel it is too big of a risk to take when we don't know if there is anything wrong with my heart to begin with. Rationally, I tell myself the chances of it being my heart must be small. I am 36, healthy weight, no risk factors. However, I feel like I am literally going to die some days! I just don't know what to do. I guess my biggest fear at this point is doing the cath, having it turn out that my heart is totally fine, and something terrible happening to me because of the cath. How do I justify putting myself at the risk when no dr has said to me they think there is a good chance that it's my heart??? I just want to get better and be here for my children!! I should add that I do have anxiety about my health, I always have, which is why my husband thinks there really isn't anything wrong with me. The difference is, the anxiety has always been there, this crazy debilitating sickness has not been. Any advice would be greatly appreciated!

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Have you had your back and your stomach checked to rule those out? If so, and nothing was found, I would be insisting on a cath. I have had one and actually stayed awake for it because I wanted to watch. There are no nerves in your arteries (which is what the cath goes through, so it doesn't hurt. Just make sure you get a cardiologist who has done many caths. You don't want to be his/her first rodeo. Ask for referrals from your MD and tell him/her your concerns. You can also check patient ratings on doctors at ratemd.com, vitals.com, and many other rating services. Can't think of them all right now. Just Google.

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I ignored symptoms for months. Get a heart cath and get an "ejection Fraction" reading.
I now have terminal heart failure that could have been caught in time. Act Now. & Best of Luck

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Thank you both so much. My gut is telling me to do it, just so scared of something going wrong and it all being for nothing if it turns out to not be my heart. I have had my stomach and back checked. My back was fine except for mild disk deterioration, and my stomach they did find was twisted, which gastro dr said could def cause nausea and some pain but did not feel comfortable saying it was causing the shoulder, arm and back pain. My cardiologist has done tons of caths and is actually the head of 2 hospital's cardiac units. So i do feel very comfortable with him and his ability to do the procedure. It's more of me worrying about afterwards when I am in recovery...if I start bleeding internally and the nurses don't realize. I know it's a small percentage, but I do know it can and does happen and that women are slightly more of a risk for this than men (don't know why but that is what all of my research has said).
Dorothy, can I ask what kind of symptoms you were having?

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I am 46 not over weight, walk 5 miles everyday and had similar syptoms to you. I took myself to the ER and was admitted over night. The hospital drew blood to check for heart enzymes and did an ekg, chest xray, and head CT. They checked my cholesterol and blood sugar. EVERYTHING was normal. They said that I was healthier than any of them! They sent me home with "non cardiac related chest pain" told me to continue with the diet and exercise and to see my primary care physician for my physical appointment which was already scheduled for three weeks later. My doc had a fit because they did not perform a stress test. So she ordered a cardiac referral. I had the heart cath the day after the stress test. They ended up calling the specialist down to insert two Stents. It turns out I had major blockage. I was told by the doc that put in the stents that I was very lucky to not have had a heart attack.

I knew something was wrong...follow your gut.

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Thank you for your reply. I am so glad you had such a good dr!! Did your stress test show something abnormal and that is why they did the heart cath? Or did they do the cath because they still did not have an answer?

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Yes it did. But not until we were well into the test. I went for 17 minutes on that treadmill! It is a tough test.

They did tell me that women tend to have more false positiives than men. But, they felt it was beyond that. So we scheduled the heart cath for two days later. They wanted to do it on Valentines Day, but I said no. It just didn't seem right to mess with someones heart on Valentines Day!

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I had the nuclear stress test done and it did not show any problems. This is partly why I am so concerned about doing such an invasive procedure...none of the tests that have been done so far are pointing to it being my heart. I had a very hard time on the treadmill (which i found strange because before all of this started happening I was working out several days a week). I couldn't breathe and was dizzy and my chest hurt. Dr said it was fine. He was not very nice...said "you're too young for heart problems and sometimes pain is just pain and there is nothing wrong with you" That is when I switched cardiologists. My new one is wonderful. He isn't saying that he thinks it def is my heart, just that the cath is the only way to know for sure. I am so worried of making the wrong decision...not having it done and it being my heart, or having it done, something going wrong and it all being for nothing if my heart is fine...feel like I am losing my mind!

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I wish I had a definitive answer for you. I was told that my symptoms were "Atypical" and that the heart cath was the only way to know for sure. Everyone one of the doctors and nurses were shocked at the amount of blockage that I had.

All I can say is I knew something was wrong. I followed my gut. I didn't really care that they all thought it was nothing. I knew that it wasn't in my head. I knew it wasn't just anxiety.

I wish you luck. I know how hard this is!

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Thank you so much. I wish I had more to go on other than just how I feel, but I do know something is wrong and all of the symptoms point to my heart. I think I am going to schedule it. How long were your symptoms going on for before you went to the e.r.? Were they better at times and worse at others?

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If you are offered cath angio have it done , ok your arteries may be clear but they are ble to do a provocation procedure to see if the vessels go into spasm and then give you a diagnosis .
By the way you are not too young I was in my 20s I am now 58 there is certainly life to be lived unfortunately diagnosis can be slow in coming , believe in yourself .

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My blood pressure was all over the place for a few weeks before. It wasn't until I felt the pressure on/in my chest and a very high blood pressure reading that made me go to the ER. Now, thinking back when out on my daily walks, it seemed that they were getting more difficult probably a week or so before I went.

Absolutely there were better times than others. I wasn't always exerting myself when I had symptoms either! Sometimes when I was exerting myself I had no symptoms. This is why the docs thought it was anxiety. Everthing was Atypical.

The Heart Cath was not a terrible experience. I was awake for the entire thing. They did sedate me some...but I remember most of the procedure.

I hope this helps.

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Thank you for your reply. Is that procedure always done during the cath or do you have to ask for it?

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It definitely does help. My biggest problem is being okay with making this decision to have it done without the support of my family. No one thinks i should do it! They think I should listen to all of the test results that we have and accept that it is not my heart.

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Hang in there. I hope all works out. Keep us posted on how things turn out!

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Although I am a good bit older than you (57) I recently had a heart cath because of the following symptoms: nausea, very brief pain in my left jaw, dizziness, shaking, feeling weak and having a low grade fever. These started on a Thursday night and although I woke feeling better, the symptoms returned after I'd been at work for about 30 minutes. Results were that it was either an arterial or esophageal spasm. There were no blockages but my cholesterol is elevated. My cardiologist gave me prescriptions for nitro pills, something for indigestion, and gas. This may be what you are experiencing because I did have one about 12 years ago but experienced more pain with that one. The procedure was very quick and I actually slept through it. My doctor showed me the films from the test that showed no blockages. I'm still not sure what actually caused it but it could have been stress as I lost my mother in January and was experiencing stressful situations around the time I had the first one.
I would recommend having the test and also feel that it is good that your doctor has done many of them. Your family can't decide what is best for you. Only you can do that. And if a problem is detected, then you will be able to address it. If it still doesn't show any heart problems, make sure your cholesterol is ok. If the symptoms continue, then I would insist that the doctor work to find the answer.
Good luck and my prayers are with you.

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http://www.nhlbi.nih.gov/health/health-topics/topics/arm/signs.html

Anuerysm or Spontaneous Coronary Artery Dissection?

Thoracic Aortic Aneurysms

A thoracic aortic aneurysm (TAA) may not cause symptoms until it dissects or grows large. If you have symptoms, they may include:
•Pain in your jaw, neck, back, or chest
•Coughing and/or hoarseness
•Shortness of breath and/or trouble breathing or swallowing

A dissection is a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall.

If a TAA ruptures or dissects, you may feel sudden, severe, sharp or stabbing pain starting in your upper back and moving down into your abdomen. You may have pain in your chest and arms, and you can quickly go into shock.

If you have any symptoms of TAA or aortic dissection, call 9–1–1. If left untreated, these conditions may lead to organ damage or death.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132700/
*Spontaneous coronary artery dissection (SCAD) is a rare and fatal cause of acute coronary syndrome (ACS) that has been reported by autopsy in many cases historically.1) The clinical diagnosis of SCAD has increased because coronary angiography (CAG) and intravascular ultrasound (IVUS) available for providing detailed morphological information of vessel layers is frequently performed for evaluation of ACS. Although several modalities including percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG) and medical therapy have been performed to manage patients with SCAD, no treatment guideline has yet been established. We report a case of SCAD which was presented as ST-segment elevation myocardial infarction (STEMI) and treated successfully with medical treatment

*I think the "rare" cause of acute coronary artery syndrome is because this is usually not discovered, unless an autopsy is done. There are several people on Inspire who have posted about having SCAD and problems in getting correctly diagnosed. Some of them were in a clinical trial sponsored by Mayo Clinic. You might do a search through Inspire for some of their posts.

Signs and symptoms of spontaneous coronary artery dissection include:
Chest pain
A rapid heartbeat or fluttery feeling in the chest
Pain in your arms, shoulders or jaw
Shortness of breath
Sweating
Unusual, extreme tiredness
Nausea
Dizziness

This is detected by an MDCT http://www.mayoclinic.org/spontaneous-coronary-artery-dissection/
This site explains the procedures for detecting heart disease: http://www.heartscan.com/faq.html

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Thank you so much for sharing your story. I am, so glad they figured it out, and I am so sorry about the loss of your mother! I can completely relate to that. In July we lost my aunt . My parents passed away when I was a child and my aunt raised me and has been my mother ever since. I have been having a hard time dealing with it which is why my husband thinks it is stress and anxiety and not something with my heart. I just don't know how stress and anxiety would cause this much pain, fatigue, numbness, etc.

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Thank you so much for all of the information!! I am going to check out the websites now.

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One other question. Has anyone had the cardiac ct or cardiac mri? I know they are supposed to be very accurate, just I guess not quite as accurate as the cath. What do you all think about me possibly having one of those non-invasive tests since non of the tests I have had so far have shown anything with my heart? Thank you all so much for your stories and replies!

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Hello... The ct and MRI are pretty accurate for regular CAD. but if you end up having MVD or CMD you would not necessarily see anything. Its diagnosis is by exclusion of everything else. My ST depressions, showed on some stress testing but has hid out for lots of other tests even though I have coronary microvascular disease CMD.... My dysfunction is in the microvasculature and can't be easily found by current testing. I was fit and this slammed me out of the blue at 40. No blockages, etc or bad blood tests. Everything said I should be healthy. My symptoms told me otherwise. Keep looking into symptoms and weeding out what you feel and do not. Keep asking questions. You may want to check out the category understanding Microvascular disease and see if our posts seem to fit! Good luck. We all know how frustrating diagnosis can be.

Hugs
Annette

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The information provided by this online support network through WomenHeart: The National Coalition for Women with Heart Disease and Inspire is for general informational purposes only. The information is not intended to substitute for professional medical advice, diagnoses, or treatment. If you are ill, or suspect that you are ill, see a doctor immediately. In an emergency, call 911 or go to the nearest emergency room. WomenHeart: The National Coalition for Women with Heart Disease never recommends or endorses any specific physicians, products or treatments for any condition.