Q:
I am a 34 year old female. I have recently had awful chest pain starting about 4 months ago. I went to my primary physician in September and he told me it was likely because I had a cold and had been coughing and strained something. I went back when it kept happening and he did an EKG and said I was fine. It happened again the next month and I tried to ignore it. It happened again 2 weeks ago, even worse, and I went to the ER in the middle of the night, convinced I was having a heart attack. They did chest x-ray, ekg and bloodwork (cardiac enzymes). I was told I was not having a heart attack, that there were some ‘irregularities’ on the EKG but that that could be due to breast tissue (?). I was given a prescription for basically prilosec because it *could* be stomach related. The script hasn’t helped. I was also told at the ER to get a stress test due to my family history.
As for my family history, my maternal uncle (mothers brother) at age 37 started complaining of chest pain, saw his doc, had ekg, bloodwork AND stress test which came back with ‘irregularities’ but he was told to quit smoking and lose weight (about 30 lbs. oveweight). Months later, at age 37, he dropped basically dead on his daughters soccer field. He was revived by an onsite doctor and turned out he’d had a heart attack (anterior descending artery?) and had bypass surgery, and has since had multiple stints. My maternal grandmother (his mother) has also had multiple stints, and my paternal grandfather has had probably 3 heart attacks.
Anyway, I went to see a cardiologist today who did another ekg and echocardiogram (?) and then a stress test. He said I have some irregularties and mitral valve prolapse, that my ekg had some changes since my september one (I gave him a copy to view). He put me on a low dose beta blocker (I have normal to below average blood pressure and always have) and said to come back and see him in 6 weeks.
My mother (an RN) is concerned because this is presenting just like it did with my uncle and it went undetected with him. She wants me to have a heart cath (I think that’s what it’s called). Is this overkill or would it be recommended? I can’t just ask for one, the doctor would have to order it right? And my cardiologist said it wasn’t necessary. I’m just more than a little concerned about all of this and just would like advice, thoughts, etc? Thank you.
A:
You have told me a lot about your family, but very little about your self. Other than your age & gender, I don’t know anything!
That said, with a strongly positive family history, you need look at other factors that put you at risk: diabetes, cholesterol, high blood pressure, smoking and obesity.
You can read more about this here:
http://www.cardiac-risk-assessment.com/heart-information/coronary-artery-disease
And in this blog:
http://www.cardiac-risk-assessment.com/ca-blog/is-smoking-hypertension-or-diabet
Of course there are many other reasons for chestpains:
http://www.cardiac-risk-assessment.com/ca-blog/i-have-these-intermittent-chest-pains/
http://www.cardiac-risk-assessment.com/heart-information/coronary-artery-disease-angina/prinzmetals-angina
http://www.cardiac-risk-assessment.com/ca-blog/something-is-wrong-with-my-heart-and-circulation/
While a negative stress test is pretty good evidence against symptomatic coronary artery disease,there are some non-invasive tests that might also be of use. They include a Cardiac CT for Calcium Scoring, CTCA and a cardiac MRA:
http://www.cardiac-risk-assessment.com/heart-disease-diagnosis/calcium-scoring
http://www.cardiac-risk-assessment.com/heart-disease-diagnosis/ct-angiography-fo
http://www.cardiac-risk-assessment.com/heart-disease-diagnosis/cardiac-mri
Last, but not least, you can calculate your risk here:
http://www.cardiac-risk-assessment.com/app/risk-assessment.php
Hope this helps,
Dr T
http://www.cardiac-risk-assessment.com/