Chest Pain. But not THAT kind of chest pain. I think. (Read 327 times)

mab411


Proboscis Colossus

    Either should be able to order the test. Your PCP, however, may elect to defer to the cardiologist. If so, you already have the appointment and don't have to wait to get in.

     

    You'll have to play that part by ear. I've dealt with both scenarios: PCP ordering the stress test and the PCP deferring to cardio.  You're in a good position by being prepared.

     

    Is there any advantage to going to the PCP before the cardiologist?  I mean, any reason not to look at it as one copay vs. two?

    "God guides us on our journey, but careful with those feet." - David Lee Roth, of all people

    ShuffleFaster


      I think I'd suggest just seeing the cardiologist since he's agreed to see you.  (Not sure what the PCP would have to add at this point.)

      mab411


      Proboscis Colossus

        Shufflefaster, that was kind of my thought, too, and yesterday I had my cardio appointment.

         

        He couldn't find a thing wrong with me during his examination, and nothing in my story threw up any red flags for him (other than the discomfort that started this whole thing off).  He cleared me to run, but cautioned me not to "push it any harder than you would ordinarily," which I'm going to interpret as continue with my training plan, but maybe back off the paces of my strength and speed workouts a bit.

         

        Now obviously, this was an at-rest examination he gave me, so we've got a stress test scheduled for a week from today.

         

        More later, class is starting...

        "God guides us on our journey, but careful with those feet." - David Lee Roth, of all people


        A Dance with Monkeys

          It is the stress test that should clear you, not a stethoscope on your chest while at rest.

          mab411


          Proboscis Colossus

            It is the stress test that should clear you, not a stethoscope on your chest while at rest.

             

            Well, there was that, another EKG, and the long talk we had about family history, risky habits (or the lack thereof), the nature of the symptom and when it's occurring, etc., etc..  He didn't just stick a stethoscope on my chest and declare me good to go.  But yes, I understand, my heart may behave differently under exertion, which is why I'm going to take it relatively easy until Thursday.

             

            Speaking of which, slight update as to the symptom...on Tuesday, a scheduled strength/interval workout day, I went out intending to just go as many miles as I would have gone for the workout, but at an easy pace.  Listening to an audiobook, I was 2.5 miles in before I realized I hadn't felt any discomfort at all.  I'd forgotten completely about it.  So...and I know this is ill-advised, but I couldn't resist...at that point I went ahead with the 7 X 1mi intervals I would have done.  Did not hit them as hard as I would have, but still had a good time, and still not a peep from the ticker.

             

            Again, I know that probably wasn't a good idea, it's just that, as this drags on and the symptom gets better instead of worse, and more and more doctors of increasing qualification say it's probably nothing, it gets harder and harder for me to take this seriously.  For the sake of the gal on the right in my avatar pic, I'm taking it as seriously as I can, and will go easier this week than I would have ordinarily.  But I've got a long history of episodes of worrisome symptoms (non-heart-related until now) cropping up, freaking everybody out (including myself, sometimes), then going away with no explanation by the doctors.  It's starting to look like this will be another one of those episodes.

            "God guides us on our journey, but careful with those feet." - David Lee Roth, of all people

            cookiemonster


            Connoisseur of Cookies

              Glad it went well. Glad you got the stress test scheduled.

              ***************************************************************************************

               

              "C" is for cookie.  That's good enough for me.

              ShuffleFaster


                I'm glad things are progressing and that your little self-stress session *ahem* did not appear to harm you.

                 

                Please continue to take it seriously.   The two gentleman whose pictures I posted earlier were able to run without symptoms as well.

                 

                Good luck on your stress test, and please keep us apprised of what happens.  (Said a prayer for you.)

                mab411


                Proboscis Colossus

                  Thank you for the prayers, Shuffle!  I am continuing to take it easy.  Last night I had a tempo run scheduled, and with the exception of two or three miles, went considerably below my target pace, even though my legs were chomping at the bit.  Also laid off the cooldown session (though that was partly because it was late and I have to drive students three times this weekend).  Still no discomfort.

                   

                  The medical network I use uses "MyChart," an online service that lets you contact your doctors, view test results, pay bills, etc..  Pretty handy-dandy so far.  I noticed on my test results, it mentioned "abnormal EKG," so I sent a message to my doc about it (since he had specifically mentioned my EKG looked "great").  Got a message back very promptly from one of the LVNs:

                   

                  "Abnormal EKG. He has borderline right axis which I really think reflects an athletic rather vertical heart in this very thin, physically fit male. Plan: Stress EKG as noted above." This is the exact sentence Doctor says about the ekg. Nothing to worry about. The Stress test will tell us if anything is wrong.
                  Thanks, LVN Lady

                   

                  "Very thin?!??"  Clearly he wasn't in the room when the shirt came up for the EKG.

                  "God guides us on our journey, but careful with those feet." - David Lee Roth, of all people


                  A Dance with Monkeys

                    My general approach to patients is that if there are more than one diagnosis for a given symptom or finding, and one is potentially life threatening, then not simply choose the happy diagnosis.

                     

                    An abnormal ECG may well be because you are a thin, fit, athletic runner (they die from heart disease too, btw), and it may well be because you have serious heart disease. In my mind, it is incumbent on the healthcare professional to make sure that you don't have the potentially fatal cause.


                    Get that stress test.

                    sbpbrent


                    Ludwig Classic Maple

                      I hate to bring this up, but in 2007 I had an EKG at my primary care doctor on one of those EKG machines you can find on ebay for about $350.  I was having weird symptoms - chest tightness, light headed, etc.  On the chart that the machine spit out the words "Borderline EKG" were clearly printed at the bottom.  I made an appointment with a cardiologist who gave me a nuclear stress test.  After the test he told me that the test was "normal" and that I needed to stop drinking so much beer and exercise more.  Ten months later I had a heart attack.

                       

                      Don't freak out here, please, it doesn't mean your case is like mine.  Fortunately, the damage was minimal and I have run 6 marathons since 2011 and I have another on the 20th.  I took the exercise to "heart" and I quit drinking anything with alcohol.  I also have a family history that oddly includes heart disease and longevity.  The mistake I made was staying with the same cardiologist.

                       

                      A year later, I had another nuclear stress test and this one showed that there was something wrong.  On a Friday, I was told to "be very careful" over the weekend and that I had a trip to the cath. lab. on the following Monday.  My wife was freaking out, but I made it to Monday, and...voila!......everything was fine.  It was a "false positive".  (As it turns out, that made the nuclear stress test 0 for 2 - one false negative and one false positive).

                       

                      I am mad at myself because I'm an engineer with a nuclear background.  When I went over how the nuclear stress test was conducted, I realized that the nuclear test was about as accurate as wetting your finger and sticking it in the air.  At this point, I would get very angry at any cardiologist who tried to convince someone to get a nuclear stress test.  My new cardiologist uses a regular stress test, which is what I believe you are getting.

                       

                      My advice is to listen to your body and be very honest about your symptoms with your cardiologist.  It sounds like you have a better cardiologist than I initially had.  I wish you the best - you are doing the right thing!

                      Marathon PR: 3:46:52, Denver R&R Marathon 2013

                      1/2 Marathon PR: 1:39:15, Heart Center Half, 2013

                       

                      mab411


                      Proboscis Colossus

                        My general approach to patients is that if there are more than one diagnosis for a given symptom or finding, and one is potentially life threatening, then not simply choose the happy diagnosis.

                         

                        An abnormal ECG may well be because you are a thin, fit, athletic runner (they die from heart disease too, btw), and it may well be because you have serious heart disease. In my mind, it is incumbent on the healthcare professional to make sure that you don't have the potentially fatal cause.


                        Get that stress test.

                         

                        That's the plan.

                        "God guides us on our journey, but careful with those feet." - David Lee Roth, of all people

                        ShuffleFaster


                          I hate to bring this up, but in 2007 I had an EKG at my primary care doctor on one of those EKG machines you can find on ebay for about $350.  I was having weird symptoms - chest tightness, light headed, etc.  On the chart that the machine spit out the words "Borderline EKG" were clearly printed at the bottom.  I made an appointment with a cardiologist who gave me a nuclear stress test.  After the test he told me that the test was "normal" and that I needed to stop drinking so much beer and exercise more.  Ten months later I had a heart attack.

                           

                          Don't freak out here, please, it doesn't mean your case is like mine.  Fortunately, the damage was minimal and I have run 6 marathons since 2011 and I have another on the 20th.  I took the exercise to "heart" and I quit drinking anything with alcohol.  I also have a family history that oddly includes heart disease and longevity.  The mistake I made was staying with the same cardiologist.

                           

                          A year later, I had another nuclear stress test and this one showed that there was something wrong.  On a Friday, I was told to "be very careful" over the weekend and that I had a trip to the cath. lab. on the following Monday.  My wife was freaking out, but I made it to Monday, and...voila!......everything was fine.  It was a "false positive".  (As it turns out, that made the nuclear stress test 0 for 2 - one false negative and one false positive).

                           

                          I am mad at myself because I'm an engineer with a nuclear background.  When I went over how the nuclear stress test was conducted, I realized that the nuclear test was about as accurate as wetting your finger and sticking it in the air.  At this point, I would get very angry at any cardiologist who tried to convince someone to get a nuclear stress test.  My new cardiologist uses a regular stress test, which is what I believe you are getting.

                           

                          My advice is to listen to your body and be very honest about your symptoms with your cardiologist.  It sounds like you have a better cardiologist than I initially had.  I wish you the best - you are doing the right thing!

                           

                          Sorry to hear it went so poorly with you.  I wouldn't be mad at yourself--how were you to know?   I hope you are well now.

                           

                          What this points out is that any type of stress test, ECG, labs, whatever only form a part of risk stratification for acute coronary events.  I've taken care of at least 1 patient who had a whopping STEMI about 2 weeks after he was discharged from another hospital cardiology service with the diagnosis of "atypical chest pain" .

                           

                          Try as we might, short of doing a cardiac cath on everyone, we can't completely rule out bad cardiac events happening (and even that's been questioned lately).  The fact is:  we can't cath everyone, which is why surrogate testing is done.

                           

                          Therefore, stress tests must be interpreted in light of the context of the case/person as a whole, which is why the history and physical exam, the ability to correctly interpret ECG's and labs, and the clinical acumen of the cardiologist is so important.

                           

                          Nuclear stress tests do have their place in the work up of chest pain, but they must be ordered and utilized on the right patients using evidence based guidelines.

                           

                          That's why it's called risk stratification.  There will always be a small number of folks who even if the test is applied correctly, will go on to have a bad outcome.  All you can do is use the tests correctly and try to determine the highest risk people to cath.   It's also important to remember that population based statistics in no way predict the exact fate of an individual.

                           

                          Sadly, there is no secret ingredient, but your best defense is a smart, educated, well-trained physician at the bedside who cares about you as a person.

                          sbpbrent


                          Ludwig Classic Maple

                            I am doing very well, Shuffle, thanks!  I hope the OP gets a great check-up and has no further issues.  Unless someone gets Superman x-ray vision, then the angiogram is about the only way doctors can "see" into coronary arteries.

                             

                            In my case, the biggest problem was that my first cardiologist had a really bad business model.  He was trying to operate a one-doctor clinic. He had too many patients to spend time meeting with face-to-face, so he tried to make up the difference with a couple nurse practitioners and a bunch of tests - the more expensive the better.  After I left for another doctor, he ended up joining another cardiology office that was more conventional - one with enough cardiologists on staff to handle the patient load.

                             

                            What is most important for the OP, and anyone else who has similar concerns, is that it's most important to recognize that there is a fine line between hearing what you want to hear (that everything is OK) and really being honest with both yourself and your doctor when you suspect that something isn't quite right.

                            Marathon PR: 3:46:52, Denver R&R Marathon 2013

                            1/2 Marathon PR: 1:39:15, Heart Center Half, 2013

                             

                            mab411


                            Proboscis Colossus

                              Okay, so, stress test is tomorrow.

                               

                              How much should I taper?  Will there be stress test day packet pick up?  Most importantly, can I listen to earbuds during the stress test?

                              "God guides us on our journey, but careful with those feet." - David Lee Roth, of all people

                                Okay, so, stress test is tomorrow.

                                 

                                How much should I taper?  Will there be stress test day packet pick up?  Most importantly, can I listen to earbuds during the stress test?

                                 

                                Haha.  Enjoy, and I hope all is well.

                                A couple of years ago, I had a stress test for an abnormal EKG finding (RBBB), and the stress test was fairly routine.

                                No earbuds.

                                The workout results were finished earlier than I would have thought (maybe 20 minutes).  I remember it being more of a tempo and hill workout combined than a pure tempo workout.

                                The test results were also that quick.

                                I went back to the gym that afternoon to repeat the workout after getting the green light.  I enjoyed it.

                                2014 Goals:

                                #1: Do what I can do. <DOING>

                                #2: 365 Hours training <NOPE, INJURED>