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Hello, Just A Few Questions. On January 11th I Was
Question: Hello,
Just a few questions. On January 11th I was hit with excruciating chest pain upon waking up, vomiting, clammy, extreme dizziness & has taken by ambulance to the local ER. EKG's all came back sinus rhythm but my troponin was elevated so they kept me over night for observation due to covid & no beds available at a hospital with a XXXXXXX Lab. I was put on a handful of meds, beta blockers, plavix, a statin, etc. to hold me over until I could see my cardiologist. Before I could see my cardiologist it happened again on the 7th of February again it woke me up in the morning & was given nitro 3 times on the way to the heart hospital. Once getting there my troponin levels were elevated again but normal EKG. Kept my overnight for observation & an angiogram which showed 2 40% blockages in 2 of my arteries so no stents were placed. Told me I may be having coronary artery spasms & sent me home. 2 days later I am back in the hospital after it woke me up again with the same chest pain & symptoms. Again, troponin was elevated but ekg normal. Nothing was done for me, sat overnight in the ER & was sent home the next day. Saw my cardiologist yesterday and he's scheduling a stress test next week. He put me on Isosorbide Dindrte (not sure on the spelling) & Xanax (thinking it's just at my anxiety now) took my off plavix & coreg. Then mentioned esophageal spasms. I don't have GERD, heartburn, trouble swallowing or anything like that & how can an esophagus issue cause cardiac enzymes to show up in blood work? I am beyond frustrated & I feel like no one is listening to me. I am so worried it's my heart but the doctors are confusing me.
I have no history of heart problems, except I have been dealing with High blood pressure since my 4th was born 1.23.2020 after an emergency C-section due to sudden high blood at 36 weeks. I've been on low dose lisinopril over the past year for that. Other than that, my heart history is clear. I was diagnosed with Hypothyroidism (I take 100mcg pee day of levothyroxine) in 2012 & Multiple sclerosis in 2014 which is currently inactive & I do not take medication for it. I am 36 years old 215 pound, 5'8. Active daily.
Just a few questions. On January 11th I was hit with excruciating chest pain upon waking up, vomiting, clammy, extreme dizziness & has taken by ambulance to the local ER. EKG's all came back sinus rhythm but my troponin was elevated so they kept me over night for observation due to covid & no beds available at a hospital with a XXXXXXX Lab. I was put on a handful of meds, beta blockers, plavix, a statin, etc. to hold me over until I could see my cardiologist. Before I could see my cardiologist it happened again on the 7th of February again it woke me up in the morning & was given nitro 3 times on the way to the heart hospital. Once getting there my troponin levels were elevated again but normal EKG. Kept my overnight for observation & an angiogram which showed 2 40% blockages in 2 of my arteries so no stents were placed. Told me I may be having coronary artery spasms & sent me home. 2 days later I am back in the hospital after it woke me up again with the same chest pain & symptoms. Again, troponin was elevated but ekg normal. Nothing was done for me, sat overnight in the ER & was sent home the next day. Saw my cardiologist yesterday and he's scheduling a stress test next week. He put me on Isosorbide Dindrte (not sure on the spelling) & Xanax (thinking it's just at my anxiety now) took my off plavix & coreg. Then mentioned esophageal spasms. I don't have GERD, heartburn, trouble swallowing or anything like that & how can an esophagus issue cause cardiac enzymes to show up in blood work? I am beyond frustrated & I feel like no one is listening to me. I am so worried it's my heart but the doctors are confusing me.
I have no history of heart problems, except I have been dealing with High blood pressure since my 4th was born 1.23.2020 after an emergency C-section due to sudden high blood at 36 weeks. I've been on low dose lisinopril over the past year for that. Other than that, my heart history is clear. I was diagnosed with Hypothyroidism (I take 100mcg pee day of levothyroxine) in 2012 & Multiple sclerosis in 2014 which is currently inactive & I do not take medication for it. I am 36 years old 215 pound, 5'8. Active daily.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome to Ask a Doctor service!
I passed carefully through your question and would explain that cardiac stress testing (like recommended by your doctor) would be a rationale strategy to investigate potential inducible cardiac ischemia even in the apparently non-significant coronary stenosis.
In case exercise cardiac stress testing is inconclusive , then additional provocative cardiac imaging tests could be more helpful: cardiac stress echo and cardiac stress MRI depending on the available local expertise.
Another alternative would be investigating the hemodynamic significance of those coronary stenoses by evaluating FFR (fractional flow reserve ), but this is an invasive procedure (in the XXXXXXX lab).
You should discuss with your doctor on the above tests.
I hope you will find this information helpful!
I remain at your disposal in case of further questions whenever you need!
Kind regards,
Dr. Ilir Sharka, Cardiologist
I would recommend as follows:
Detailed Answer:
Hello!
Welcome to Ask a Doctor service!
I passed carefully through your question and would explain that cardiac stress testing (like recommended by your doctor) would be a rationale strategy to investigate potential inducible cardiac ischemia even in the apparently non-significant coronary stenosis.
In case exercise cardiac stress testing is inconclusive , then additional provocative cardiac imaging tests could be more helpful: cardiac stress echo and cardiac stress MRI depending on the available local expertise.
Another alternative would be investigating the hemodynamic significance of those coronary stenoses by evaluating FFR (fractional flow reserve ), but this is an invasive procedure (in the XXXXXXX lab).
You should discuss with your doctor on the above tests.
I hope you will find this information helpful!
I remain at your disposal in case of further questions whenever you need!
Kind regards,
Dr. Ilir Sharka, Cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Have you ever had a patient with elevated troponin due to esophageal spasms. I'm beside myself with the mention of that from my cardiologist because the pain I having is mid, left sided & between my shoulder blades with vomiting, cold sweats, etc. No issues swallowing, no reflux, no heartburn, nothing like that. They're saying they want to scope me if the stress test is inconclusive. I don't have pain when active or after eating, only in the early morning. One of the documents I have says Prinzmetal angina, I don't know what that is but was told to "push through the pain, it won't kill you" and that just broke my heart because they just aren't understanding the pain I am in, in those 30-45 minutes of no relief unless I use nitro (which scares me because my BP has been sitting in the 90/58ish category over the past month). I feel like I am going to just die from this. I am terrified to even sleep because that's when it happens.
Brief Answer:
I would recommend investigate further on the presence of cardiac ischemia.
Detailed Answer:
Hello again!
I agree with you on the fact that elevated troponin levels are not related to esophageal spasms.
So, we need to investigate further on your heart and on the possible presence of myocardial ischemia
Regarding Prinzmetal Angina or Variant Angina, it is a special type of cardiac ischemia caused by a spasm in the coronary arteries. It typically occurs while resting or in the early hours of the morning and it is severe, relieved by nitro. So, this can not be excluded either.
Coming to this point, the first thing to do is to investigate potential inducible cardiac ischemia even in the apparently non-significant coronary stenosis.
For this reason, it it important performing the above mentioned cardiac tests.
In case exercise cardiac stress testing is inconclusive , then additional provocative cardiac imaging tests could be more helpful: cardiac stress echo and cardiac stress MRI depending on the available local expertise.
Another alternative would be investigating the hemodynamic significance of those coronary stenoses by evaluating FFR (fractional flow reserve ), but this is an invasive procedure (in the XXXXXXX lab).
You should discuss with your cardiologist on the above tests.
Hope to have been helpful!
Wishing all the best,
Dr. Iliri
I would recommend investigate further on the presence of cardiac ischemia.
Detailed Answer:
Hello again!
I agree with you on the fact that elevated troponin levels are not related to esophageal spasms.
So, we need to investigate further on your heart and on the possible presence of myocardial ischemia
Regarding Prinzmetal Angina or Variant Angina, it is a special type of cardiac ischemia caused by a spasm in the coronary arteries. It typically occurs while resting or in the early hours of the morning and it is severe, relieved by nitro. So, this can not be excluded either.
Coming to this point, the first thing to do is to investigate potential inducible cardiac ischemia even in the apparently non-significant coronary stenosis.
For this reason, it it important performing the above mentioned cardiac tests.
In case exercise cardiac stress testing is inconclusive , then additional provocative cardiac imaging tests could be more helpful: cardiac stress echo and cardiac stress MRI depending on the available local expertise.
Another alternative would be investigating the hemodynamic significance of those coronary stenoses by evaluating FFR (fractional flow reserve ), but this is an invasive procedure (in the XXXXXXX lab).
You should discuss with your cardiologist on the above tests.
Hope to have been helpful!
Wishing all the best,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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