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Could I have Micro cardiovascular disease?

By August 5, 2010 - 4:25am
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I have been having chest pain since 2006. I started having rapid heartbeats that got to 180 and went to ER. They kept me in ER for several hours trying to get it down. I was kept in hospital and I was given stressed test (I passed). I wore heart monitor while in hospital (I was told it was fine, just PVP's. I had heart nuclear test (negative). Echo was negative. I was diagnosed with high blood pressure and put on Atenelol , diagnosed with high cholesterol and put on 10 mg of Liptor and sent home. Chest pain did not let up and I went back to ER. Readmitted still could not find anything wrong. I was then told it was all in my head and was put on anxiety meds. Anxiety meds did not help the symptoms of constant chest pain and rapid heart heat. Started having severe leg pains, went back to Dr who then sent me to ER for D-Dimer test. I was told the test was highly elevated. They did a blood test and found the my potassium level was 2.6. I was given two potassium pills. They gave me a CT scan to check for blood clot and doplar which was both negative. Sent home told still anxiety. I knew in my heart that the reason I was anxious was because no one was taking me serious. I told myself I would just have to live with it, but it got to where I could not even walk to the bathroom without getting shortness of breath. Finally in 2008, my Dr. ordered a CT scan of my chest, I was found to have a small amount of water around my heart but was told it was not enough to cause me any problems. My ankles, legs and hands would swell, I was given Lasix with potassium pills to take. My condition got so bad that I had to move back home with my dad in 2009. I was having pain all over my body which pain meds did not help. I went to a Internist in a small town when I moved back home. He listened to my symptoms and ask if my CPK levels had ever been checked (they hadn't). The results came back 10 times the level they should have been. He took me off Lipitor and told me to take 2 baby aspirin everyday. Chest pain was still constant. Went to another Cardiologist who ran EKG (said it was abnormal) and did a nuclear stress test (negative). I was sent for a heart cath which came back negative. Here it is 2010 and I am still have constant chest pains, shortness of breath, leg, hand and ankle swelling. The pain sometimes feels like my heart is being shocked. My cousin came across an article about Micro cardiovascular disease in women and she felt I had a lot of the symptoms. I started looking online and my symptoms are some of the same. I have had some stress in my life, my pet of 13 years died, my Mom died and I am in a bad marriage, I also went to a psychiatrist who told me that anxiety would not caused me to have all this chest pain and health problems and told me to shout from the mountain top that I knew my body and that he felt something was wrong that had not been properly diagnosed. I feel as if I will have to die first and will only be diagnosed by an autopsy, Could you please give me some insight on what maybe going wrong? Some things i forgot was I was admitted again in 2009 to hospital with a potassium level of 2.9. I was given potassium IV was was sent home when level went back to normal. As I type this I am short of breath, have chest pains and my right ankle and hands are swelled. Any input would be greatly appreciated. Thanks so much.

P.S. I have taken Lasix for 3 days and I have not noticed that I going to the bathroom to urinate anymore than when I hadn't taken it.

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Dear Dianne,

I am sorry about your difficulties. You describe a very frustrating four year experience. Unfortunately, there are many women with similar stories. In the medical world your main problem is described as “atypical” chest pain to distinguish it from “typical” angina chest pain cause by coronary artery blockages. Unfortunately what is considered “typical” for men is often not how things present in women. The evaluation and treatment of atypical chest pain, especially in women, can be difficult and frustrating for the doctor and more importantly the patient. The difficulty arises from the fact that the symptoms can be vague and unpredictable; there are a wide variety of possible causes not just from the heart but other areas such as the esophagus, the chest wall, etc.

As with most women in your situation, you have over time had a variety of standard tests by several doctors to rule out the most typical causes of chest pain including stress tests, echocardiograms, CT scans and a heart cath (coronary angiogram). These can rule out serious problems like coronary artery blockages, valve problems, heart muscles problems, etc.

A couple of things I did not see in your history. One is a gastrointestinal evaluation. Esophageal problems like spasm and reflux (GERD) can mimic heart pains. Another is a more complete evaluation for heart arrhythmias like atrial fibrillation, flutter or other types of SVT. You describe episodes of a rapid heartbeat and wearing a heart monitor while in the hospital but there are monitors that can be worn up to a month to see if your symptoms correlate with episodes of an abnormal heart rhythm.

Finally, there are a couple of heart conditions that can mimic angina-type heart pains. Again, the typical cause of angina is a blockage in a coronary artery that can be clearly seen on a heart cath. In some patients with variant angina (also known as Prinzmetal’s angina) the arteries do not have visible blockages but can develop intermittent spasm or tightening.

The other condition, which your cousin mentioned, is called microvascular angina or cardiac syndrome X (CSX). In this condition the problem is not in the bigger arteries on the surface of the heart that can be visualized on the heart cath but in the small microscopic arteries within the heart muscle. The precise mechanism is not well understood but they appear to difficulty relaxing to the usual triggers. There is also a suggestion that the pain signaling mechanisms in the heart are extra sensitive. CSX is more common in women, especially post-menopausal women, and there has been some evidence that estrogen deficiency may play a role. In the classic definition of CSX patients, unlike you, have an abnormal stress test but many now feel it can occur with a normal stress test. There are several additional studies that can help in showing the microvascular problem. A heart cath with measurement of “coronary flow reserve” can show that the microscopic arteries don’t relax to a chemical trigger (adenosine). PET scans and MRI can also pick up microvascular flow abnormalities. There are a variety of treatment options for CSX, not all are 100% effective and the response can vary among patients. As always, the traditional advice for staying heart health apply – diet, exercise, stress reduction, blood pressure control, cholesterol control, not smoking, good sleep habits, etc.

The most important thing is to not give up and assume you have to live with your symptoms. Continue to take an active role in your health. It is important to try and find a specialist with experience evaluating unusual causes of chest pain in women like I have described above. We might be able to help you in that search.

Hope that helps and good luck.

Dr. Aklog

August 6, 2010 - 1:45pm
EmpowHER Guest
Anonymous (reply to Dr. Lishan Aklog)

Thanks so much Dr. Aklog. I did have a GI work up of endoscopy and colonoscopy. The Doctor told me I had the bacteria that causes ulcers and he removed a polyp that was pre-cancerous. I took the Prev-pack for 2 weeks. He actually showed me the pictures of my stomach and it was what he called blood red. So I know I have those issues, Sometimes the only relief from the heartburn is baking soda. GI problems couldn't possibly be causing the rapid heartbeats, shortness of breath, or the swelling issues could they? Something the cardiologist told me left me puzzled. He said that maybe the abnormal EKG was normal for me. Did not understand that at all. Women are never treated fairly when it comes to chest pain. We are mostly told it is anxiety and all in our heads which is a bunch of crap. I was watching Dr. Oz the other day and he said the same thing, women are not taken as seriously as men and that heart disease is the number one killer of women. He said that women have to demand to be taken seriously. How sad is that. Anyway I am still in pain, still short of breath and still swelling. I live is a small town where health care is not readily available. I have to travel at least 2 hours away. How do I go about finding a Dr that specializes in treating undiagnosed chest pain in women. Thanks again.

August 16, 2010 - 10:39pm

Hi Dianne Claxton,
Thank you for your question, and for being on top of your health. Here is a link from the Mayo Clinic website on small vessel disease, it may help you in working with your doctor:
I'm also going to forward your question to one of our doctor resources to get his take on your symptoms.
In the meantime there are some things you can do to help your situation, as outlined on the "Prevention" page of the Mayo Clinic information, by following a heart healthy diet, and walking a little bit each day, only consuming one alcoholic drink a day (if you drink), managing stress, and getting your cholesterol checked regularly, you may be able to improve function of your system. Go slow, start small, and rest as needed. More information about prevention:
Good luck and let us know how you're doing. I will let you know if I hear back from our expert resource.

August 5, 2010 - 9:20am
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