I'm still stuck on the difficulty breathing and pain that radiates to both arms. Does anybody else think Prinzmetal's angina is in the differential here? Retnav, did they do coronary angiography?
chest pain and hard to breathe, I need some help here
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Cruisin Home
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Nuclear SPECT scans are not CT scans.
Cruisin Home
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I agree with you Duke. Acid reflux does not fit the symptoms originally posted. Many DDXs to consider. He quoted pain while standing up working on his MC. Normally acid reflux might give problems while lying down, particularly at night.
He also said his symptoms were exertional, which is certainly not typical of esophagitis. Prinzmetal's could CERTAINLY be in the differential; chronic dissection, maybe. I agree that ruling out ischemia with just a nuc med test is inadequate.
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retnav7696
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I am assuming coronary angiography is where they go through my groin area? If thats correct then no they have not. They said because of the nuclear test I do not warrent that. They (VA) have now changed my meds to PROTONICS I have not got them yet but these new meds are on the way. Today is the 1st of November and I am scheduled for shoulder surgery on the 5th of November. Should I say no or let them do it? I walk 30 feet and have to stop so that I can catch my breath and breathe ok, tightness in my chest and I still have pain in both arms(it feels like my bones in my arms hurt). After I stop for 2-3 minutes I'm ok. Thats 2 minutes minimum and normally 3 minutes maximum. Believe me I am paying attention. Anyone heard of Barretts diesease? The one VA doctor thinks thats it, but needs me to be scoped to verify!
The groin is the usual access point for an angiogram. AFAIK, an angiogram is still the gold standard for coronary artery examination.
Employing a Holter monitor for longterm ECG study is another possibility.
Without more info about the shoulder surgery, it would be best to discuss that with the surgeon, obviously emphasizing your current situation with chest pains. Your new complaints are worrying.
Of course, the current course of cardiopulmonary and GI examinations must be played out. But I'm still struck by the coincidence of your exertions on the dive boat ladder and subsequent complaints. To my way of thinking, that's reason to look for an acute, possibly traumatic cause; e.g. my early thoughts of a hiatal hernia. If all exams continue to remain unrevealing, I would consider an orthopedic or neurologic referral, especially looking at the nerve bundles related to the lower cervical and upper thoracic spine. These are related to the (referred) pain patterns of cardiac events. Problems in this area, such as a slipped disc (possibly secondary to unbalanced muscular forces, degenerative diseases, or a combination), can on rare occasions produce chest and pain radiation patterns which could mimic a cardiac cause.
Employing a Holter monitor for longterm ECG study is another possibility.
Without more info about the shoulder surgery, it would be best to discuss that with the surgeon, obviously emphasizing your current situation with chest pains. Your new complaints are worrying.
Of course, the current course of cardiopulmonary and GI examinations must be played out. But I'm still struck by the coincidence of your exertions on the dive boat ladder and subsequent complaints. To my way of thinking, that's reason to look for an acute, possibly traumatic cause; e.g. my early thoughts of a hiatal hernia. If all exams continue to remain unrevealing, I would consider an orthopedic or neurologic referral, especially looking at the nerve bundles related to the lower cervical and upper thoracic spine. These are related to the (referred) pain patterns of cardiac events. Problems in this area, such as a slipped disc (possibly secondary to unbalanced muscular forces, degenerative diseases, or a combination), can on rare occasions produce chest and pain radiation patterns which could mimic a cardiac cause.
ScubaNurse758
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In regards to the diving connection to your symptoms, I would venture that is purely coincidental. I do believe that Urban Meyer (head football coach at University of Florida) had similar symptoms that landed him in the ER late last year that was eventually diagnosed as esophogeal spasms. I would definitely be interested in the GI scope results, but as a critical care RN with a background in interventional cardiology, I personally would refuse to undergo any surgery and or general anesthesia without a cardiac cath, that's the only definitive diagnoses to confirm/rule out any degree of coronary ischemia. I have seen too many patients with normal nuclear scans that ended up with stents and or CABG. And a quick aside on cardiac caths, groin is the traditional access for this procedure, but more recently depending on where the cardiologist trained and anatomical anomalies, radial (wrist) or brachial (elbow) access can also be done, but I'd go ahead and plan for the free brazilian shave job!
Best of luck either way.
Best of luck either way.
The exertional component of your pain really worries me. Esophageal pain is not exertional -- it may be related to meals or not, but it doesn't come on with exercise, and it doesn't resolve with rest.
I think you need an angiogram. It may come out normal, but honestly, your description of your persistent symptoms has me really worried. Nuclear medicine testing isn't perfect or we wouldn't still DO coronary arteriography.
I think you need an angiogram. It may come out normal, but honestly, your description of your persistent symptoms has me really worried. Nuclear medicine testing isn't perfect or we wouldn't still DO coronary arteriography.
Gotta love scubaboard. As an outsider listening in I want to give a big shout out (thanks) to those sharing their expertise purely out of concern for one of our fellow scubaboarders. It is touching to sense the urgency expressed to encourage him to get further examination. Good luck and godspeed
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