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Angina pectoris - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1762 Questions
User :   Female age 53 / Father heart attack at age 50 / stopped smoking about 23 years ago / high colesterol / I was just discharged from the hospital... I went to ER due to pain under my left shoulder blade that went into my left arm for three days... which had started after cliambing 4 flights of stairs each day.. 2 low does asprin would cause the pain to subside but my Dr. told me to go to ER... now days after all tests possible EKG... blood work ... Thalyum Stress test.. echochardiogram... I'm told everything is normal... The Dr. has me set for the XXXXXXXX lab on Monday I think jus to set my mind at ease... ... Also during the stress test I had the pain under my shouldblade that also went to my chest.. ekg stayed normal! Due to the fact that all other tests came back oXXXXXXXX ... What else could this be
Doctor :   Hi
User :   Hi Doctor
Doctor :  
Let me read it.
Doctor :   Did you have similar pain in the past?\
Doctor :   Are you there?
User :   only on occasion but again early in the day at work after I had climbed the stairs... I've kept low dose asprin at my desk and have taken them when felt the discomfort in retrospect now that you ask I did recently by a new bottle after using all that I had over that last few weeks.
Doctor :   Ok.

Doctor :   I shall explain it to you.
User :   The pain is a pressure under my left shoulder blade... which ends up going into my left arm .. making my left arm weak .. on day two it went up my neck with slight pain and the along my jaw
User :   ok
Doctor :  
There are two causes for such pains.
Doctor :  
1. Angina pectoris
Doctor :  
\2. Myocardial infarction which is a severe form of angina pectoris.
Doctor :  
Since there was no other symptoms associated with pain, it may not have been MI
Doctor :  
The tests that were done to you till now are indirect evidences.\
Doctor :  
The confirmatory evidence to know if these symptoms were part of angina or were these just symptoms of stress will be known by an angiogram.
Doctor :   A negative report on angiogram may indicated that the pain was non cardiac and could have been induced by stress factors.
Doctor :  
Have you followed?
User :   Yes
Doctor :   These tests are essential because
Doctor :  
1. You have classic symptoms of stable angina
User :   So the Angina Pectoris symtoms can come on with pain under the shoulder blade after excercise
Doctor :  
2. You have a family history.
Doctor :  
3. You have risk factors too.
Doctor :  
Angina pectoris is defined as pain in the thoracic region, most commonly on the left side of the chest radiating to the left limbs or the neck.
Doctor :  
When this occurs with exertion, this is known as stable angina.
User :   Would any of the tests that I mentioned have picked up on angina?
Doctor :  
ECG and Thread mill test can pick up the angina.
User :   Do you consider the chest the front and the back ( I've heard so much in the last few days
Doctor :  
Classically the front, but it is not common to have pain in the back too.
Doctor :  
Have you followed?
User :   YES ...Did the stress test laying down with injection ... EKG stayed normal but I had pain under my shoulder blade and chest
Doctor :   That is the reason why angiogram is very necessary.
Doctor :  
Since you did have the symptoms,
User :   is angiogram the same as XXXXXXXX lab?
Doctor :  
it is necessary to see if you have the condition.
Doctor :  
XXXXXXXX lab is the place or the lab where angiogram would be done.
Doctor :  
Have you followed?
User :   Yes I am told they will move a tube through my arm and into my heart to look around
Doctor :  
It is a minor procedure, but an invasive procedure.
Doctor :  
A small chord like tube would be passed through the vein.
Doctor :  
It can occur through the arm or through the lower limb.
User :   if I have stable angina will there be signs of it?
Doctor :  
Then a dye would be injected followed taking a scan.
Doctor :   Angina whether stable or unstable occurs due to obstruction of the blood vessels of the heart.
Doctor :  
That is what is looked for in this test.
Doctor :  
So if any blocks in the circulation are found then it would imply that your symptoms were do to angina.
Doctor :  
Have you followed?
User :   So... is it possible to go through all the test I have taken already .. stress test and photos ecogram and not picked up on blockage
Doctor :   Yes, Occasionally the EKG and Stress test may not pick up evidences of blockage.
Doctor :   Have you followed?
User :   Yes
Doctor :  
Do you have any other query?
User :   No Not other than if it is confirmed as such ... is there treatment?
Doctor :  
Yes.
Doctor :   The primary treatment would be release of the blocks, if the blocks are major.
Doctor :  
The primary treatment includes stent placement/angioplasty/bypass surgery which ever is feasible.
Doctor :  
If the blocks are minor, it can be managed by aspirin.
Doctor :  
Apart from these you may have to quit smoking.
Doctor :  
Cholesterols have to be kept under control.
Doctor :  
Regular weight reducing exercises may be needed.
Doctor :  
Have you followed?
User :   Sorry you must have mis understood I haven't smoked in 23 years
Doctor :  
And regular follow up may be needed.
User :   oh no you misunderstood I have not smoked for 23 years ... sorry
Doctor :  
Sorry.
User :   so XXXXXXXX
Doctor :  
But the other measures are essential.
Doctor :  
Have you followed?
User :   yes
Doctor :  
Do you have any other query?
User :   No you've been very kind taking the time Thank you
Doctor :  
Please fill the feed back form too.
Doctor :  
Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
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