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Chest pain, ECG and blood test normal. If a patient has a cardiac event, do symptoms worsen when running up steps?

DOCTOR OF THE MONTH - Jan 2013
Jan 2013
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Internal Medicine Specialist
Practicing since : 2003
Answered : 1658 Questions
Question
Fist and foremost this is for my information, I am not having any symptoms at all.

Without medication I have high tryglysorides and blood pressure. With medication Metoprolol Succ SR 25 MG, Famotidine (Pepsid)     20 MG, Lipitor 10 MG, Lisinopril 2.5 MG all my labs and BP are well within guidelines bp 126/64 pulse 56

As a general concept if a patient is having a cardiac event or MI would whatever symptoms a patient has usually get worse when the patient runs up a few flights of steps?

I had non specific chest pain last week, went to ER, and there there was no sense of urgency to treat me as I was not even hooked up to any monitor after my initial 12 lead ECG and blood draw showed normal.

Doctors in hospital evaded answering the above question.
Posted Sat, 29 Sep 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Mayank Bhargava 2 hours later
Hi XXXXXXX
Thanks for posting your query.
I have read whole blood reports and seen your ECG report.
Your ECG showed qs pattern in lead III and inverted T waves in V1.
Inverted T waves in female is a normal variant. Pathologic T wave must be equal to or more than 0.3 mm in size.
This inverted T waves is present only in one lead, for diagnosis any abnormality in ECG, abnormality should be present in minimum 2 leads.
Your blood reports are normal with normal Triglycerides and LDL.
Treatment of dyslipidemia is decided by LDL and Triglycerides. Your LDL is 52 and Triglycerides is 58, which is controlled range.
In fact, you can request your treating physician for stopping Lipitor.
Your pulse rate 56 bpm, you should request your physician for reducing the dose of Metoprolol from 25 mg to 12.5 mg.
Metoprolol is a beta blocker and heart rate should be tried to keep up to 60 bpm, not below this.
If a patient suffered from cardiac event and MI, then future performance depends on the percentage of heart damage.
You should consult with cardiologist and should go for 2 D echo for ejection fraction (EF) detection.
If EF is <15-20%, then only patient is not able to perform his routine daily activities.
In general, there are multiple causes of decreased ability and heart is not the sole organ for this.
Put your query if you have.
Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Chest pain, ECG and blood test normal. If a patient has a cardiac event, do symptoms worsen when running up steps? 13 minutes later
Doctor,

Thank you for the detailed answer about my ECG and labs.

I was in the ER this past Sunday. The next day Monday (two days ago) I had a stress ECG and echo that were nearly identical to November 2011. I also had blood drawn yesterday with a lipd panel and am waiting for results. Ill forward them to you when I get them.

I was told my heart is close to normal and there is very little damage.

My real question that I wish to have answered is: As a general concept if a patient is having a cardiac event or MI would whatever symptoms a patient has usually get worse when the patient runs up a few flights of steps?
 
 
Answered by Dr. Mayank Bhargava 14 minutes later
Hi XXXXXXX
I think I have already answered your question.
What you are asking is a normal phenomenon, whether patient is known case of cardiac disease or a normal healthy person.
When a person/ patient runs up a few flights of step, there is load on heart and heart starts pumping briskly. But still patient may have breathlessness.
This a normal phenomenon.
Sincerely,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Chest pain, ECG and blood test normal. If a patient has a cardiac event, do symptoms worsen when running up steps? 2 minutes later
With the moderate chest pain I had (not crushing, pressure or squeezing) I was able to run up a few flights of steps and even take a long walk up hill with no change in chest pain.

If a patient has moderate chest pain with an unknown cause (like I did) and running up a few flights of stairs does NOT make the chest pain get worse does that mean the cause of the chest pain is not cardiac?
 
 
Answered by Dr. Mayank Bhargava 5 minutes later
Hi,
Yes...you are right. If all your cardiac test appears to be normal and pain is not increasing then it is non-cardiac in origin.
Don't bother about this.
Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
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