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Chest Pains In The Morning. Dr Did ECG, All Normal, Gave Dexilant. Should We Go For Further Tests ?
Question: Hi my mom (75yoa) had chest pains this morning and didnt want to go to the er. I took her to a doctor at an urgent care and he did an ecg. It came back normal and he gave her dexilant and said it was stomach related. Should I still take her for more testing?
or is the normal ecg enough?
or is the normal ecg enough?
Hi XXXXXXX,
Thanks for your perceptive question.
Yes, the first possibility in a 75 year old lady with chest pain is that of coronary artery disease. A normal EKG does not always rules out that possibility. The point that it was relieved by stomach related medicine does not help much. According to WHO criteria two out three should be negative to exclude heart attack for chest pain:
1. Normal EKG (practically two EKGs separated by 6 hours showing no changes)
2. Normal Cardiac enzymes (CPK MB and Troponin are two most frequent enzymes)
3. Absence of Chest Pain
.....so far only one criteria has been satisfied.
Another normal EKG and blood study for enzyme will exclude Heart Attack (Myocardial Infarction) and depending upon the condition of your mother sometime in next one week, a normal Tread Mill Test or Stress Thallium will be able to exclude angina. While you are there, your doctor would assess for risk factors for coronary artery heart disease and advise accordingly. Then we would be sure that she is not suffering from ischemic heart disease and is not predisposed to it. Before that, taking one EKG as conclusive evidence will be premature. She does need more testing as of now.
I hope I have answered your question. If you need any clarification, I will be happy to help.
With Best Wishes
Dr Anil Grover
Thanks for your perceptive question.
Yes, the first possibility in a 75 year old lady with chest pain is that of coronary artery disease. A normal EKG does not always rules out that possibility. The point that it was relieved by stomach related medicine does not help much. According to WHO criteria two out three should be negative to exclude heart attack for chest pain:
1. Normal EKG (practically two EKGs separated by 6 hours showing no changes)
2. Normal Cardiac enzymes (CPK MB and Troponin are two most frequent enzymes)
3. Absence of Chest Pain
.....so far only one criteria has been satisfied.
Another normal EKG and blood study for enzyme will exclude Heart Attack (Myocardial Infarction) and depending upon the condition of your mother sometime in next one week, a normal Tread Mill Test or Stress Thallium will be able to exclude angina. While you are there, your doctor would assess for risk factors for coronary artery heart disease and advise accordingly. Then we would be sure that she is not suffering from ischemic heart disease and is not predisposed to it. Before that, taking one EKG as conclusive evidence will be premature. She does need more testing as of now.
I hope I have answered your question. If you need any clarification, I will be happy to help.
With Best Wishes
Dr Anil Grover
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Aparna Kohli
Answered by
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