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Syncope, palpitations, chest pain, pressure and stabbing. EKG shoed incomplete RBBB, myoglobin, troponin negative. Advise?

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syncope, palpitations and sob for several months. sudden onset of increase in these symptoms as well as the worst pain i have ever experienced in my life in my chest. severe pressure and stabbing. present to er, ekg shows incomplete rbbb and unable to rule out anterior infarct. labs are drawn within 20-30 minutes of onset of chest pain, myoglobin is present, troponin negative, ck and ckmb are close to abnormal ranges. strong family history of early mi. given ativan, gi cocktail and sent home after 2 hours. pain is gone but symptoms slighty present after 3 days. were they wrong to not repeat testing, suggest no follow up and not even mention that i had symptomatic rbbb.
Posted Wed, 23 May 2012 in Hypertension and Heart Disease
Answered by Dr. Ravindra L Kulkarni 1 hour later
Thanks for writing query.
As per history by you these are significant points to be taken:
Shortness of breath (SOB)
Increase frequency of chest pain, syncopal attacks.
Mild elevated cardiac enzymes, we definitely need to evaluate it further to rule to coronary artery disease.

ECG showing RBBB is not a serious thing to worry.
However considering strong family history and nature of complaints the typical treatment plan should include:
1 Detail cardiac risk evaluation, lab ~ lipid profile, blood sugar
2 consider to repeat troponin as it may be missed in early hours of chest pain
3 cardiologist examination along with echocardiography to asses pumping capacity of heart
4 stress test which will also determine severity of complaint like SOB and chest pain
5 If echocardiography and stress test indicate underlying heart problem, then consider for coronary angiography.

If you would have seen an expert cardiologist one should go by this plan. If not done this detail evaluation is essential. ER physicians would not manage as per the plan mentioned above. They should have referred you to a Cardiologist if they suspect.

Hope this information will help you. Please feel free to ask any query you have.

Wish you a good health.
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