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Hypothyroidiam, reflux problem, anxiety, shoulder pain. How accurate is EKG, 12 lead and blood tests in predicting heart attacks?

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Practicing since : 1981
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pain how accurate is a 12 lead, ekg, and blood work on predicting a heart attack cause I have all the symptoms of a heart attack and I've been too the er thousands of time had all those test ran keep saying its not my heart what should I do I'm 27 yr old female only have hypothyroid diease ,reflux,anxieties, I'm scared cause I don't no what else to do I have pain in inside of both arms,Sharp stabbing pain in shoulder blade, short of breath, fast heart rate please someone help ....
Posted Fri, 22 Jun 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 3 hours later
Thanks for writing in.
I am a cardiologist and on an average deal with 3 patients every week presenting to emergency room with chest pain. A normal EKG and normal blood work can reasonably rule out a heart attack. World Health Organisation (WHO) has laid down criteria to diagnose heart attack (Myocardial Infarction) for pain may be typical squeezing and yet the heart coronaries may be normal on the other hand pain may be absent still the person is having unstable angina, acute coronary syndrome or Heart Attack meaning thereby coronary artery disease may still be damaging the heart. WHO's criteria are if you fulfill 2 out of 3 criteria you are in all probability suffering from heart attack:
1. Pain, central, retro sternal, squeezing usually associated with breathlessness,
sweating, rapid heart rate and rapid respiratory rate.

2. Abnormal EKG (Practically 2 EKGs done 6 hours apart should show no recent
ischemic change then it is considered to have normal EKG)

3. Abnormal cardiac enzyme on blood test (most common enzyme to rise is MB
fraction of CPK others are Troponin T & I levels and serum myoglobulin).

With these criteria, your doctor also assess your risk factor profile and if you are sent home that means you have practically nothing to suggest Heart Attack for threshold of admission in a suspected heart attack is kept low. We do not want to miss any.
Your chest pain could be due to anxiety or due to reflux disease. For management of reflux, i would suggest the following:
a.     Have small meals at regular intervals
b.     Keep your head elevated at night using 2-3 pillows
c.     Avoid caffeine, alcohol and tobacco
d.     You can take Tablet Prevacid OTC once daily whenever you have chest pain.
You can minimize your anxiety by XXXXXXX breathing, yoga and some meditation. Talking to friends and family will also help. You can speak with a psychiatrist if the symptoms still persist.

I hope I have answered your question. If not, please get back for any clarification.

Best Wishes

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Hypothyroidiam, reflux problem, anxiety, shoulder pain. How accurate is EKG, 12 lead and blood tests in predicting heart attacks? 35 hours later
Ok so I would ask this I've been to the hospital a lot have seen a cardiogisit last year did a stress test ,xray,blood work, ekgs, 12 leads, my symptoms are: short of breath- achy arms insides, neck,shoulder,jaw pain on left side, I even get horrible naseaua, lightheaded,headaches,and bad Sharp pains under breast n shoulder blade.. very scary and they keep telling me its not my heart but very hard to believe for me I'm 27 and 5'5 250 so I'm over weight ,I only have thyroid ,reflux,anxeity that I kno of my cholesterol was high until they fixed my thyroid but now it bak to normal so what could be causing all the symptoms I have 3 kids and I can't even take care of them because of all the pain I go thru on a daily basis what can you tell me that can reassure me that its not my heart that the other Dr can't I'm at loss for words on this just two days ago my heart jump up to 180 was clammy, pain in both arms, gel like I'm suffocating they hooked me to 12 lead ,heart montior said heart was fine sent me home with a xanxa still with pain please help thank you
Answered by Dr. Anil Grover 2 hours later
I am going by the information provided by you. Certainly it was your heart which was beating at the rate of 180. I would be wrong if I say your thyroid is now not playing any role in your symptoms : Your being overweight, having high cholesterol and anxiety means that evrything is not perfect. Nonetheless, tolerating 3 pregnancies and repeatedly different times yourr cardiac workup being normal takes me away from heart disease.
Though, I have learnt it hardway after comitting errors of judgement when I disbelieved the patient, I will suggest you to consult a cardiologist in person and tell the whole story with this conversation included. You may be advised to undergo either of three tests:
1. Stress Thallium or
2. CT angio of coronaries or
3 Conventional coronary angiography.
That will objectively decide the question. Thereafter have trust in professsional judgement.

Best wishes

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Hypothyroidiam, reflux problem, anxiety, shoulder pain. How accurate is EKG, 12 lead and blood tests in predicting heart attacks? 2 hours later
Ok I completely understand you and as I said my thyroid is under control now and my cholesterol is back to normal, so with that said last year in Aug, and Nov I seen two different cardiogisit that did xray, ekg, blood work and stress test that all came back great so with that said they won't do any future test cause they say it all looks good so what now :) Like today I woke up had horrible pain n my jaw ,and I've already seen a dentist I do have some teeth damage ,also I had sharp pains in back in chest, neck and shoulder and felt as if the room was spinning and I couldn't get it to stop I think I'm more scared than anything because I kno young women can have heart attacks and Dr miss it and send them home to find out they die 24 hrs later of a massive heart attack so just wondering how I would need to go about this and if not my heart then what else is causing all these pains and symptoms of heart when its not?? I thank u for taking the time to hear me out just need a lil more perspective on this cause my husband stays gone a week at a time so it would help to no a lil more as to why its not my heart as u said Dr see young women and don't think heart related but truth be told a lot of younger women die from heart disease help me understand better thank you XXXXXXX
Answered by Dr. Anil Grover 2 hours later
It is a pleasure interacting with you. Agreed, that coronary artery disease can occur in a young women and it is not common to send back some patients of chest pain from ER back to home. It is simply that law of probability has been used along with other features of presentation that makes a given hypothetical patient DOES NOT have heart disease. As emergency room attending doctor we are trained to keep threshold of admission very high, it does not matter if you admit twenty patients and ten turns out to be normal. Chances of error judgment would mean criminal negligence for the doctor, so I referred to 2 cases in thirty years of practice (by the way two of these thirty years were in the US). Now tell me any sane doctor would send a heart disease symptomatic patient home and commit professional misjudgement?

It is good your cholesterol is normal but I wish we can say same thing for anxiety and your weight. Your concerns are to an extent justified but I still see no reason for worry! It’s time to move on, that does not mean you stop consulting your primary doctor who is keeping watch on thyroid, let him/ her decide when you ought to see a cardiologist. Have faith and start living without fear of some unknown disease. Have a good day or what is left of it. You are always welcome to ask a follow up question.
Good luck.

Dr Anil Grover, MBBS, MD(Medicine), DM(Cardiology)
Above answer was peer-reviewed by
Follow-up: Hypothyroidiam, reflux problem, anxiety, shoulder pain. How accurate is EKG, 12 lead and blood tests in predicting heart attacks? 4 days later
Ok so another question I drove a 30 he trip two days ago got home been have a lil cheat pain ,serve burning in throat, bleching,tight feeling n back,throat get to feeling anxious like I can't breathe and my heart rate has been up to 136 n higher please help me can mi reflux be causing this I have a lot of problems I ate last night after wards heart rate jump up it went down after a bout 30 mins or so then this morning I'm XXXXXXX bad burning n throat again sure this isn't heart related I'm so scared just need more in put on my different pains , and also I talked to u bout the leg n thigh paain I've been having well now its worse from the 30 hr drive do u think its a clot I'm scared
Follow-up: Hypothyroidiam, reflux problem, anxiety, shoulder pain. How accurate is EKG, 12 lead and blood tests in predicting heart attacks? 7 days later
and another question I have woke up every morning with serve left arm pain tingling in pinky,and ring side of palm also I been having serve ,serve burning in my throat for past 3 days now and I've took everything possible for it and it won't go away any suggestions and could this possibly be heart related every once n awhile ill get Sharp pains under left breast too I'm freaking out I have been feeling so sick to mi stomach and I don't know what else to do I've been to the er so many times they just send me home and I can't get into my Dr for another two weeks :( So if u could give me some advice as to what to do for these problems I've done just about all I kno to do just don't think I can take much more pain
Answered by Dr. Anil Grover 42 minutes later
Contrary to popular belief human, the heart is central organ and is not left sided. The pain in the left arm you are describing with tingling looks more like cervical spondylitis. All the nerves supplying areas above stomach on both sides come from and take sensation to spinal cord through your neck bones. Tingling is typical symptom for irritation of nerve. You said that you are sick in stomach and you have severe burning in throat. These are also not symptoms of heart. In the very first mail I had described what you ought to do and try Prevacid OTC once a day. How about giving that a try? If you feel as bad thereafter, I will recommend you have a visit to emergency room. Trust the treatment advised or administered to you there in good faith. You will feel better.
Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
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