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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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I am sorry if I sound like a broken record,

Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7096 Questions

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Posted on Fri, 5 Apr 2019 in Hypertension and Heart Disease
Question: I am sorry if I sound like a broken record, but can an ECG show angina? I just saw my GP and she has now ordered a Mibi test since I cannot do the normal stress test (claudication). She wishes to rule everything out...I had an ECG last Thursday and all was OK...When I press with a finger between my ribs in three spots (top to bottom) on my sternum, I get pain. And at times, I get an ache across my chest after walking and a pressure feeling...pain is 4, 5 out of 10.

I am anxious...sorry about that. Any information would be appreciated doctor. I sleep OK though.
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Follow up: Dr. Ilir Sharka 0 minute later
I am sorry if I sound like a broken record, but can an ECG show angina? I just saw my GP and she has now ordered a Mibi test since I cannot do the normal stress test (claudication). She wishes to rule everything out...I had an ECG last Thursday and all was OK...When I press with a finger between my ribs in three spots (top to bottom) on my sternum, I get pain. And at times, I get an ache across my chest after walking and a pressure feeling...pain is 4, 5 out of 10.

I am anxious...sorry about that. Any information would be appreciated doctor. I sleep OK though.
doctor
Answered by Dr. Ilir Sharka 59 minutes later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome to Ask a Doctor service!

I passed carefully through your question and would explain that the fact that pressure on this sternum can trigger the chest pain is not suggestive of coronary artery disease, but could be indicative of musculo-skeletal pain (including costo-chondritis).

The pain and pressure feeling while walking, could be related to the heart.

A resting ECG is not specific test for coronary artery disease or angina. It should be coupled with the patients clinical symptoms and cardiac enzyme levels.

For this reason, I agree with your doctor on the recommendation for a Mibi test, in order to exclude possible coronary artery disease.

Other test options to help investigate for coronary artery disease would be:

- dobutamine cardiac stress echo
- coronary angio CT scan.

You should discuss with your doctor on the above test options.

I remain at your disposal for any further questions whenever you need!

Wishing all the best,

Dr. Ilir Sharka, Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ilir Sharka 0 minute later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome to Ask a Doctor service!

I passed carefully through your question and would explain that the fact that pressure on this sternum can trigger the chest pain is not suggestive of coronary artery disease, but could be indicative of musculo-skeletal pain (including costo-chondritis).

The pain and pressure feeling while walking, could be related to the heart.

A resting ECG is not specific test for coronary artery disease or angina. It should be coupled with the patients clinical symptoms and cardiac enzyme levels.

For this reason, I agree with your doctor on the recommendation for a Mibi test, in order to exclude possible coronary artery disease.

Other test options to help investigate for coronary artery disease would be:

- dobutamine cardiac stress echo
- coronary angio CT scan.

You should discuss with your doctor on the above test options.

I remain at your disposal for any further questions whenever you need!

Wishing all the best,

Dr. Ilir Sharka, Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 41 minutes later
Doctor - OK, I am going for a Mibi asap.

Physical activity - including walking - that makes the ribs move can indicate costochondritis, according to you, four days ago...In my case, it began about a month ago after a bad cold when I coughed and coughed and sneezed very much. And last Thursday, I reached very strenuously for some items in the closet...

Here is what you wrote below:

''Anyway, there are symptomatic clues that help in making the difference between constochondritis and cardiac angina.''

''Pain intensity modulation from arm and body movements, from local palpation and respiration are clue elements in favor of costochondritis. Also, local swelling and temperature are frequently found.''

''Now, coming to your case, it can be concluded that the actual symptomatology is due to the local inflammation (costochondritis) which may be disturbing when moving and walking too."

Mayo clinic says that an ECG Electrocardiogram (ECG or EKG) can see if the blood flow through your heart has been slowed or interrupted or if you're having a heart attack, or had a heart attack.

So, what do I do now while waiting for the Mibi? I have nitro spray in case....My chest pain is an aching one...not a crushing or stabbing one...My doctor listened to my heart today also and all was good.

Attached is the ECG from last Thursday plus my Echo cardiogram from last March 2018 which was identical to one taken this past December 2018. My muscolo-skeletal system is not good since I have spinal stenosis and spondyolisthesis, so when I walk, I get tired quickly along with the vascular claudication. WE discussed that at one point. The pain on walking is not pain - it is a pressure feeling only...in upper chest.

When I press the three points on my sternum, it is localized pain right under my finger...
So, what do you think?



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Follow up: Dr. Ilir Sharka 0 minute later
Doctor - OK, I am going for a Mibi asap.

Physical activity - including walking - that makes the ribs move can indicate costochondritis, according to you, four days ago...In my case, it began about a month ago after a bad cold when I coughed and coughed and sneezed very much. And last Thursday, I reached very strenuously for some items in the closet...

Here is what you wrote below:

''Anyway, there are symptomatic clues that help in making the difference between constochondritis and cardiac angina.''

''Pain intensity modulation from arm and body movements, from local palpation and respiration are clue elements in favor of costochondritis. Also, local swelling and temperature are frequently found.''

''Now, coming to your case, it can be concluded that the actual symptomatology is due to the local inflammation (costochondritis) which may be disturbing when moving and walking too."

Mayo clinic says that an ECG Electrocardiogram (ECG or EKG) can see if the blood flow through your heart has been slowed or interrupted or if you're having a heart attack, or had a heart attack.

So, what do I do now while waiting for the Mibi? I have nitro spray in case....My chest pain is an aching one...not a crushing or stabbing one...My doctor listened to my heart today also and all was good.

Attached is the ECG from last Thursday plus my Echo cardiogram from last March 2018 which was identical to one taken this past December 2018. My muscolo-skeletal system is not good since I have spinal stenosis and spondyolisthesis, so when I walk, I get tired quickly along with the vascular claudication. WE discussed that at one point. The pain on walking is not pain - it is a pressure feeling only...in upper chest.

When I press the three points on my sternum, it is localized pain right under my finger...
So, what do you think?



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Follow up: Dr. Ilir Sharka 9 minutes later
My heart ejection factor is 60%. When I bend to the front while sitting, I feel pain and discomfort in the sternum near one of the localized points I mentioned.
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Follow up: Dr. Ilir Sharka 0 minute later
My heart ejection factor is 60%. When I bend to the front while sitting, I feel pain and discomfort in the sternum near one of the localized points I mentioned.
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Follow up: Dr. Ilir Sharka 19 minutes later
When I press the points I mentioned, the pain is right under my finger on the sternum, but I imagine this could radiate down right into the chest under the sternum, right?
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Follow up: Dr. Ilir Sharka 0 minute later
When I press the points I mentioned, the pain is right under my finger on the sternum, but I imagine this could radiate down right into the chest under the sternum, right?
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Follow up: Dr. Ilir Sharka 3 hours later
Hello, are you there please?
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Follow up: Dr. Ilir Sharka 0 minute later
Hello, are you there please?
doctor
Answered by Dr. Ilir Sharka 24 minutes later
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again!

It seems that your clinical symptomatology is very likely related to a musculoskeletal disorder, including costochondritis (clinical characteristics of your pain and the local findings go in favor of such an alternative).

It is true that a resting ECG is specific for confirming any cardiac ischemia issue (when blood flow through coronary arteries is disturbed in some way). But, it lacks an absolute sensitivity (around 50-60%), so many ischemic problems could result unrecognized.

Coming to this point, if you doctor has noticed any suspicious changes on your ECG, and considering your different elements of chest pain, coupled with vascular claudication, it would be wise to go further with clinical investigations.

You may try any anti-inflammatory drugs (like ibuprofen, naproxen, etc.) for your pain.

I couldn't find the attached ECG and ECHO report on the system.

Please could you upload them again for a review here and a second professional opinion?

I remain at your disposal for any further discussions.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ilir Sharka 0 minute later
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again!

It seems that your clinical symptomatology is very likely related to a musculoskeletal disorder, including costochondritis (clinical characteristics of your pain and the local findings go in favor of such an alternative).

It is true that a resting ECG is specific for confirming any cardiac ischemia issue (when blood flow through coronary arteries is disturbed in some way). But, it lacks an absolute sensitivity (around 50-60%), so many ischemic problems could result unrecognized.

Coming to this point, if you doctor has noticed any suspicious changes on your ECG, and considering your different elements of chest pain, coupled with vascular claudication, it would be wise to go further with clinical investigations.

You may try any anti-inflammatory drugs (like ibuprofen, naproxen, etc.) for your pain.

I couldn't find the attached ECG and ECHO report on the system.

Please could you upload them again for a review here and a second professional opinion?

I remain at your disposal for any further discussions.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 16 minutes later
Yes, I will upload again...

The doctor said there was NO change in the ECG from last year and it was taken last Thursday.
OK, here they are uploaded.
One of the sensitive painful areas is up around clavicle on the right, and the other is mid-sternum on the right and the third one is lower left. When I press on them and rotate my pressure, they are painful...
My LDL is 1.28 mmol or 49 mg L. It has been low for almost 3 years.
My total chol. is 2.67 mmol and total chol./HDL ratio is 2.7....
I have both vascular and neurogenic claudication but that swill be taken care of...PTA for vascular, and neurogenic and spinal stenosis has stabilized now.
Thank you so very much Doctor. Your intervention is very appreciated!
Also, I gave up smoking 5 years ago, I do not drink and I usually walk 4 times a week but lately I have decreased this due to costochondritis...or whatever I do have.
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Follow up: Dr. Ilir Sharka 0 minute later
Yes, I will upload again...

The doctor said there was NO change in the ECG from last year and it was taken last Thursday.
OK, here they are uploaded.
One of the sensitive painful areas is up around clavicle on the right, and the other is mid-sternum on the right and the third one is lower left. When I press on them and rotate my pressure, they are painful...
My LDL is 1.28 mmol or 49 mg L. It has been low for almost 3 years.
My total chol. is 2.67 mmol and total chol./HDL ratio is 2.7....
I have both vascular and neurogenic claudication but that swill be taken care of...PTA for vascular, and neurogenic and spinal stenosis has stabilized now.
Thank you so very much Doctor. Your intervention is very appreciated!
Also, I gave up smoking 5 years ago, I do not drink and I usually walk 4 times a week but lately I have decreased this due to costochondritis...or whatever I do have.
doctor
Answered by Dr. Ilir Sharka 6 minutes later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

I reviewed carefully your resting ECG and cardiac ultrasound report and would explain as follows:

There are no specific changes on your ECG, just QRS axis deviation in the frontal plane.

Considering the fact that you have mild aortic stenosis and dilated ascending aorta, probably the most appropriate imaging test in your case would be a coronary angio CT scan, including also the sequences of aorta visualization.

In such case, it would be possible to clarify the coronary artery blood flow and also the exact dimensions of the aorta.

Anyway, you should discuss with your doctor about these two tests (coronary angio CT scan and Mibi test).

Wishing all the best,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ilir Sharka 0 minute later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

I reviewed carefully your resting ECG and cardiac ultrasound report and would explain as follows:

There are no specific changes on your ECG, just QRS axis deviation in the frontal plane.

Considering the fact that you have mild aortic stenosis and dilated ascending aorta, probably the most appropriate imaging test in your case would be a coronary angio CT scan, including also the sequences of aorta visualization.

In such case, it would be possible to clarify the coronary artery blood flow and also the exact dimensions of the aorta.

Anyway, you should discuss with your doctor about these two tests (coronary angio CT scan and Mibi test).

Wishing all the best,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 40 minutes later
Ok mibi it is...

But I still believe I may be correct about costochondtitis.
Do you agree?
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Follow up: Dr. Ilir Sharka 0 minute later
Ok mibi it is...

But I still believe I may be correct about costochondtitis.
Do you agree?
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Follow up: Dr. Ilir Sharka 20 minutes later
When I raise my right arm to comb my hair, i Feel the pressure in clavicle area
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Follow up: Dr. Ilir Sharka 0 minute later
When I raise my right arm to comb my hair, i Feel the pressure in clavicle area
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Follow up: Dr. Ilir Sharka 21 minutes later
Ok I will rate you once you reply to my last comment please...
Thanks!
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Follow up: Dr. Ilir Sharka 0 minute later
Ok I will rate you once you reply to my last comment please...
Thanks!
doctor
Answered by Dr. Ilir Sharka 19 minutes later
Brief Answer:
Costochondritis seems a reasonable diagnosis

Detailed Answer:
I agree with you that costochondritis sounds the most reliable explanation of the majority of your complaints.

But considering your dilated aorta and mild aortic stenosis I would also agree with your doctor on the recommendation about further cardiac imaging tests.

Wishing you good health!

Regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Ilir Sharka 0 minute later
Brief Answer:
Costochondritis seems a reasonable diagnosis

Detailed Answer:
I agree with you that costochondritis sounds the most reliable explanation of the majority of your complaints.

But considering your dilated aorta and mild aortic stenosis I would also agree with your doctor on the recommendation about further cardiac imaging tests.

Wishing you good health!

Regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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