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Suffering from chest pain. Blood test, ekg and xray done. Is there any heart related problem?

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i am a 50 yo female who presented to the ER with some chest pressure, HBP - triponan level was .6 (1st bloodwork that was done, then it went to .25, then to .13 - dr said either coronary spasm or heart attack (mini)....1.5 weeks later i was back at ER for same symptoms - only less severe - triponans (they did 2 tests for that were perfectly normal, along with normal ekgs and chest xray....does this mean is DID or didn't have a heart issue? please reply i am very concerned and have been in panic mode since this all happened. this was my first incident....oh, and i had a heart XXXXXXX my first ER visit , which was clear, no clogged arteries
Posted Thu, 25 Oct 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 7 hours later
Hi there,
Thanks for writing.
I am a qualified and certified cardiologist and I read your mail with diligence.

You are right about positive tests and people having heart attacks. However, something is positive in them too. World Health Organization has decided to for diagnosis of heart attack one has to fulfill two of these criteria (and most of cardiologists agree)
1. Typical pain that is mid line central suffocating may radiate to neck and left arm, always associated with some shortness of breath (may also be associated with sweating palpitation)
2. Typical ECG changes if one is normal subsequent ECG may show changes
3. Elevation of enzymes like myoglobin, creatine phospho kinase MB fragment, Troponin T or Troponin I levels
In my opinion these criteria were partly satisfied when you were taken to ER first time. You ought to consult a cardiologist if already consulted take a second opinion. For heart attack due to coronary artery disease is a serious disease and all doubts should be settled. If you have any other question, I will be most happy to answer. Regarding other tests you must undergo are (apart from thorough physical examination) Pharmacological Stress Echo Test (if your ECG is normal), Lipid Profile, Fasting Blood Sugar and other tests suggested by the doctor who examines you. Good Luck.
With best wishes.
Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
Follow-up: Suffering from chest pain. Blood test, ekg and xray done. Is there any heart related problem? 10 hours later
Sorry, but i don't feel that my question was answered - i had all other blood work, which was normal - what is your take o your opinion did i have a minor heart attack or no? is a triponan of .25 very high? it did go down to .13 4 hours after that, and with my 2nd ER visit blood tests were normal, even the triponan.i also would like your take on a coronary spasm? could my pain have been due to that? is this a ONE time thing ? serious? i have a f/u with my cardiologist on thurs and plan on asking him these questions also, but i would like your advice on this too - with the triponan levels being elevated with my first ER visit and being normal almost 1.5 weeks later - what does that signify?? wouldn't my tripnonan level stay elevated if i did in fact have a heart attack?
Answered by Dr. Anil Grover 12 hours later
Thanks for writing back.
First the easy answer, damage to heart muscle raises the troponin level which settles within a time span (normally up to two weeks or so to come back to normal but depends when your sample was taken). So two values being different is explainable.
You are right that you could be having coronary artery spasm. However, it is not a diagnosis of exclusion, I mean, it is demonstrated when coronary angiography is done. A brief explanation to which most of the cardiologists agree I am enclosing, this is what is believed. I quote (I am endorsing only part of what is believed that is treatment):
"A coronary artery spasm is a brief, temporary tightening (contraction) of the muscles in an artery wall in your heart. This can narrow and decrease or even prevent blood flow to part of the heart muscle.

If the spasm lasts long enough, it can lead to chest pain (angina) and possibly a heart attack (myocardial infarction). These spasms may also be referred to as Prinzmetal's angina or variant angina (EKG CHANGES ARE DIFFERENT IN PRINZMETAL ANGINA) . Unlike typical angina, which usually occurs with physical activity, coronary artery spasms often occur at rest.

Coronary artery spasms are more common in people with risk factors for heart disease, such as high cholesterol and high blood pressure, but the spasms can happen in people who have no risk factors, too. Coronary artery spasms can also occur in people who have conditions that affect their immune systems, such as lupus.

Coronary artery spasms may be triggered by:
Tobacco use
Exposure to cold
Extreme emotional stress
Use of illegal stimulant drugs, such as amphetamines and cocaine

Treatment of coronary artery spasms may include medications such as:
Nitrates, which can relieve chest pain
Calcium channel blockers, which can help reduce muscle tightening in your chest
L-arginine, a supplement that can help prevent spasms
Statin medications, which not only lower cholesterol but have other beneficial effects on your heart arteries to prevent spasms

You can reduce your risk of coronary artery spasms by quitting smoking and controlling high cholesterol and high blood pressure" END OF QUOTE

I have not seen your coronary angiography, therefore, I am not in a position to tell whether you have disease of smaller vessels or not which I still suspect. In my opinion there is no other explanation but for a minor muscle damage (or heart attack) to explain your first visit to ER. Good you have recovered. If you have any more question. I will be happy to answer. Good Luck.

With Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Suffering from chest pain. Blood test, ekg and xray done. Is there any heart related problem? 13 hours later
Wouldn't the heart catherization show if i had disease in the small arteries? doctors said that was a perfectly clear XXXXXXX ..and regarding the troponin levels i'm still confused...i still don't understand why they were elevated 1.5 weeks ago and then a week later all was normal???? and is .25 a pretty high level or is it just minor?
Answered by Dr. Anil Grover 8 hours later
Thanks for writing back.
Well, in medical science no test is 100% specific and 100% sensitive. I had always thought troponin qualitative level come close to that but It seems that laboratory error can occur; that is best I can think of if the logical explanation written in my last email is wrong.
If we take coronary angiography into account, if muscle had got damaged and you have normal coronaries then there are only three explanations
1. Prolonged spasm of coronary artery.
2. Thrombotic occlusion where thrombus got dissolved.
3. Small (smaller than normally seen on angiography) vessels disease.

That is why I asked to take a second opinion because everything is not fitting in. Good Luck.


Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Suffering from chest pain. Blood test, ekg and xray done. Is there any heart related problem? 41 hours later
Thank you. After visiting with my cardiologist yesterday, he set me up for an echo stress test for next week. However, he did mention the same things you wrote in your last reply to me - he said my troponin level of .25 is VERY small, since the abnormal numbers for that are 10 and above....he states there is no way to know for 100% sure what and why this happened. said could be because my blood pressure was high - and the fact that my stress level really increased when i first got my symptoms - its just frustrating not knowing the REAL cause of something like this....He didn't seem to think i had coronary artery disease - i hear the coronary spasms usually occur between 12 am and 8 am? i don't have that symptom....and in your opinion, will the stress echo show more than the heart XXXXXXX did???
Answered by Dr. Anil Grover 7 hours later
Thanks for writing back.
Why are you not happy that you have concurrence of two persons sitting across the world on the point that you do not have heart disease. Cardiologists are trained to keep threshold of suspicion very low ans suspect too early this way heart attacks are not missed. That created the whole series of issues here. Reason is missing a heart attack can risk life over diagnosis initially may cause some inconveniences to the patient, so please understand the dilemma a cardiologist faces. I expect stress echo to be normal. Good news does not end here if you keep your blood pressure down and stress level under control it is unlikely that you will have heart disease in next 30 years. Is not that something worth knowing. Good Luck. Forget this as a nightmare, it makes me happy for you. It was pleasure interacting with you. Regards.
Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
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