Update since my A+E visit Saturday

[Rob6868]

So after being taken to hospital by ambulance Saturday with a tempature of 39.4 and both feeling very unwell and chest pain.I was finally discharged at 3.30am with no way of getting home . Thankfully I hitched a lift because buses were not around till gone 4am and taxi had a long wait before picking me up.

So I've asked for my discharge notes (my right)

2 things! It says "poor R-wave progression in V2-V3,no acute ST segment change....What does this mean?

They said they heard a crackle in ambulance but when I got to hospital Dr's disagreed with paramedics so eventually at 3am I was sent to have chest xray. Saw the notes and it says

"Right lower lobe consolidation "

So I believe that means pneumonia?

So the paramedics trump the Dr again!

I was discharged by someone I really couldn't understand very well and told I had a shadow on my Chest/lungs And I will need to see my cardiologist asap to follow up?

It says at the end of my notes "he was provided safety netting,highlighting red flag symptoms.

So I'm now on 500mg Amoxicilin for 5days hoping this solves the problem whatever it is even though they have noted pneumonia.

I can't get hold of my cardiologist in London as he's away until end of September. My local cardiologist has not answered 3 emails I've sent nor has he's secretary.

So here I am with a dull ache over my chest that is there all day most days and wakes me and leaves me feeling vulnerable all day not knowing if this is my microvascular angina or part of the course of pneumonia? Feeling pretty isolated now so will be trying (and it's bloody hard) To get a doctors appointment this afternoon to then see a doctor to then ask for another xray by the end of the week because it feels like if I don't do all this myself nothing will get done if I can't even get a cardiologist to speak to.

You couldn't make it up!!!!!

[Howardl]

Hi Rob

A&E patch you up and move you on, usually back to the GP a few weeks later. Your right English is very poor in hospitals and most doctors and nurses are not angels as tv would have us believe. Ive had dealings with my local hospital over the past 6 months and as you can probably guess it didn’t go to well.

[Inamoment in reply to Howardl]

Doctors and nurses are all really nice to me. I think this is because I'm nice to them. Maybe you should try it

[Rob6868]

So what was it? All I was told by a non English speaking Dr was that I needed to see my cardiologist for a quick appointment. But I can't get hold of either of them nor there secretaries.

Bloody pointless.

I was told that a chest infection was bad for us hearties mate..

Have you heard anything regarding microvascular angina?I've finally been diagnosed with it.Mind you I think he doesn't actually know what one I have?Microvascular angina or coronary artery spasm. So just went for the first one

[Hidden in reply to Rob6868]

I am guessing the doctor did actually speak English or you would have received no information. If you understanding of what you are being told is not clear - ask. Doctors from abroad keep the NHS going and I have not had any unresolvable issues with any. Have you tried ringing the consultant’s secretary? My experience, again, is that speaking to them gets things done rather than sending emails. Take care.

[Rob6868 in reply to Hidden]

I did ask thank you an awful lot of times only to be met by a very confused doctor who had to keep looking at my notes to finally see that the paramedics were right even though that said doctor who's spoken English wasn't particularly good may I add was ready to discharge me. Not even knowing I had a shadow on my chest.

Ok just to keep you happy since I feel you think I'm having a dig at foreign doctors.Just for your information I'm NOT. But if her spoken English was not particularly good then it's going to be hard to understand her even if she had a level of English. And actually it was the English speaking sister that had to explain everything in the end thank god.

Doctors from abroad do help the NHS and I've not said otherwise. But so may I add do the British born doctors that you haven't mentioned. Seems you have a chip on your shoulder just because I dare mention the fact I couldn't understand her.What would you prefer?I go home with no facts about my health because I dare to ask an English speaking doctor."Have I tried ringing the Secretary? Err yes on many many occasions including my other consultant in London..Plus leaving copious messages .

I don't know about your circumstances but my cardiologist will generally call back after an email but this time it didn't happen hence I called several times.

I hope I've cleared matters for you.

[Hidden in reply to Rob6868]

No need to clear matters for me.

On one issue: there was no need for me to mention home grown doctors. They were not an issue in your story. Sadly we do not have enough of them and many have opted to go to places like Canada and Australia - so much so that Australia is having to impose restrictions!!

[Rob6868 in reply to Hidden]

Yes and we have to ask ourselves why they still feel the need to fly to the other side of the world.

But we all know the answers. I personally would love to see the old ward sisters walking the wards and more home grown nurses.Thats not a slate on the nurses and doctors from abroad but I believe there should be a good standard of spoken English when your talking to a patient with problems like heart issues and other conditions in particular. But as I said

We all know why nurses from here are leaving.

[Mitzi-13 in reply to Rob6868]

I entirely agree with you,thank goodness i don't have the need to visit a hospital,the last time i went i needed to ask my doctor what the conclusion was! This was concerning having my eyes examined.

[Hidden in reply to Rob6868]

The need is for more money and less work. Nurses are leaving to go back to their EU countries of origin and that supply has almost dried up. Interestingly some healthcare professional thrive on busy days but the period of Tory austerity has not helped in retention.

Doctors from abroad have to pass various tests before they can register with the GMC. Sometimes it is not the speaker but the hearer who has the real issues. As you had a healthcare professional to ensure you understood then you were served well. Healthcare professionals work well when they supplement each other. You can, of course, utilise PALS to complain if you wish.

[Rob6868 in reply to Hidden]

I have used pals and have got the answers I wanted thanks to them.

I'm certainly not backwards in coming forward when it comes to my health in particular

You only need to ask my consultant.

[Hidden in reply to Rob6868]

You sound as though you are now a satisfied customer. We thank you.

[Speakeazi in reply to Hidden]

The NHS used to pay for nurses’ training. This stopped some years ago and it is hard for anyone to take on such a substantial debt £27k just on fees when the salary they can expect to start on is low.

They also work in the NHS when they are training.

I wish we could return to the days when nurses trained on the job and it wasn’t necessary for everyone to have a degree.

[Hidden in reply to Speakeazi]

It is a problem. My niece had recently done a nursing degree following her first degree and it is expensive. I dread to think when she will ever have it repaid.

[Milkfairy Heart Star in reply to Hidden]

'Interestingly some healthcare professional thrive on busy days ......'

Really?

After 30 years of working in a stressful, physically and emotionally demanding job my Cardiologist comment was that I had literally given my heart to my profession....

Many healthcare professionals are burning out and develop compassion fatigue. The NHS needs to ensure those who care for us have the support to have the resilience to care for their patients without damaging their own health.

[Hidden in reply to Milkfairy]

I have talked to those who are happy with their lot, as strange as that may seem. The problem of understaffing will only really be overcome with more staff. I do, however, play my part as a volunteer in our local Hospital Trust, as a member of our regional NHS Clinical Senate and as a co-applicant on national clinical research projects. It is the least I can do for all the help I have had from the NHS.

[Milkfairy Heart Star in reply to Hidden]

The importance of the lived experience of being a patient is widely acknowledged.

Your volunteering is a fantastic way of ensuring this happens

However perhaps we should also acknowledge the expertise by those on the forum with an actual lived experience of being a employee of the NHS.

[Hidden in reply to Milkfairy]

Indeed we should and I communicate with them at work on a regular basis.

[Hidden in reply to Rob6868]

Report that to the GMC.

[Maisie2014]

OMG doesn’t fill you with confidence does it? I didn’t understand your first sentence Gunsmoke. I have worked for hospitals for a number of years and this is the worst they’ve ever been. It’s lack of funding and resources. Low motivation from staff who are expected to carry on regardless. HDU nurses being told to cover on neuro wards. This is unsafe for heart and neuro patients. It’s supposed to be one patient per nurse for heart patients but often it can be more.

[Prada47 in reply to Maisie2014]

Hello Maisie

In my Local Hospital it's one Nurse per patient in CCU in HDU it was a much higher ratio ?

[JonathanH]

Rob,

I don't know what to say. We've all been there, unceremoniously ejected by A&E while feeling lousy and no answers.

I find that infections cause my MVA to flare-up. Continuous chest pain with flare-ups in the small hours matches my experience of MVA ... but that doesn't say what is now causing you pain.

I expect that Dr Google has already told you that "Poor R-wave progression (PRWP) is a common ECG finding that is often inconclusively interpreted as suggestive, but not diagnostic, of anterior myocardial infarction (AMI). " So it's a common finding from which no conclusion can be drawn?

ST-changes indicate ischemia - I get them - but why use "acute"? Indicates no heart attack??? Did you have a troponin test to check for myocardial infarction, just in case?

Total frustration, misery and suffering for you. Really wish I could help!

Jonathan

[Rob6868 in reply to JonathanH]

Just looking at my discharge letter now Jonathan and troponin T level was 5.00 nanogram. as per notes normal is (0 and 14.

So I wasnt really worried about that.

[Healthyheart1]

Sorry to hear that Rob6868, hope you get the answers you need. Sheena x

[Healthyheart1]

Hi Gunsmoke123, I've already started with my pains. I would long for summer but it's too hot. I really hope you too start to feel a bit better soon. Sheena x

[Rob6868]

So am I mate dreading winter.Already had a few attacks walking down the chilled section of Asda (yes I know I'm cheap😁😂) But they do nice Yeo yogurts lol.Oh I've had all that crap that men don't get MVA well then maybe I'm a female in reality because I've got it or so Prof peter Collins says.Ive also had the old "it's not cardiac chucked at me but I refused to listen and kept at them like a mad dogs! That's why I eventually got my diagnosis even though I went around the houses several times to get there.

Apparently coronary artery spasm is more equal amongst male females bit MVA is more female so I've been told

So I'm a rare one being a bloke! Maybe I'm a hermaphrodite but I haven't checked lately lol.

Anyway Milkfairy will put us in our place regarding microvascular angina 😆But anyone in the know will tell you they have to catch it at that precise moment on an ECG even paramedics said that in the ambulance.

I really hope you find the bloody answers mate because like Milkfairy says! I really wouldn't wish this on my worst enemy.

[Milkfairy Heart Star in reply to Rob6868]

Tutorial coming😉

Microvascular angina ( the symptom) can be caused by microvascular dysfunction eg the inability of the small vessels to dilate associated with being over weight, autoimmune diseases, diabetes, or being a woman of a certain age.

Or due to spasms in the small vessels

Then vasospastic angina which is when there are spasms in the large coronary arteries.

In this case when the coronary arteries spasm you see ST elevations and or ST depressions on the ECG

The nursing staff now chase my spasms by doing consecutive ECGs when my chest pain starts and then gleefully shove the ECGs under the noses of disbelieving Cardiologists who have to eat humble pie....love my Cardiac nurses.

With MVA the ECGs can be much more subtle just T wave inversions or nothing at all.

Don't get me started on Troponins.....

Men and women both get Vasospastic angina about 50:50

You can of course have ongoing angina despite stents and following open heart surgery

Refractory angina.

The Gold standard test is an Angiogram with acetylcholine to detect vasospasms and Perfusion MRI to detect microvascular dysfunction.

References supplied on request🙂

There is no competition or hierarchy of suffering for men or women it all hurts lots and lots....

Group hug and sign required.

😭😫😖🤗

[Rob6868 in reply to Milkfairy]

I need a beer or two after that😀😁And I don't even drink!

[Milkfairy Heart Star in reply to Rob6868]

Mine's a New England IPA!

See you in the Euston Tap😉

[Rob6868 in reply to Milkfairy]

Hang on

Right I'm not a woman (apart from on sundays)

I'm not overweight

I'm not diabetic

And as far as I know I. don't have any autoimmune disease

So where do I fit in with this bloody condition.

Maybe I'm some kind of different lifeform😁😂😂

[Milkfairy Heart Star in reply to Rob6868]

You can have both Coronary Heart Disease and Microvascular angina or Vasospastic angina due to the lining of your blood vessels not working properly endothelial dysfunction.....

I don't have microvascular dysfunction.

But I may have microvascular endothelial dysfunction

I can exercise

BMI 21

Very low Hba1c

No autoimmune disorders

No clotting disorders

Didn't have Blood pressure problems in pregnancy

I had my symptoms from my 30's

I have unobstructed coronary arteries .

We all have our own individual underling cause of our particular flavour of chest pain

Forget the women thing except maybe on Sundays of course😉

[Rob6868 in reply to Milkfairy]

just when I think I'm starting to understand you Milkfairy You throw a curve ball in for good measure 😀😁😁

microvascular endothelial dysfunction

and microvascular dysfunction?

[Milkfairy Heart Star in reply to Rob6868]

This might help.

heart.bmj.com/content/early...

[Gladwyn in reply to Milkfairy]

You are so clever I'm impressed and in awe! In fact so many posters on this site amaze me with their knowledge I wonder where they learnt it all!!! I'm a geriatric novice but reading this very knowledgeable site has increased my knowledge .... A bit 😀

[Milkfairy Heart Star in reply to Gladwyn]

Gladwyn

Thank you for your kind words.

I am often blow away by reading about other people's amazing courage and dignity sometimes sprinkled with humour as they share their experiences on the forum

[Milkfairy Heart Star]

Harvard system ? 😉

[Rob6868]

But our Milkfairy is forever our wise one

What would we do without you Milkfairy?

[judes]

Rob

Firstly big hugs what a nightmare for you, tho unfortunately typical of A+E these days.

With that sort of temp, chest pain etc. You really shouldn’t have been discharged, it’s not good practise, do contact PALS sometimes there useless but it always makes me feel better. You could of course refuse to leave, it’s well within your rights.

I was told to see my cardiologist, which was interesting as I don’t have one! My heart probs are secondary to other issues.

As for not understanding overseas docs, when your not well the last thing you need is to try and understand someone.

Hoping you are feeling better and do remember to rest.

J

[Hidden in reply to judes]

how come you don't have a Cardiologist if it's ok to ask?

Useful to have one since many heart diseases tend to progress.

[judes in reply to Hidden]

That’s ok ask away it’s a very long story so will try and keep it brief.

Up until last summer never had any issues with my heart, I then had pneumonia on and off for 8 months, well more on than off ! In the past also had clots on my lungs.

This all resulted in my heart not being able to cope with it all had a regular pulse of 161 just to keep my lungs going, and still couldn’t breath.

Put all that together with an auto immune syndrome I have, my lungs are knackered and yes my heart has progressed to the point it’s not going to last much longer. However, I’m fairly positive and make the best of every day and managed a holiday this year.

J

[Hidden in reply to judes]

Fantastic (about the holiday)!

Thank you for sharing.

[Rob6868]

Was it a barbecue spare rib mate?😀😁😂😃Couldn't help myself as I sit waiting to see the doctor again...all good fun NOT!!!

[Rob6868]

Bloody hell you must get so hungry if your resorting to actually eating the crisp packets😁😂😂

[Rob6868]

Do you have shares in walkers?😀😁😂OH how I would kill for a packet of golden wonder right now 'old school and still better than walkers the imposter! But must think of the heart and those clogged arteries