My wife had an x-ray of the heart done while on a gurney with a portable machine.
She then had 2 blood tests and 2 ECG's done.
From that they determined she was fine and sent her home. No heart attack.
With me they did an x-ray with contrast, ECG, blood tests and then an angiogram. The angiogram was the deciding factor that my heart was fine.
Women are more likely to have their heart attacks or major cardiac events misdiagnosed.
Women are also more likely to live with non obstructive coronary artery disease, microvascular dysfunction and vasospastic angina.
Both poorly understood and under recognised. These conditions cause angina and can lead to heart attacks.
leeds.ac.uk/news/article/42...
The usual way to diagnose a heart attack, are symptoms eg chest pain, nausea, breathlessness, extreme fatigue, chest tightness.
A rise and fall of Troponin, a protein which is released when there is damage to heart and skeletal muscle.
ECG changes
Changes to the way the heart wall moves seen during an echocardiogram.
It can be an art to diagnose some heart attacks. The jury is still out as to whether my first very severe coronary vasospasm caused a heart attack. Some Cardiologists say yes, others no.
With my heart attack, I was taken from home by ambulance with a suspected heart attack and while on route to the a&e dept of local hospital my ecg readings changed and ambulance diverted to specialist heart hospital where I went straight to their cath lab for angioplasty (one stent). I’ve had a couple of incidents since with chest pain, only needed a&e dept each time and a troponin blood test and a few hours of monitoring managed to rule out further heart attacks thankfully.
I was picking up clothes to get dressed, phoned ambulance myself. They and emergency staff kept reassuring me, 56yrs, no family history, no you are fine. I have very mild symptoms with heart attack. They let me wander around emergency until blood tests came back, then hooked me up on monitor. They wanted to send me home to come back for angiogram, but registrar made me stay in hospital for a week until I could get angiogram. I had 99% blockage, 2 stents. Registrar had helped look after my husband weeks earlier for renal failure, nearly lost him. She saw that stress was a big factor and still is. She probably saved my life.
Thanks for the replies. Very interesting.
The hospital that does angiograms is closed over weekends so I suspect this is the reason why she was sent home without a diagnosis.
Only an angiogram can confirm vasospasm after the fact.
Only an angiogram with acetylcholine can confirm a diagnosis of vasospastic angina.
There are only a few centres in the UK performing these types of angiogram.
When a person has a vasospasm the ECG shows ST elevations or depressions and T wave inversions.
Sometimes accompanied by a small rise in Troponin.
Typically the chest pain is really severe and prolonged. Usually occurs at rest in the night between midnight and 6 am.
My coronary vasospasms feel like I am in labour.
I think people definitely underestimate the crushing pain of these vasospasms! My last episode was horrendous, out of the blue and so like my initial HA pain (STEMI) that even I was convinced I’d had another HA - but I told my husband and son definitely not as I didn’t want to worry them. Even though not a HA according to ECG and bloods the doctor said there still could have been some damage caused to heart because of severity. As we know though only medication can attempt to control these attacks 🥲
Mine was a trip to A&E by ambulance after paramedics felt my ECG was a bit odd; 5 hour wait in A&E, eventual troponin test and several hours wait for the results then admitted. Angiogram and stents next day.
I was about to make a 60 miles trip and suddenly felt unwell, nothing specific but I knew something wasn’t right. I went to my local walk in centre where, after blood tests and ecg I was given a letter to take to A&E. I never thought to ask what the problem was! 45 minutes later I was in A&E being checked out. 20 minutes later I was on my way to the cardiac unit, where I had an angiogram and 2 stents. The cardiologist thought I probably had my heart attack in the car on the way to the hospital. I was so lucky I didn’t start my trip.
I had a silent heart attack. My only symptom was breathlessness when walking. A blood test showed elevated troponin levels so they did an angiogram which showed a 90% blockage in the LAD.
I went to my GP after 3 weeks of a "gastro" problem. She sent me for a blood test which included troponin. 8 hours after the blood test I got a call from a panicking out-of-hours doctor shouting "YOU'RE HAVING A HEART ATTACK, YOU NEED TO BE IN HOSPITAL! I'LL CALL YOU AN AMBULANCE!!!!" As I was sitting in a pub with friends at the time, I politely declined his invitation, but, after discussion with my friends, got a bus to the local a&e, where I was eventually (and grumpily) transferred to CCU for all the other tests. I had had a rather serious heart attack 3 weeks earlier.
ECG changes showed that I had had a heart attack, two weeks previously, the only sign that i can recall is really bad reflux ?? this was followed with an angiogram, to determine blockages, followed by a triple by pass, all done within 5 months (pre pandemic).
I've had two heart attacks. The first time, I had bad neck and shoulder pain and almost passed out. I called an ambulance myself. They took bloodwork twice. Certain enzymes show up in the blood that lets them know something is wrong with the heart. I had an angiogram and one stent was put in. Second time (20 years later), I felt like something was terribly wrong with me and called for an ambulance. Same thing, 2 blood tests and then an angiogram to see what's wrong. Triple bypass 7 months ago and doing great. So in answer to your question, I would say they didn't see anything wrong in the bloodwork. or the ECGs which don't always show anything wrong. They obviously felt there was no need for an angiogram based on the test results.
Heart Attack
Unexpected heart attack over Christmas 
Heart Failure & coughing 
Silent heart attack
Heart murmur
