Suspected Heart Attack or not

I've written a few times on this post about the shortness of breath and chest pain in walking not even far which has got steadily worse. After 2 ECG that's showed a problem along with an Echo showing Hypokinetic inferior wall my cardiologist was almost certain I had blocked arteries so I had a echocardiogram, I had no blocked arteries so an MRI was ordered along with a CTPA. Monday I was taken into hospital with severe chest pain. A marker for Troponin was 20 which on the second reading went up to 30 an indication of a heart attack. The problem is my ECG did not show I was having one so now no one will commit to what has happened. It leaves me waiting for the MRI. I feel very unwell my bloods fir my lupus have come back normal for me. Anyone else heard of this. One dr said ECG aren't always right another one took it has gospel. Feeling very confused. Any advice would be helpful. Stayed overnight in hospital. They have changed one of my tablets to help spasms in the heart and nitro lingual for under the tongue. Unstable angina they first said it was. Not feeling clear on the conclusion.

17 Replies

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  • I think if it were me I'd be getting someone to help me follow this up - I have always been under the impression that an ECG doesn't always show a heart attack, that's what I was taught at Uni when we learnt how to read ECGs (a long time ago, couldn't do it now!) I think it is something to do with where the electrodes are positioned relative to where the damage is.

    This agrees

    myheartsisters.org/2014/03/...

    While you were in hospital - did you see your cardiologist (does he know about it) or just the A&E/AMAU staff?Did no-one suggest an angiogram?

    My paramedic daughter says "Yes, happens in non ST elevated MI. Why I encourage all those with chest pain to go into hospital."

    So if you have any more chest pain - 999 again I think. Is the nitro helping?

  • Yes I had an angiogram 3 weeks ago because my cardiologist was almost certain my arteries were block with the results of an Echo and the dips on my ECG reading. They weren't blocked. So he ordered the MRI . So this week the hospital were not prepared to confirm a heart attack due to the ECG not confirming it although my Triponin levels were going up. They have passed me back to my own cardiologist, I did get them to confirm with his secretary I had an MRI booked I just have no date yet. It would have meant me staying in for days to get one while I was in hospital and they just don't have the beds hence I am home waiting. Thank you for answering . Good to have so many people agree the ECG is not always correct.

  • Wow what an interesting article. I am lucky in some ways my daughter is a nurse and in the past has stepped in especially when I had a mini stroke and they were going to send me home. She said she didn't agree with the findings so I was kept in and an MRI showed I had had 2. Frightening isn't it.

  • You can get a silent heart attack or NSTEMI (non ST Elevation Myocardial Infarction) which is a heart attack that does not show up on an ECG. Then there is a STEMI (ST Elevation Myocardial Infarction). That is a heart attack which does show up on an ECG and the treatment now is generally emergency angio.

    A troponin can be significant at different levels and can depend on whether the hospital you attended was using a Trop I or a Trop T assay. (This knowledge is two years old so may have changed, I've been away from work too long)!

    Either way, the above is almost irrelevant. What I think is important is that you get a definitive "yes" or "no" to the question if you have had a heart attack or not.

    If you don't have a follow up with your Cardiologist soon I would try and arrange one or at least see your GP. And I totally agree with PMRpro, in view of your raised trop and diagnosis of unstable angina call 999 if you get further chest pain and the GTN gives you no relief.

    Good luck and keep us posted.

  • Funny how 2 patients know about NSTEMIs and an A&E doctor didn't...

  • There's a famous saying in my world, "behind every great doctor is a fabulous nurse doing their best to stop the doctor from killing you!"

    (A very dry sense of humour)!

  • Ah - you, like me, are not "just" a patient!!!!

    Yes - shame some doctors no longer appreciate the safety net that their nurses provide for them ;-)

  • Yes that's my daughter, she was not happy with the cardiologist talking at me rather than to me. Thanks

  • Thank you this was my way of thinking, the ambulance, A&E staff were fantastic and the doctor in A&E said they were treating me for unstable Angine has I had an elevated Troponin level and although the ECG didn't back it up she said after talking to her boss they don't always show a heart attack. Up on the ward the cardiologist I saw tried to blame the pain in a bulge in my back until the radiologist told them that was showing up on a cat scan back to 2010 I hadn't known about that. He then changed the diagnosis. No one listens to people with multiple illnesses I told them I have to listen to my body that's what st Thomas told many years ago. I know something is going on I just wish it was t so hard to be listened to when you are feeling so ill. Thank you for your answer. X

  • I tend to agree with their assessment of unstable angina - it's caused by cardiac spasm which only lasts a short while, then it settles down. Troponins are high but no heart attack.

    Look up Prinzmetal angina or cardiac spasm symptoms. It's difficult to diagnose. There are very few specialists dealing with this in the U.K, I saw one of them at the Royal Brompton in London.

    Nitro is not always useful to release the spasm. It's good that they gave you medication for it. Have they told you what could cause the spasm?

  • Will look into what you said. Thanks

  • I don't really have anything to add - I don't even bother calling anyone when I feel the chest pain because no one seems particularly bothered; I'm a fat woman and clearly if I die of a heart attack it's all my fault anyway (apparently, or at least one consultant in A&E seems very convinced). I've had ECGs show something was clearly 'off' but the on staff consultant dismissed it. Mostly I just try not to think about it - if I go, I go.

  • Hi gillyg

    I just wanted to say I hope the doctors can decide soon if you've had a heart attack or not!. Think it's awful there can be doubt which is added stress for you!. As someone who lives with this chest pain and has a GTN spray for emergencies , luckily no heart attack , I totally agree with the others that if you continue to get unresolving pain it should be A&E for you again until your better sorted. Glad they were good with you though and hope you are better soon. X

  • thank you for your reply, I have my MRI booked for this thursday so I really hope we can resolve this matter. I can do so little without bringing on the pain. Everything I look up says if you have elevated Triponin level which increases which my did it means you have some degree of heart damage because triponin is what is released when you have a heart attack or other injury of some description. I don't feel like going on our once in a life time holiday but even to cancel it I need a diagnosis so I need the answer one way or another. Why do they give you gtn spray do they say you have angina, that is what they said they were treating me for Unstable angina due to the troponin level being elevated. x

  • The pain of angina happens because arteries in your heart are narrowed and unable to supply enough blood and oxygen for your heart to work properly - so it becomes what is called ischaemic (short of oxygen and glucose) and that causes pain. The GTN spray makes the arteries dilate - more blood can get through so the pain reduces and hopefully stops. If it doesn't stop with the dose you are told to take, for example as described here:

    guysandstthomas.nhs.uk/reso...

    then you need to call 999 because it could be a heart attack and you need medical help as soon as possible.

    Explain to the doctors that you need either a diagnosis or a letter saying you should not travel for the insurance for your holiday. It would be no fun if you are feeling so unwell - and so much more enjoyable once you feel better.

  • Hi gillyg

    Good luck for your MRI on Thursday. Hope it solves the queries!. I can't understand why there are for you as traponin increase like you have usually means heart attack. I have been lucky although I've had the pain which GTN helps with , my traponin has been within the normal range. I've got a diagnosis of inflammation of lining of the heart and take colchicine for it which is a strong anti inflammatory. It's transformed me as it's stopped the A&E visits and strong pain!. Fingers crossed for you. X

  • Hi everyone, had MRI, and a follow up appointment to see cardiologist the next day. The MRI was clear no heart attack and no sign of damage. (Great news) but what on earth is going on, the dr was completely baffled he had to admit. He couldn't explain why my Troponin level was elevated or had even increased. The reason I am feeling unwell and still have breathlessness and chest pain. He is no expert but suggested it may be a flare of my lupus around the heart with maybe the smaller blood vessels. That would not show on the MRI. Here we go again back to square one. We all know if it is how hard it is to get an answer. I have phoned my lupus nurse and asked if she can talk to my consultant, she suggested I had another blood test but I don't hold out much hope of getting an answer. At least we have been told we can go on holiday and they will back me up with my insurance. The last thing I want to do is go on holiday it will be very hard, but I need to go and try for my husbands sake. Thanks everyone for staying on this long trek and giving advice. Think it will be the normal hard hard work to get an answer. X

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