heart attack scare

[mickbr]

my brother who is younger than me, about 46 went to the ED with severe chest pains. He thought he was on the way out. I got into see him some hours later, he is a fit and athletic(for his age) firefighter and I have never seen anything floor him like this. Angio scans showed no heart damage or blockages thank heaven, but still feeling chest discomfort and a protein apparently associated with heart attacks is showing high in his blood. Cardiologist plans an MRI next I think. He is lucid and positive, plowing into the dinner the nurse brought when I left today so I assume thats a good sign. Anyone heard of similar complaint?

[Trailboss]

Not intending to stir up anything but just wondering, was he vaccinated? How recently?

[mickbr]

No he is unvaccinated, like myself.

[Trailboss]

No he is unvaccinated, like myself.

Ok, same as myself. I had my first heart attack when I was 50, caused by stress. A change of lifestyle and it's now been 16 years. My doctor says heart disease is 50% genetic and 50% stress. I'm still higher risk but keep my stress levels low.

[jeepnik]

Here’s a silly idea. Ask a cardiologist. I’m sure all the stories you read on the net are gospel. But I figure a person with about a decade of education and training, not to mention experience mught just maybe know a bit more.

[Bill in Oregon]

Glad to hear your brother survived this. I had that same troponin test a while back after suffering what turned out to be a vasovagal episode. Phew!

[piller]

Glad he is better. Might not hurt for him to make a small change in eating habits. Certain foods can be a problem for those who are genetically inclined to heart issues. A small decrease in portion size of those foods can yield a big difference. Avoiding those foods is not always necessary. Have him talk to a nutritionist.

[Old No7]

Anyone heard of similar complaint?

Over the last 10 years, I've had 2 emergency trips to the ER with "heart attack like" symptoms -- one by car (wife drove) and 2nd by ambulance (felt a lot worse). Luckily, both times it was an acute anxiety attack brought about BY STRESS.

"Just in case", we now keep Bayer Children's chewable aspirin available in the house -- per the Doc's recommendation; if it ever is the real thing, chew 2 or 3 right away. Then seek immediate help.

But speaking of STRESS -- the Docs tell me:

It's not a question of "IF" stress can kill you -- it's only a question of "WHEN" and "HOW".

In fact, he just told me within the last few weeks, that he can "medicate the symptoms" -- but I've got to get a better grip on how I handle WORK STRESS.

Still workin' on that (pun intended)...

Old No7

[Ysabel Kid]

It's not a question of "IF" stress can kill you -- it's only a question of "WHEN" and "HOW".

Bingo.

I worry about this (and shouldn't - worry is stressful, after all). Some heart issues in the family. I've had an episode years ago. And like a lot of us, the job is way too stressful.

[jeepnik]

Stress is all in your head. Literally! Stuff happens in life. Deal with it and move on.

As a psych instructor once asked “what was your worst problem last year?” Most cannot remember. Even if they do they don’t recall two years ago.

[piller]

Aspirin does not do anything for me. If I have a heart attack, I will need to eat some of that D-Con which looks like sawdust. It has Warfarin in it. Yes, I keep some around. The only blood thinner which works on me is Warfarin and Effient. All the others do absolutely nothing to me.

[gamekeeper]

I take Aspirin every day, just a small dose but if feel like something ain't right I take a couple of regular Aspirin as insurance. I left stress behind when I retired.

I know medical professionals will throw their hands up and not agree BUT I remember when nearly everyone smoked there seemed to be a lot less stress and mental illness, I'm not suggesting smoking is good for you it's just that I know how good it felt to relax with a smoke.

[AJMD429]

.
What I see slip through and cause heart attacks and death:

Docs relying on A1C's and glucose levels and forgetting that elevated fasting insulin levels cause just as much danger
Docs not checking OXIDIZED LDL (or LDL particle counts via NMR), and relying on ordinary 'LDL' levels instead
Docs not checking free (vs total) testosterone levels in males just because no obvious 'symptoms' exist
Docs not checking for elevated estrogens (there are three different kinds in humans) in men, even if testosterone is normal
Docs not checking homocysteine and making sure it is under 8 or so, and not attending to the MTHFR SNP's that cause it
Docs not checking free T3 and reverse T3 and relying only on TSH to assess thyroid function
Docs not measuring fatty acids and keeping the Omega-3 levels high
Docs relying on calcium score tests, nuclear treadmills, and stress echos, when they should be using CPET ('Met-Test') instead

The rationale for most of this is the tests I cite find much EARLIER disease than the tests ordinarily done, which are GREAT for finding late or severe disease requiring intervention. Both have a role, but the weak link is in the non-glamorous, non-lucrative stuff the primary care physicians SHOULD be doing, but don't. If they are a 'hospital employee' they are paid for fast throughput and incentivized to bounce patients through every 'specialty clinic' possible - but if in the room over 6 minutes they will not be profitable under a third-party (insurance-based) system, so of course they don't do anything complex or time-consuming.

Instead of taking the time to replace the rotting section of brake line, the mechanic is relying on the body shop to repair the automobile after the inevitable collision.

These are all things the primary care docs SHOULD be doing a decade before the cardiologist needs to be involved, but few are doing so. The cardiologists are electricians and plumbers, and fabulously talented in those areas, but if we primary care docs would do our job and be the 'chemists' and 'nutritionists' we would slow the disease process hugely. Sadly, most don't, leaving the cardiologists to go outside their normal function and start doing preventative stuff instead of the interventions they save lives with. Sadly, most cardiologists are about as good at the preventative stuff as most primary care docs would be at treating arrhythmias or placing stents, but they do what they can to compensate for the primary care docs slacking.

However what I see is that even the best and brightest cardiologists making the mistakes listed, in part because many of the things involve endocrine or other issues tangential to cardiology, and good luck getting an endocrinologist to deal with any of the things. The "Men's Clinics" only focus on testosterone, and not really from any perspective other than bedroom goals.

Part of the issue is we are 'trained' to only attend to the worst 10% or so of any given lab test, when we are dealing with a population in the U.S. where a third will have a lethal coronary event, and another third a non-lethal one. The thirds overlap, but still at least half of the population will have a serious cardiovascular health issue - so why would we only 'flag' and treat the worst ten per cent or so...???

[Bill in Oregon]

Andrew, I'm gonna print this out and take it to my next appointment with my internist.

[mickbr]

Thanks all for the comments and also to Docs very comprehensive post. My brother was discharged after angiogram(or the one where they steer the camera into the major arteries, whatever its called), ultrasound, MRI all showed nothing untoward, though the elevated troponin levels at the time had the cardiologists scratching their heads. From Docs post maybe the answer lies at the feet or other medical specialties. Anyway he feels 100% and main advice at this stage was dont lift weights until the angiogram and other holes they poked in him heal up.

[jdad]

.
What I see slip through and cause heart attacks and death:

Docs relying on A1C's and glucose levels and forgetting that elevated fasting insulin levels cause just as much danger
Docs not checking OXIDIZED LDL (or LDL particle counts/b] via NMR), and relying on ordinary 'LDL' levels instead
Docs not checking free (vs total) testosterone levels in males just because no obvious 'symptoms' exist
Docs not checking for elevated estrogens (there are three different kinds in humans) in men, even if testosterone is normal
Docs not checking homocysteine and making sure it is under 8 or so, and not attending to the MTHFR SNP's that cause it
Docs not checking free T3 and reverse T3 and relying only on TSH to assess thyroid function
Docs not measuring fatty acids and keeping the Omega-3 levels high
Docs relying on calcium score tests, nuclear treadmills, and stress echos, when they should be using CPET ('Met-Test') instead

Andrew,
My PCP switched over to a concierge program about 6 years ago. It costs me an extra $1800 per year, but I can get same day appointments, 24/7 access to his personal cell and email, and his patient count is down to 400 from 2,000.

Part of the extra cost is having annual tests done that normally aren't done. Spirometry, EKG, hearing, advanced blood work, etc. Everything you mentioned above and more is done. It makes keeping me healthy easier.

My total cholesterol is now down to 125 and my ldl particle count is down to 800. We never would have known about the particle count without the tests. my total C was 210 and the particle count was over 1400 several years ago. I have genetic issues with high cholesterol from my mom's side. She's 89 and still goes to the gym 5 days a week. I'm just as active, but It's just something diet and exercise hasn't corrected. I take the lowest dosage of Rosuvastatin and Ezetimibe.

My PCP is the same age as me. His birthday is the day after mine. I am not looking forward to his retirement. I've been a patient of his for almost 20 years.

[marlinman93]

Sounds similar to some symptoms I had before they took my gall bladder out. Excruciating pain in my sternum, and bad enough to make me toss anything I tried to eat. As soon as they removed the bad gallbladder I was back to better than I'd felt in years. Doc told me the gallstone was the largest he'd ever seen, and was just one big stone, and not a single small stone. 1.5" x 1" football shaped.

[piller]

I got put on ezetimibe once. Two weeks and I couldn't walk. Every muscle hurt as I if had been tortured. I threw it away. My Doctor got angry. He tried me on a statin. 6 days into it and the whites of my eyes were turning darker. My urine looked like strong coffee and smelled like I had cancer. I came off of it. My total cholesterol is still 145. No change in eating habits.
Some of us cannot take those medicines. A good Doctor treats the patient. A bad Doctor just prescribes what they were taught in school without ever thinking about why and whether they need to adjust anything. The worst Doctors I ever dealt with were trained at Baylor and could not be bothered to learn about liver function and enzymes.

My current General Practitioner is in the same building as my Endocrinologist. The two of them communicate about my treatment. I am healthier than I have been since insurance made me leave the Doctor who had his advanced degree in genetic medicine. We all need to be treated as if we have different physical and medical needs.

[jdad]

I got put on ezetimibe once. Two weeks and I couldn't walk. Every muscle hurt as I if had been tortured. I threw it away. My Doctor got angry. He tried me on a statin. 6 days into it and the whites of my eyes were turning darker. My urine looked like strong coffee and smelled like I had cancer. I came off of it. My total cholesterol is still 145. No change in eating habits.
Some of us cannot take those medicines. A good Doctor treats the patient. A bad Doctor just prescribes what they were taught in school without ever thinking about why and whether they need to adjust anything. The worst Doctors I ever dealt with were trained at Baylor and could not be bothered to learn about liver function and enzymes.

My current General Practitioner is in the same building as my Endocrinologist. The two of them communicate about my treatment. I am healthier than I have been since insurance made me leave the Doctor who had his advanced degree in genetic medicine. We all need to be treated as if we have different physical and medical needs.

I couldn't agree with you more. My doctor always takes a conservative (dietary, PT, etc) approach first before prescribing meds. I wasn't able to get in the safe zone any other way due to genetics. Ezetimibe and Rosuvastatin are the only cholesterol meds that didn't give me muscle pains or negatively affective my other functions.. 10mg each is a pretty low dose.