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Chest pain. Hospital trip. Now what?
March 15, 2012 9:14 AM   Subscribe

Surprise hospital trip yesterday for chest pain. Now what?

A little backstory: I am a 43 year old obese female. I had left arm pain and numbness that got worse and spread to my armpit and breast area. Figuring that this wasn't something to fool around with, I went to a walk-in clinic where my EKG looked "abnormal" according to the doctor. He wanted me to get more tests, and sent me to the hospital via ambulance. I had another EKG from the paramedics, and a 3rd at the hospital. In addition, I had blood tests, a chest x-ray, and an ultrasound on my legs to check for clots.

A cardiologist visited me, asked me what happened, and left me with his card. Later I got a prescription for an exercise stress test, a 2D echocardiogram, and a followup appointment with the same cardiologist. After a followup blood test 7 hours after the original one (looking for enzymes that would indicate some sort of "cardiac event" as I understand it) they discharged me. Today I called the cardiologist's office, and the first appointment they could give me was 11 days away! I had the impression that I should call the office immediately and that I would go today. So...

1. Should I be freaking out and insisting on an appointment today? Also, what can I expect from my stress test and my echocardiogram (which is a week later)? I'm familiar with treadmills. Should someone drive me or can I drive myself?

2. Should I be following up with my primary care physician? That was my first stop yesterday, since they do walk-in appointments, but those were full, and I didn't want to wait until today. What do I tell them?

3. Clearly diet and exercise need to change. I do Weight Watchers, and after some weeks of being bad, I've tried to get back on the stick recently. I've lost over 40 pounds, so I know how to do it, I just need to. Same with exercise - I've not gone to the gym in ages with my work schedule, but that's got to change too. I enjoy the treadmill, but what else will help?

4. If you've had a similar scare, what did you do next? What do you wish you had done?

5. I've got a note for work for today and tomorrow, but no doctor's appointments scheduled now. The ER doc said to go back tomorrow if I feel better, but I'm debating if I should if there's a chance of rescheduling an appointment to tomorrow.

Sorry I'm all over the place; I've never had to go to the hospital for myself, and yesterday was a little surreal. My natural tendencies to be calm and reassuring are wearing off, and I'm feeling a little freaked out.
posted by booksherpa to Health & Fitness (10 answers total)
 
The blood tests they did were cardiac enzymes. They would not have discharged you if there was evidence of ischemia or heart attack.
1. Should I be freaking out and insisting on an appointment today? Also, what can I expect from my stress test and my echocardiogram (which is a week later)? I'm familiar with treadmills. Should someone drive me or can I drive myself?

Echocardiogram is ultrasound of the heart. It's easy. They will move a wand with gel over your chest. Sometimes they have to press a bit hard but no biggie. They are doing this test to examine the physical structure of the heart and to measure cardiac output -- Ejection Fraction.

The treadmill stress test is administered to see how your heart behaves under physical stress. They are going to crank up the speed and incline until they can get your heart rate to a desired number. What to expect treadmill stress test. Google "Bruce Protocol" if you are interested.

2. Should I be following up with my primary care physician? That was my first stop yesterday, since they do walk-in appointments, but those were full, and I didn't want to wait until today. What do I tell them?


I would say you don't have to. You could give them a courtesy call and tell them what happened and you have appt. with cardiologist. Cardiologist should send notes to your primary.

3. Clearly diet and exercise need to change. I do Weight Watchers, and after some weeks of being bad, I've tried to get back on the stick recently. I've lost over 40 pounds, so I know how to do it, I just need to. Same with exercise - I've not gone to the gym in ages with my work schedule, but that's got to change too. I enjoy the treadmill, but what else will help?

Congrats for losing over 40 lbs. Walking every day, or at least 5 days a week is a good idea. Since you were not admitted to the hospital, and you are having a treadmill stress test, I am inclined to say you have no restrictions on activity. If you like walking, you are in good shape. Half the battle is finding an activity you enjoy. Keep up with Weight Watchers. Be mindful of areas where you can improve: Are you getting enough sleep? How are your portions? Are you eating too many refined carbs? etc.

5. I've got a note for work for today and tomorrow, but no doctor's appointments scheduled now. The ER doc said to go back tomorrow if I feel better, but I'm debating if I should if there's a chance of rescheduling an appointment to tomorrow.


I would return to work. It will get your mind off things. There is no need to reschedule for earlier appt. if you are asymptomatic. If this were an emergency you would not be at home right now.

Bottom line: from the sound of it, it doesn't sound like you have injury to the heart. If the stress test is abnormal they may recommend a cardiac catheterization. I'm betting it will be normal. That might be a careless thing to say (I have no idea) , but I still bet it will be. Good luck and try not to worry.

I am not a doctor. I am a nurse. Take my advice with a grain of salt.
posted by Fairchild at 10:01 AM on March 15, 2012 [2 favorites]


I'll let those more experienced address your cardiac questions - it's scary stuff, and I'm sorry you didn't get more answers more quickly.

If you enjoy the treadmill, try mixing it up with the stationary bike or elliptical. See if you can find a Really Good personal trainer who can help you find other activities that you enjoy that will help you build strength. As someone who's a similar age and has lost similar amounts of weight, I find that adding muscle enables me to do more and boosts the metabolism even when I'm not using those muscles. I'm now a Huge fan of the exercise classes at my Y like bootcamp that combine cardio and strength. But before you move on to something like, talk to your cardiologist about what they recommend.
posted by ldthomps at 10:07 AM on March 15, 2012


Forgot to add: you can drive yourself for treadmill stress test and echocardiogram.

You don't need earlier appointment and you should not be freaking out. :-) Good luck.
posted by Fairchild at 10:07 AM on March 15, 2012


I concur with most of the above.

(About a year ago I (male, 45, average weight) walked into an emergency room after deciding that the recurring mild chest sensations I felt when pushing myself were probably not normal, and being informed by internet searches that I should drop everything and call 911.

I was admitted and wasn't discharged until four days later, after going through the tests you've been prescribed (mine was a nuclear stress test), and a subsequent angiogram based on stress test results, and having three stents implanted based on the angiogram.

Wish I had just gone to a doctor, who would have prescribed the tests, and everything could have been accomplished as an outpatient (the stent probably with overnight stay), with far less disruption to my family, and far less mental trauma to myself. (And less cost to my insurance company).

1. If the eleven days seems like a long time you could ask them to check with the Cardiologist you were dealing with so see if he's happy waiting 11 days to see you - if he isn't he'll move something around.

2. Definitely keep your Primary in the loop. It's unlikely they would be offended, and and regardless you should never be embarrassed with your doctor - it's counterproductive. They might also be helpful for putting evything in context and advising you on what to do next.

3. Until the tests and follow-ups are done, don't start any new exercise regimen. Take it easy, you'll have time to make the changes later. Depending on that the tests find, you might want to resume exercise in the context of supervised Cardio Rehab where medical pros can monitor you and help keep you confident that you're OK.

4. A week after my experience, on my first day back at work, my boss' boss walked into my office and asked me if I had had any panic attacks yet. That simple question did more to heal me psychologically than you can imagine. He also told me his cardio history, which was considerable. You need to speak to someone who has been where you are.

Your anxiety and freaking out is more than natural - it is to be expected. Just knowing that will help you put your feelings into context. My Cardiologist was great at talking about my heart, but sucked at addressing all the rest of it - the fallout from my finding out that I wasn't invincible and immortal.

Based on enzyme tests and being released, you're either 100% OK, or have caught some problem (hopefully not serious) before it turned urgent. We were both lucky this way.

Stay calm, and follow through.
posted by BK Phil at 10:13 AM on March 15, 2012 [1 favorite]


Cardiac nurse here. 7-10 days after some sort of chest pain and an abnormal EKG with no elevation on your cardiac enzymes is a very typical length of time between leaving the hosp and when we send people to the cardiologist. I wouldnt worry about the length. Take the appointment, go to work but take it easy, don't go doing any overly strenuous exercise, give your mind and your body a break in the meantime. I'm not minimizing the seriousness of this experience, just saying that this is a pretty typical timeline and as Fairchild said, if there was any elevation of those enzymes that indicated damage to your heart, they wouldn't have sent you home. You were very wise to go get things checked out, kudos to you for not resisting when it was suggested and for doing so much beforehand (like the weight loss) to invest in your future cardiac health.
posted by takoukla at 10:19 AM on March 15, 2012 [1 favorite]


Thank you all for the reassurances, especially on the appointment scheduling. I feel much better now about the wait. I guess I'm freaking out not just because it's my first major health scare ever, but also a sense of hurry up and wait. I want to be running around doing things to Fix This, and other than my appointments, I don't have an obvious next step (other than continuing to behave myself diet-wise). It's frustrating.

But again, thank you for helping me feel better emotionally and mentally.
posted by booksherpa at 10:31 AM on March 15, 2012 [1 favorite]


I had a similar incident. I had sharp pain in my upper chest. Went to the doctor next day. He did an ekg. Was perfectly normal. But he sent me to the hospital. Had a nuclear stress test. That resulted in having two stents put into me to open what the attending said was a 98% blockage. When asked why I was still there to talk about it with such a large blockage, he said not to dwell on the past, but worry about your kids and getting better. Roger that. I was in my low 40s at the time.

Follow up with whatever they suggest. Don't panic if they released you. As mentioned before, they will not release you if there is a reason not to. Believe me. I tried to get released to drive myself to the stent procedure. Ending up riding in the ambulance. Got him to turn on the siren!
posted by JohnnyGunn at 11:06 AM on March 15, 2012


booksherpa, you didn't mention having any other medical history aside from obesity, so assuming you don't have other issues/family history, as a 43 year old woman you are low risk for coronary artery disease. I am an ER doctor and I can assure you that following up for a stress test in a week is a standard protocol in such cases. I'm glad that this is prompting you to make important lifestyle changes for your health.

I can't speak to your case and I am not your doctor, but I always tell patients to follow up with their primary care doctor after an episode of chest pain of unknown etiology. There are many causes of chest pain that are not cardiac, and once the cardiac issue is ruled out as a problem, your primary care doctor can help you figure out if it is a gastrointestinal issue, a pulmonary issue, or a musculoskeletal issue (or sometimes it's just a one-off thing and we never figure it out).
posted by treehorn+bunny at 1:09 AM on March 16, 2012


You probably *can* drive yourself to the treadmill test, but if you're like my dad, you may be absolutely freaking exhausted afterwards and not want to drive home. It might be nice if you can find someone to drive you home.
posted by IndigoRain at 9:27 AM on March 17, 2012


Hi there! Three weeks later...

Well, I ended up moving both tests even farther back to take advantage of some time off. I had the echocardiogram yesterday and the exercise stress test today. The tech told me the echocardiogram looked fine, though I'm still waiting for official results. I got the stress test results right away, and the doctor told me everything looked fine. I'm thinking my next step is to make an appointment with my primary care physician to say "Okay... now what?"

In the intervening three weeks I've recommitted to Weight Watchers and am down about 10 pounds, plus I got my husband to join up with me. It's hard to say no to your wife when she asks you from her bed in the ER. :) If nothing comes out of this adventure but that, it was worth the hassle.
posted by booksherpa at 7:22 PM on April 3, 2012


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