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icthus
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How do we tell if we're having a heart attack or it's just dysautonomia dysregulation?

Last night I had severe left shoulder pain, clammy palms, great pain the heart area, white pallor, freezing cold. Clonazapam didn't remediate. Laying down didn't help. Lasted 2 hours. Although I finally did sleep, I still have it this morning. Last time, when i asked the doctor what to do in these events, he couldn't give a definitive answer. I am looking for practical advice.

But...this has happened before. I refuse to go to ER because they either dismiss me as a nut-case or admit me in the stepdown unit only to find very low bp and irregular heartbeats. I already know this. Then I'm released.

If I go to the doctor, what tests should I ask him to consider?

If a similar thing happens to you, what do you do?

How do you tell if it is a heart attack or just dysautonomia rearing it's ugly head when the clonazapam doesn't remediate the symptoms?

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I understand your reluctance to go to the ER. With that said...any time you are having an episode that feels like it could possibly be a cardiac event you should go to the hospital. Unless you are hooked up to an EKG machine at home there isn't a way to rule out a heart attack. Do you have a doctor that you see on a regular basis? Cardiologist, Autonomic Specialist, or even a General Practitioner? If you don't...get one. If you do perhaps they could collaberate with the hospital and in the event you need to go to the ER they will be familiar with your medical history.

I know that we can experience a lot of scary symptoms that can be contributed to dysautonomia and it that MAY be the case in this instance too. But b/c these symptoms are classic for an MI as well I wouldn't risk it...please see a doctor!! :P

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I do this. We've finally determined that the most severe episodes are likely due to either vasospasms or small vessel angina.

I would go have a good cardiac workup done. Have a nuclear stress test. Talk to your doctor about any specific heart attack risk factors you might have.

I've done this for years, so I don't obviously run to emergency rooms every time it happens. If it's a milder episode (which they now tend to be since I've been on various meds), I take a couple of aspirin (usually Excedrin) and have a glass or two of wine. This does seem to help about as much as anything. If it's a particularly bad episode, as in the pain being equal to that of childbirth, well, I just do whatever it takes to get through it. This probably isn't particularly helpful to you, but I've done this for years and obviously they haven't all been heart attacks. I wouldn't be here responding to you if they had been.

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The ability to discern between Non Cardiac Chest Pain NCCP and a heart attack is something I had to address for decades. Once I got my gastric system in better shape, I had less "refferred" chest pain and so I don't now often get the sharp or lasting pain that I had previously. (But those skipped heart beats! That's another story!! :P )

Aside from my cardiologists reassurances, I would do things like note the color of my nail beds, or take my blood pressure. Also did the pain change when I moved positions? Did the pain get worse when I took a deep breath? Pains that are impacted by muscle movement or feel like they are on the surface are often non-cardiac.

Collect some information on your own about non-cardiac pain and then take the list to your Doctor and say .... Hey are any of these a good way for me to distinguish on my own if I am having a cardiac or a non-cardiac event? Hopefully they can help you to find some peace of mind for your own unique body and circumstances.

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Hi icthus,

It sounds like we were in the same boat last night. I have been having awful chest pain with shortness of breath for a few weeks now, in fact I have these most days of my life, but they have been really bad in the last few weeks. Well last night it became worse with feelings of dizzyness, vomitting, numbness and pain down my left arm and hand, blurred vision...you get the idea. Knowing all to well these are clasic heart attack symptoms scares me sometimes, and last night was one of the times. And of course the fear was just made matters worse. I have a wonderful repore with my local ER (NOT!) But I was really concerned, so I had my husband take me up to the ER. The thing was I couldn't get out of the car. All the thoughts of what would happen went through my head, They would (like you said) dismiss me as a nut, and send me home with less money, and feeling bad about myself. So I sat there in our car for a short period of time, and decided to come back home. Then I did some things that helped me feel better. I ate. Because I realized I hadn't ate yet, and this was around 6 pm. And I drank some gatorade. I started to feel better almost immediatly. Not perfect, but better. Then I stretched my neck, and it cracked, and it let up on all my symptoms :P ! So what that tells me is mine anyways I am not saying yours was related to my neck.

I like the idea of doing some research, and try to find other things that could be the cause, and bring this to your doctor. The only thing to be ware of is when you do the research you will find a LOT of information on heart attacks and other stuff. I wish I could be more help, but I wanted you to know you are not alone. It is very upseting to have symptoms that feel like a heart attack. Deffinatly make sure that any "other" cause of this has been ruled out first though.

Suzy

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Thanks for all your input. I took your advice and "boldly" asked if the EP could do an EKG to rule out heart attack, which he kindly agreed to. I found a driver, went in (25+ miles away) and my heart is ok.

Interestingly, they said that the typical patient presenting with a heart attack generally does not "get better" when they walk around. That's it for me! When I have these episodes, for some reason, a very slow and steady "geriatric walk" around the room usually seems to quiet the symptoms to some degree. It's still a terrifying experience to have. I live a few miles from Great America, and I can't imagine any of their rides being more rivoting, if you will.

When I left the office, I ended up tearing up - the stress of "Is it or isn't it" is so pressing. And as you all know, even with the good ECG, you still leave the office in the same compromised state that you walked in with. It's not fixed. Life is hard but at least it's good.

Thanks, thanks, thanks for all your input.

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I've been in the same boat over and over. If you are having new symptoms that have not been checked out, they need to be. At minimum, they can do an ekg and check enzymes for heart damage. I've had a bazillion tests, including a cath. My symptoms are a combo of dysautonomia, and possible vasospasm. but it helps to have a good relationship with a cardiologist. My cardiologist has saved me a couple er trips, as I could call her, tell her what was going on, and we could then see whether I needed to go in.

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I'm so glad to hear that everything checked out okay!!!

These episodes sound terrifying and my heart (no pun intended) goes out to you. :rolleyes: It sounds like others have offered some great advice. Perhaps the "walking around" test will work for you...ie. if the pain gets more managable no ER! Maybe you and your doctor can come up with some sort of protocol for when these symptoms present themselves....like take some asprin like bjt22 does and walk around to see if the pain disappates...and if it doesn't call them before going to the ER...something like that.

I hope that you get some answers so that you can find a tx. that will help aliviate these horrible symptoms.

Again...so happy that the EKG was good!

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Thanks for all your input. I took your advice and "boldly" asked if the EP could do an EKG to rule out heart attack, which he kindly agreed to. I found a driver, went in (25+ miles away) and my heart is ok.

Interestingly, they said that the typical patient presenting with a heart attack generally does not "get better" when they walk around. That's it for me! When I have these episodes, for some reason, a very slow and steady "geriatric walk" around the room usually seems to quiet the symptoms to some degree. It's still a terrifying experience to have. I live a few miles from Great America, and I can't imagine any of their rides being more rivoting, if you will.

When I left the office, I ended up tearing up - the stress of "Is it or isn't it" is so pressing. And as you all know, even with the good ECG, you still leave the office in the same compromised state that you walked in with. It's not fixed. Life is hard but at least it's good.

Thanks, thanks, thanks for all your input.

Eased while walking around? That sounds like mine can be many a time. This does indicate atypical angina, or "vasospasm". Surprise, surprise, it's another sort of autonomic dysfunction. It's believed to be a case where sympathetic and parasympathetic controls are out of whack. The same mechanism will trigger cluster/migraine headaches when I'm in that mode, and I'm often dealing with the angina and the headache at the same time. Really, a glass of wine does help me. Or, maybe it just helps me not mind so much! Excedrin helps, too...much as it does with a migraine and the aspirin in the Excedrin is certainly a safeguard.

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  • 4 weeks later...

Glad to have found this post. I have had what feel like angina episodes (for years, off and on)- they do usually come on after exertion, anger, etc - which worries me a lot; but they last 1.5-2 hrs. I also feel anxious, digestive upset - like need to go to the bathroom, etc. I cannot sit still though! I have to move around at a slow, regular pace - I usually just tidy up the house very slowly. I thought I was just distracting myself so as not to get more anxious, but it seems to help the chest "feeling", which is very hard to describe.

Anyone have the same experiences? I am almost 35 and have echo, stress echo, holtermonitors, reveal, etc that never showed anything but my lovely regular PVCs and rapid heartrates.

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I hate ER'S at but, WHEN IN DOUBT CHECK IT OUT!

I'D RATHER BE HERE TOMORROW THAN NOT!

I've even been back two days in a row and they have said we would rather you come back, with your condition it's hard to tell.

At least you get right in with chest pain and don't have to wait.

I do hope all is well, but it is hard to decide sometimes.

Cardio Dr. always sends me PC too!

Blessings~

BellaMia~

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I can give an update, but it's rather disheartening (no pun intended). First of all, I followed up with the EP the next day for a 12-lead ECG and it showed the normal (for me) stuff. Then, a few weeks later I had an ESOPHAGEAL SPASM in which the entire throat occluded. AHHHH which, according the the follow-followup of the neurologist was misdiagnosed as anaphylaxis but was really the spasm, even though there was total occlusion. AHHH. And the neuro added that the prescribed epi-pen "would give me a 'real trip' to the ER if that's what I wanted." Sarcasm or attempt at humor was not appreciated. I was not the one who diagnosed anaphylaxis and prescribed the epi-pen, and I'd never heard of esophageal spasms before - at least with any measure of understanding. (For those of you who don't know about it - the throat tightens, swallowing and breathing become difficult. Google for more info, though none of the sites I found talked about total occlusion)

The neuro said my heart and lungs don't communicate well per the valsalva and deep breath tests. In addition, I am hypovolemic, hypotensive, vascular constrictive, and probably categorized as low-flow pots. These heart episodes go along with all that. And esophageal spasms do also - in about 40% of the patients. Total occlusion, though, is rare. Well, thanks.

And he remarked that I'm still here. Did it really occlude? Well, no, I like to exaggerate because I like to waste $$$ blathering on to a doctor and exaggerating will sabotage his ability to assess, which is exactly what we are all wanting. Ok, I'm a little upset. At that point, my driver, who sat in the appointment with the great one and me, spoke up and said she came minutes after it happened and saw the high school student who witnessed it all and then she gave physiological remarks about my condition. At that point, the neuro sort-of believed it happened. OR... should I get an affidavit from the student and his mom!!!! I'm sortof angry, as you can "see."

So how did I get out of the occlusion? I told him I was trained in acupressure and after a moment of prayer had the presence of mind to do the "high ones", and showed him. With that he changed his attitude and asked specific questions. Then he remarked that holding the high ones "as I call it" (ahhhhhh) was excellent. It diverted the concentrated energy in the throat area down to the legs, dissipating the event by moving the energy away from it. He told me to do it whenever I feel the throat tightening. If anyone wants to know what I did, pm me.

His treatment - see a psychiatrist for dealing with all this. Right. I have a great life as long as I don't have to talk about the details of my symptoms. Who wants to live through those things again and again. I've reinvented myself based on my limitations, and I'm very content with my life. It's only when I'm with him and talking about this stuff that I get edgy. I just want to live. Anyway...

According to him, as far as VARIANT ANGINA, it goes hand-in-hand with LOW FLOW POTS and ESOPHAGEAL SPASMS and there are no clear answers as to treatment when presenting with those three things. The neuro said nitro is absolutely out of the question. He never went any farther because time ran out. And that's the only reason I went to see him. OK - wait another 9 months and try again. If any of you can give insight, it would be so appreciated.

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Sounds as if you had a crappy experience, but variant angina is another of those things that's very hard to treat. The doctor was being correct with this. Some recommend calcium channel blockers. For me, this is helped by all the other drugs I use, but I still have break through episodes. And yes...I'm still here, too. As sucky as it is, sometimes we're just going to hurt. I'm sad to have to tell you that, but maybe that's why the psychiatrist was suggested...maybe you need some help in dealing with scary things happening to you and in dealing with the health care community. Heck, I get a little crazy having to deal with them, too.

There is no excuse for rudeness, but it sounds as if this doctor did tell you what would be considered true. It's doubtful you occluded. I know I recognized early on that I couldn't be in an emergency room every **** day, so over time, I did just learn to deal on my own with this. There's measures I can take that help, but it's just another part of my life.

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I just want to add...as has already been said..get a cardiac workup if you have not had one. I have had it all...including a cardiac cath. They told me I have the arteries of a 16 year old girl and I am 46!! :)

I feel pretty comfortable that my hr is sinus tachycarida...altho I have quite a few PVC's and plenty of ventricular events on a holter monitor...but for me...I usually try to ride it out anymore and assume it is POTS stuff.

BUT if it doesn't "pass" when I lay down (altho I have to lay down for a while)....it would make me really pay attention. AND you know when it is an emergency...or even if you think it might be....I think the ER is the palce to be...even tho we hate.

Erika

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