Suggestions, please.

[elleng]

A good friend has just been released from hospital after overnight stay. He had heart attack 5 or so years ago, watches diet, etc, so when he developed pain in arm and shoulder, he became fearful.(He's been taking aspirin, stuff for cholesterol, and blood pressure since heart attack.) As pain persisted (it comes and goes) he went to ER, where he was admitted for observation. No cardio-related problems were discovered, so he was discharged with suggestion to take stuff for pain and call them in 3 days. One doc thought it might be digestive/heartburn> related. (He was quite satisfied with care he received. p.s., medicare.)

He's home now, was working at computer (thats his vocation and avocation) and chatting with friends. He just complained of the pain and is napping. Whatever the 'cause,' I wonder whether y'all might have an approach to helping him to relax. There are several things on his mind, largely financial, and I wonder whether there's a way to relieve some anxiety which might, if not cause this pain, at least aggravate it. Ideas?

Thanks.

[Warpy]

1. Of course the pain can be stress related

but if he's having episodes of it, especially at rest, he needs to talk to his cardiologist. He might need to have some of his meds adjusted to keep him pain free.

The hospital visit ruled out an evolving heart attack. That doesn't mean his heart pain is non cardiac and he really needs to talk to his cardiologist.

ER docs are knowledgeable, but that cardiologist knows him.

[elleng]

2. Thanks, Warpy.

He was seen by cardiologists at the hospital, during his overnight stay. The doc who he saw when he first had a heart attack is in NYC; my friend is here in MD. He was at the same cardio unit here about 2 years ago, when they concluded his blood pressure needed attention.

I've not yet had a chance fully to question him about when exactly the episodes occur. I intend to do so. It is not when he's at rest, it seems, but is when he's sitting, conversing, working at computer, in church.

Thanks again, Warpy, as usual.

edit: Pain occurs when he sits, stands or walks. He drove for 6 hours with breaks every 2 hours, within an 11 hour drive Friday.

[mopinko]

3. his stress will go down when someone figures out what is causing it.

he needs to keep going back to the doc until they can tell him what it is. sounds a little like a pinched nerve to me.

[elleng]

4. Thanks, mop.

Sounds like a good one.

[Altoid_Cyclist]

5. I speak as someone who has cardiac problems including 1 MI and 5 coronary stents.

I also have severe neck problems and GI symptoms and the worst part is that all of these can cause pretty much the same symptoms. It's frustrating when I do have symptoms because the heart possibility is the one that's the scariest. If they are able to deduce that it's stress related, I've been on Clorazepate (brand name Tranxene) and that seems to work well for me most of the time. It's cheap and it doesn't make you feel as though you're medicated. It just helps control the anxiety.

I learned the hard way not to let an ER doctor determine if it's a cardiac event. The day that I had my MI I presented with classic heart attack symptoms. They went strictly by the blood test to determine if it was a heart attack and attempted to send me home when it came back negative. Luckily, they had to get permission from my PCP before releasing me and when he heard what my heart rate was, he said that under no circumstances was I to be released. If they had followed proper protocol and done an immediate catheterization, they would have found that it was a heart attack instead of finding out 15 or 16 hours later when the blood test finally confirmed it. By then it was too late to prevent permanent damage to the heart muscle.

[elleng]

6. Fortunately ER had him stay overnight,

and several specialists saw him and several tests were done. He's happy now to know that his heart's in good shape. All this as a Medicare patient. It does seem to be nerve-related, as suggested by smart DUers, so waiting for it to resolve. Improvements each day. Sorry about your experience.

[Altoid_Cyclist]

7. Tell him good luck with his health.

It does get to be taxing when you have to live with a chronic illness.
This is easy to say, but tell him that all he can do is take it one day at a time and try to stay positive.

He seems to have one thing going for him already, and that's having a good support system.
It sounds as though the doctors there are much better than the ones here.

[elleng]

8. Thanks, I will.

Pretty good docs around here, suburban DC, and hosp he went to is newly affiliated with Johns Hopkins. One of the real benefits of living here.

[hyphenate]

9. If he is experiencing chest type pain, another possibility

is that he has GERD, which while painful sometimes, often feels like a heart attack. Or there are, as some people mentioned, some signs of anxiety that manifest in a similar way to angina.

Strangely enough, I had a doctor conclude that I had had a panic attack and he gave me Ativan and sent me home, but it was really a heart attack. I had been getting severe pain, to the point where I was taking 15-20 nitro tabs a day, the top of the bed raised, and trying not to do anything that would tax me. Every few days, I would get up and drive myself to the ER, and they kept sending me home. I finally said fuck this, and drove to another hospital which was farther away, and they kept me. In fact, they did a test for troponin, and it was positive, so they left me to be observed for several days, and then did the catheterization. According to the doctor, I had, indeed, had a heart attack, and I did have damage to my heart muscle. At 43, I guess I wasn't supposed to be having heart attacks.

If your friend has had a heart attack in the past (as you mentioned), have his doctor give him a prescription for nitroglycerin tables. If his pain goes away when he takes one (they're sublingual, so they work fast), it is heart related, whether the tests say so or not. Tell his doctor he should have a troponin test as well, since it is an indicator of heart problem. A light warning--nitro works by opening up the blood vessels, and you know it's working because you get a vicious headache from it. If it's your first time, they tell you you're a nitro virgin.

My heart attacks were in 1999. I know there is no such thing as "remission" with heart disease, but since it's been 10 years since I had any problems with my heart, and I look at the 10 years as a milestone.

I wish I could help more, but I hope he gets an answer soon.

[Warpy]

10. Troponin tests have to be done immediately and again in 8 hours

and if they're patting him on the head and sending him home after the first one, they're not living up to the standard of care.

Nitro tablets can also work for some GI pain, so they're not a totally reliable indicator of the origin of the pain.

[elleng]

11. Thanks for your thoughts, hyphen.

Not heart, but neck nerve/muscle ??? Improving day by day, but he's still often uncomfortable. I think he'll see an internist, who he hopes will direct him properly.