Chest Pain...what to do?

[Dee]

Hi everybody,

As I posted several weeks ago, I had my one year check up and echo, and my cardio said everything looked great, I asked him, "then why am I having these chest pains." No real answer from him as he said, you're echo looked great so there shouldn't be any reason for chest pains. Like I was making it all up or something. He did say, If it's really bothering you, we could do a TEE, so just let me know if you want to do that. Leaving it up to me instead of suggesting that we try to figure out why I am having chest pains. So, I left there trying to forget about it, telling myself it was all in my head.

Yesterday I went to my internal medicine Dr. who I can really talk to easily about anything. He had gotten the notes from my cardio about the chest pains and was wondering why they didn't just go ahead and order the TEE. He feels like it would be a smart thing to do and is going to contact my cardio to get one ordered. The chest pains I'm having are very much like the ones that landed me in the operating room in the first place.

What would you guys do if it were you??? Would you have the TEE done or just wait and see if the pains go away? I'm "queen of denial" and try to make myself think that it's nothing. If my husband wouldn't have literally pushed me into the Dr's office the first time, I might not be here today. Just wanted to see what you're thoughts are and if any of you have had chest pains a year or so out of surgery. They started about a month or so ago, but seem to be getting progressively worse. What to do, what to do???

 

[Karlynn]

As much as I'd hate to go through the test, I'd have the TEE done. Peace of mind is priceless when it comes to your health. The stress you must be feeling, on not knowing what is causing the pain, is not good for your health and could lead to other symptoms.

Best Wishes.

 

[Dee]

Karlynn, you're right. It is causing a lot of stress just worrying and wondering what is going on. I also have a teenage son that is 'behaving badly' right now and that's also adding to my stress load. Sometimes I wonder if it's just the stress that's causing the chest pain....but I would hate to balme it on that and then to find out it was really something else. It's so hard to sort through what's going on in our bodies sometimes.

But, I think you're right....just peace of mind is priceless. I do worry about what all this stress is doing to me........teenagers

 

[Nancy]

Well, SOMETHING is causing your chest pains. Insist on finding out what that thing is. If it were my husband, he'd be in the ER with each one, until the problem was diagnosed.

I hate to see anyone not go to the ER with chest pains, especially since you have had surgery.

I'm with your Internal medicine guy. Get the TEE and find out what that shows.

 

[Jean]

I'm just chiming in to agree. As people with past heart health issues, we don't have the luxury to "waiting to see if it goes away". It might just be stress, but if not, you need to know so you can tackle the problem. Good luck and prayers, Dee.

 

[geebee]

Me, too.

Me, too.

I agree with everyone else if just for your peace of mind. Chest pains can be caused by so many things, even irritated minor muscle pulls. However, with an echo and a TEE behind you, you will be less concerned assuming the TEE is negative also. Once anything heart related is ruled out (being optimistic here), you can then go the route of ruling out other, less life threatening, problems.
Best wishes and smiles,
Gina

 

[Dee]

Thank you guys for all of your input. I'm taking your advise and they have scheduled me for a TEE on Mon. My next question......they want me to be off my coumadin for 4 days before the procedure. That sounds like a long time to me and my INR is effected so easily....it drops like a rock with just one missed dose. I know that either way there are risks. The only TEE I've had before was prior to my OHS so I wasn't on coumadin then. What experiences has anyone else had with a TEE and coumadin.

I appreciate any input you guys have!!!

 

[Ross]

See your post in the coumadin forum! There is absolutely no reason in the bleaming world to be taken off of Coumadin for a TEE. That is utter B.S. and will fit in Al's Wall of Shame very nicely. There is no bleeding involved period!

I think you better get a new doctor before this one kills you.

Dee I don't mean to sound like I'm yelling or scolding you, but this has got to be the poorest excuse I've heard yet for stopping Coumadin.

 

[ccrawford]

Dee - Ross is absolutely right. The risks of being off coumadin for 4 days are totally unneccessary and you need to be looking for another doc who does his homework.Chris

 

[tobagotwo]

Please don't go off your Coumadin for a non-bleeding diagnostic test. That physician should be raked over the coals for suggesting it. He would likely be subjecting you to a far greater risk than whatever is making your chest hurt.

I am wondering, however, if you might also be a candidate for an MRA. Is there any possibility that the issue might be blockage? Did you have any CABG work done, or any hint that there might be any in your future?

There are other things that can cause chest pains, too. Like an intercostal pull (feels just like I imagine a heart attack would). Are the pains triggered by anything, such as activity or movement?

Once we've had our valves renewed, we tend to think that every chest pain has to be associated with them. After all, our valves did just scare us half to death. If they're willing for the TEE with Coumadin, that is probably something that will give you some peace of mind. But a TEE won't help diagnose many other possibilities, such as coronary aretery blockage.

Now, that's not to scare you, especially if you had no incidence of it before. It's just to keep you mindful of other causations.

Best wishes,

 

[LUVMyBirman]

Hi Dee,

Happy to hear you are on your way to an answer. I would NOT hold for four days. Still in the middle of a nightmare from a dental proceedure. Have been living on Lovenox injections here. Started my Coumadin back up last Tuesday and still in the low 2's. I am one of those that "drop like a rock" as well. Then it takes forever to come up.

Have had successful TEE's on Coumadin. As others have had successful detal surgery on Coumadin. My guy would not touch it.

Good luck to you.

PS. Don't forget to take your Pre-Meds!

 

[Karlynn]

Doctors never cease to amaze me by their lack of knowledge regarding Coumadin. I would tell the doctor that you refuse to stop your Coumadin and if he has a problem with that you would need a referral to a doctor who will do it with Coumadin.

This goes back to the old issue of doctors fearing bleeding much more than they fear stroke. Quite frankly, I think they must look at the patients age and think "she/he's too young to be worried about a stroke."

 

[geebee]

Dee,
I agree with Ross. It's just plain stupid to endanger you with going off Coumadin for a TEE. Unless the person doing the TEE is an idiot and manages to gouge your throat, where would the bleeding danger come from? You definitely need to rethink working with whoever recommended going off Coumadin.
Sorry to be so blunt but this kind of thing really irritates me. I can't believe there are still doctors out there that think this way. I have a cardio who actually did a cardica cath without taking me off Coumadin because I was having so many problems with TIAs so, a TEE can certainly be done while on Coumadin.
Smiles,
Gina

 

[xtremlee]

Dee
I like to ignore all my woes also. Epecially the 15 year old kind.
The kids can drive you crazy at that age. I have gotten to where I just let it go in one ear and out the other. I have told my wife she needs to handle the the kids.
Good Luck to ya
Lee

 

[ALCapshaw2]

Hello Dee,

As others have mentioned, the are MANY possible causes of chest pain, including (but not limited to) :

Coronary Artery Disease with Blockage which is diagnosed by a Heart Catheterization and Angiogram

Gastro-Esophageal Reflux Disease (GERD) which is diagnosed by an upper endoscopy (similar to a TEE but uses a camera instead of an ultrasound device)

Chest muscle issues

Sternum pain which can result from bone issues OR having your wires too tight (or possibly contraction of your wires in cold weather)

IF your doctor(s) want to do more than one of those invasive procedures, you may want to ask if they could be combined and done all at once in one or two days while you are off Coumadin.

re: Going OFF Coumadin, ask (TELL) them you want BRIDGE THERAPY which can be either Lovenox injections which you give yourself as you 'pinch up some of your abdominal skin' OR a Heparin Drip which requires a hospital stay of 3 or 4 days before AND after the procedure.

Let us know how it goes.

'AL'

 

[Dee]

Got them to go from 4 days to 2 days.......I had to go to get some blood work done and get my orders for the TEE today, so I asked the nurse about the 4 days of being off coumadin. I told her how I drop so fast after just one missed dose, so she went and asked the cardio again and came back with the answer of "just skip 2 days, Sat. and Sun and start back up again after the procedure on Mon."
I don't know what to think, I'm going to keep researching it and I think I'll call the group that he's with (but they're in another town) and ask one of the Dr.'s there how they handle TEE's with patients on coumadin. I would really like to think that I can trust my cardio and his judgement.
Thanks for all of your input!!!

 

[SHerrin Hutt]

Hi Dee
I have had more TEE than I can count. I have never been off warfin for any of them. I have had them locally and one at Cleveland Clinic.

 

[Ross]

Got them to go from 4 days to 2 days.......I had to go to get some blood work done and get my orders for the TEE today, so I asked the nurse about the 4 days of being off coumadin. I told her how I drop so fast after just one missed dose, so she went and asked the cardio again and came back with the answer of "just skip 2 days, Sat. and Sun and start back up again after the procedure on Mon."

Sorry dear but this is still totally unacceptable. Ask him how many days you should hold to take a bath or maybe drive to the grocery store? There is nothing to think about. The Doctor is 100% WRONG. It's just these types that scare me to death. Sherrins Doctors were the worst Coumadin management people of all time and even they didn't take her off for a simple TEE!

 

[Karlynn]

Dee, please, please hold your ground on this one. These doctors obviously need to learn something. Ask them to show you the official protocol that requires the stopping of warfarin. If they feel mortal bleeding is a risk with a TEE, my question would be "How do they do the TEE for gosh sakes?"

"Mortal" is the operative word here - ask them to show you the mortality statistics for TEEs done while on warfarin therapy. I'm serious about this. If your INR is unstable and fluctuates with little manipulation, then they need to realize that you will not be at risk only for the 2 days you are off it, but quite possibly more. Not to mention that it could cause you to swing to the high side going back on it - and their fear of bleeding could happen, but not because of what the TEE does.

 

[Sherry]

Hi, Dee. Got to chime in with the chorus: you shouldn't be off your coumadin. I had one last year and remained on it -- with no problems. I'd really hold his feet to the fire on this one.