Heart Pain: When to Seek Further Medical Evaluation

Cardiac issues

Doctor, last year I experienced pain five centimeters to the right of my heart and five centimeters below it.
I went to Kaohsiung Chang Gung Memorial Hospital for an examination, where I underwent an exercise electrocardiogram and echocardiogram.
The report indicated that I might have myocardial infarction, but it was uncertain.
I took the report to my long-term hypertension clinic, where the doctor, who is a former Chang Gung physician, reviewed it and said it appeared there was no myocardial infarction.
However, he prescribed me Tenormin (Atenolol) 60 mg sustained-release tablets, which I have been taking for almost a year.
Recently, I have been experiencing sudden pain in the same areas I mentioned, sometimes after shopping or in the middle of the night while sleeping.
After resting for about thirty minutes, the pain subsides.
Last month, I asked the doctor if I could stop taking the medication if there was no myocardial infarction, and I went about a month without it.
I also asked the clinic doctor if I needed to go back to the hospital for further examination, and he said it wasn't necessary.
Today, during the typhoon, I took a nap and suddenly felt a sharp pain, like being stabbed, in the same area where the echocardiogram was performed last year at Kaohsiung Chang Gung Hospital.
I would like to ask if this medication can be taken long-term or if I need to go to the hospital for further tests.
Please advise me.
(I have been taking medication for hypertension for about ten years.
The last time I visited Chang Gung, the doctor suggested a 256-slice CT scan, but it was too expensive for me to afford.)

Cai Xiansheng, 40~49 year old female. Ask Date: 2016/09/15

Dr. He Dongjin reply Cardiology

Hello, can this medication be taken long-term? What examinations should be done? I need to pay out of pocket for a 256-slice CT scan, but it's too expensive.
To be honest, my symptoms are not typical of angina, but the exercise ECG shows abnormalities.
If I still feel unwell, should I ask the doctor if a cardiac catheterization is necessary? Thank you for your concern from Changhua Hospital.

Reply Date: 2016/09/15

More Info

When it comes to heart pain, especially when it has been persistent and is associated with other symptoms, it is crucial to take it seriously and seek further medical evaluation. Based on your description, you have experienced pain in specific areas related to your heart, which has raised concerns about potential myocardial infarction (heart attack) or other cardiac issues.
Firstly, it is important to understand that heart pain can manifest in various ways, and its causes can range from benign to serious. The pain you describe, particularly if it feels sharp or stabbing and occurs intermittently, could be related to several factors, including musculoskeletal issues, anxiety, or even gastrointestinal problems. However, given your history of hypertension and previous evaluations that suggested possible myocardial ischemia, it is essential to rule out any serious cardiac conditions.

The medications you are taking, such as the sustained-release medication for myocardial infarction prevention, are typically prescribed to manage risk factors and prevent further complications. These medications can be beneficial for long-term use, especially if you have risk factors such as high blood pressure. However, the decision to continue or discontinue any medication should always be made in consultation with your healthcare provider, who can assess your current health status and any new symptoms you may be experiencing.

Given that you have had episodes of pain that seem to correlate with physical activity or stress, and considering your history of hypertension, it would be prudent to seek further evaluation. While your previous tests (like the exercise electrocardiogram and echocardiogram) may not have shown significant issues, the fact that you are still experiencing pain warrants a follow-up.
You mentioned that your doctor advised against further testing, but if your symptoms persist or worsen, it is essential to advocate for your health. You might consider asking for a referral to a cardiologist for a more comprehensive evaluation, which could include additional imaging studies or stress tests to assess your heart's function under stress.
In summary, while your previous evaluations may not have indicated a severe problem, the persistence of your symptoms, especially with a history of hypertension, suggests that further investigation is warranted. It is always better to err on the side of caution when it comes to heart health. Please consult with your healthcare provider about your symptoms and the necessity of further testing or adjustments to your medication regimen. Your health and peace of mind are paramount, and ensuring that you receive appropriate care is essential.

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