Chest Pain: Insights on Heart Health and Testing

Chest discomfort issues?

Hello Doctor: I have been experiencing chest tightness and rapid heartbeat for many years.
I underwent an electrocardiogram (ECG) and a stress test, and the doctor said the results were normal.
I was prescribed Concor 1.25 mg for the rapid heartbeat symptoms.
However, in the past six months, I have occasionally felt chest tightness while lifting heavy objects at work.
During my follow-up visit, I informed the doctor, who ordered another stress test.
After a week, I returned to discuss the results, and the doctor indicated that the report showed a positive reaction, suggesting myocardial ischemia.
He recommended a cardiac catheterization.
I mentioned that I would discuss it with my family, and the doctor prescribed aspirin for me to take once a day.

I would like to ask how accurate the stress test is.
It was normal last year, so why is it abnormal this year? Would it be acceptable for me to take aspirin for three months as a preventive measure and then repeat the stress test? Additionally, why did the doctor recommend cardiac catheterization directly after the abnormal ECG? Are there no other tests that can be performed first? If I occasionally experience stomach discomfort from the aspirin, can I discontinue its use? I have a bit of gastroesophageal reflux.
I apologize for having so many questions, and I would greatly appreciate your answers.
Thank you.

Mr. Wang, 40~49 year old female. Ask Date: 2016/10/25

Dr. Li Han reply Cardiology

Hello, based on your inquiry regarding the symptoms of chest tightness and rapid heartbeat that you have experienced for many years, and considering that previous electrocardiograms (ECGs) and exercise stress tests showed no abnormalities, it is noteworthy that you have recently experienced chest tightness while lifting heavy objects at work.
This year, your exercise stress test showed abnormal results, leading to a recommendation for coronary angiography for further evaluation.

Firstly, your change in symptoms resembles the clinical presentation of angina, which may increase the likelihood of coronary artery disease to 50-70%.
If the exercise stress test is positive, the probability may rise to over 80%.
Therefore, it is essential to administer aspirin for the prevention of acute coronary syndrome.
The exercise stress test serves as a functional assessment, evaluating your running time, whether it can provoke clinical angina symptoms (in your case, chest tightness during heavy lifting), and the presence of corresponding ischemic changes on the ECG to determine your risk level.
If you fall into the moderate to high-risk category, further invasive procedures, such as coronary angiography, may be recommended.

I suggest discussing your concerns and thoughts with your attending physician.
The Changhua Hospital of the Ministry of Health and Welfare is here to support you.

Reply Date: 2016/10/25

More Info

Understanding chest pain and its implications for heart health is crucial, especially when there are underlying symptoms such as palpitations and discomfort during physical activity. Your situation highlights the importance of thorough evaluation and the need for appropriate management strategies.

Accuracy of Exercise Stress Testing
Exercise stress testing, particularly when combined with imaging techniques like echocardiography or nuclear imaging, is a valuable tool in assessing cardiac function and identifying ischemia (reduced blood flow to the heart muscle). The sensitivity and specificity of these tests can vary, but they are generally considered reliable for detecting significant coronary artery disease (CAD). The fact that your previous tests were normal while the recent one indicated myocardial ischemia suggests that changes can occur over time due to various factors, including lifestyle, stress, or progression of underlying disease.

Why the Change in Results?
The transition from a normal to an abnormal exercise stress test can be attributed to several factors:
1. Progression of Disease: CAD can develop or worsen over time, especially if risk factors such as hyperlipidemia, hypertension, or family history are present.

2. Lifestyle Changes: Changes in physical activity levels, diet, or stress management can impact heart health.

3. Testing Conditions: Variability in testing conditions, including your physical state on the day of the test, can also influence results.

Recommendations for Further Testing
Your physician's recommendation for a coronary angiogram (heart catheterization) is based on the need to visualize the coronary arteries directly. This procedure is often considered when non-invasive tests suggest significant ischemia, as it provides definitive information about the presence and severity of blockages. While there are other non-invasive tests (like CT angiography), the coronary angiogram is the gold standard for assessing coronary artery disease.

Role of Aspirin
Aspirin is commonly prescribed for its antiplatelet effects, which help prevent blood clots that can lead to heart attacks. If you experience gastrointestinal discomfort, such as from gastroesophageal reflux disease (GERD), it is essential to discuss this with your healthcare provider. They may recommend alternatives or adjunctive therapies to manage your symptoms while still providing cardiovascular protection.

Monitoring and Follow-Up
If you decide to take aspirin, it is crucial to monitor your symptoms closely. If you experience significant discomfort or if your symptoms worsen, you should seek medical attention promptly. Additionally, if you plan to undergo another exercise stress test after a period of aspirin therapy, discuss this with your doctor to ensure that it is appropriate based on your current health status.

Conclusion
In summary, your symptoms of chest pain and palpitations warrant careful evaluation and management. The exercise stress test is a valuable tool, but changes in results can occur due to various factors. The recommendation for coronary angiography is a prudent step to assess your heart's condition accurately. Always communicate openly with your healthcare provider about any concerns, especially regarding medications like aspirin and their side effects. Regular follow-up and lifestyle modifications can significantly impact your heart health and overall well-being.

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