Struggling with Heart Issues: Seeking Effective Diagnosis and Treatment

After spending countless amounts of money, the problem still remains unresolved?

Every time I go out to eat, I start experiencing chest tightness, shortness of breath, and difficulty breathing.
I feel unsteady and almost faint, along with arrhythmia.
However, when I described my symptoms to the doctor at Taoyuan General Hospital, he treated me as if I had a mental illness.
He didn't even let me sit down before he kept looking at my medical records and said, "Next, please..." Because he only focused on the medical history and didn't listen to my symptoms, my appointment felt pointless.
How can I get him to help me investigate for blood clots? I read online that some patients with blood clots may not show significant findings on an ECG due to various factors; 10-30% of patients with intracardiac thrombus may not be visible due to obesity.
Does Taoyuan General Hospital have the latest equipment to check for and potentially break up blood clots? A recent study from 2016 (JACC 2016; 67: 2506) reported that using an appropriate amount of contrast agent and ultrasound energy can fragment fresh thrombus occluding the coronary arteries in patients with myocardial infarction.
I am certain I have cardiovascular issues because I have experienced numerous episodes of arrhythmia (chest tightness, shortness of breath, weakness; my smartwatch shows sinus rhythm).
I feel somewhat better when I take antiplatelet medication.
When I visit the hospital, I might only be able to go when I feel relatively normal, so the doctor cannot perceive my condition; otherwise, I wouldn't be able to stand.
He doesn't listen to my description and just says "next." Someone told me that a CT scan of the coronary arteries has a high radiation dose, and if my heart rate is too fast, the scan won't be successful.
I really don't know how to communicate with the doctor about whether Taoyuan General Hospital's ultrasound can perform a 3D ultrasound without contrast that simulates MRI imaging effects, which could reduce many side effects.
It would only require one injection during the ultrasound to be effective, and it is very safe, costing only around 5,000 NTD.
Using a contrast agent could provide clearer imaging to assist the ultrasound.
Is it possible that the doctors at Taoyuan General Hospital are just too lazy to help me?

nv vivian, 40~49 year old female. Ask Date: 2022/11/07

Dr. Wu Xueming reply Cardiology

If you are concerned about blockages or thrombosis in the coronary arteries, a high-resolution computed tomography (CT) scan can increase the diagnostic rate.
If all other tests are normal and you still have concerns, you can opt to pay out of pocket for this examination.
If you are worried about small thrombi within the heart that are not visible on echocardiography, cardiac magnetic resonance imaging (MRI) can also be used for diagnosis.

Reply Date: 2022/11/07

More Info

It sounds like you are experiencing a range of concerning symptoms, including chest tightness, shortness of breath, and irregular heart rhythms, which understandably have you worried about potential cardiovascular issues. Your frustration with the healthcare system, particularly with the doctor at the hospital who seemed dismissive of your symptoms, is also evident. It's important to feel heard and validated when discussing health concerns, especially when they are as serious as those involving the heart.

Based on your description, it appears that you may be dealing with symptoms that could be related to several underlying conditions, including anxiety, cardiac issues, or even respiratory problems. The symptoms of chest tightness and shortness of breath, especially in a warm environment without air conditioning, could suggest a combination of anxiety and potential cardiac strain. It's also worth noting that anxiety can manifest physically, leading to symptoms that mimic those of heart disease, such as palpitations and shortness of breath.

Regarding your concerns about blood clots, it's true that some patients may not show clear signs on standard tests like an electrocardiogram (ECG). However, there are various diagnostic tools available to assess for blood clots and other cardiovascular issues. These include echocardiograms, which can visualize heart function and structure, and advanced imaging techniques like cardiac MRI or CT angiography, which can provide detailed images of the heart and blood vessels.

If you feel that your current healthcare provider is not taking your concerns seriously, it may be beneficial to seek a second opinion. Look for a cardiologist who specializes in the symptoms you are experiencing. When you do visit a new doctor, consider preparing a detailed account of your symptoms, including when they occur, their severity, and any triggers you’ve noticed. This can help the physician understand your situation better.

In terms of the specific tests you mentioned, such as the use of contrast agents in ultrasound or the potential risks associated with radiation exposure from CT scans, it's essential to discuss these options with your healthcare provider. They can explain the benefits and risks of each test and help you make an informed decision based on your specific health needs.

It's also important to address lifestyle factors that may be contributing to your symptoms. Stress management techniques, such as mindfulness, yoga, or cognitive behavioral therapy, can be beneficial in managing anxiety and its physical manifestations. Regular physical activity, a balanced diet, and adequate hydration can also support overall cardiovascular health.

Lastly, if you are experiencing severe symptoms, such as persistent chest pain, significant shortness of breath, or fainting spells, it is crucial to seek immediate medical attention. These could be signs of a serious condition that requires urgent care.

In summary, while your symptoms are concerning, there are various diagnostic tools and treatment options available. Finding a healthcare provider who listens to your concerns and works with you to find the right diagnosis and treatment plan is key. Don't hesitate to advocate for yourself and seek the care you need.

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