Posted: 1/26/2010 12:59:45 PM EDT
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My wife has been having some sharp pains in her chest, right below her right breast. Its been going on for about a week now. She went to the Dr. yesterday, had an EKG and got the results this afternoon. The Dr. suspects that she has Left Ventricular Hypertrophy (Mayo Clinic). She'll be getting a stress test soon.
Being an engineer, I'm all about problems solving and it sucks to not know the answer to this one. I've definately got to work on the feelings part of my response, so my wife doesn't hate me! Anyone know anything about this, or have any experience? K |
| I dont know anything about that specific condition, but I do wish the both of you well. Stress test and echocardiograam are usually relatively standard orders and are very good at determining whats going on in there. I've had two stress tests, an echocardiogram, and been hooked up to enough wires to make me feel like an andriod... Hope it works out for the two of you. |
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What have you got to work on about your feelings? You love her right? Then be there for her and be compassionate and caring. It almost seems you are inconvenienced by her illness and are trying to be nice when you normally would not be. Please tell me I am wrong!
slasher |
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What have you got to work on about your feelings? You love her right? Then be there for her and be compassionate and caring. It almost seems you are inconvenienced by her illness and are trying to be nice when you normally would not be. Please tell me I am wrong! slasher Nope, love the hell out of her. However, socialization from my dad and training as an engineer makes it easy for me to compartmentalize any emotion. She obviously doesn't like that! I recognize it as a fault, but in times of stress I know that I can get VERY non-emotional. Definately something that I need to work on! K |
| You sound a lot like me: Logic trumps love in most daily activities, and deeds are better than words. I've had to deal with this for years, especially after the birth of my second child. My only suggestion is to be as supportive as possible, and as positive as possible. Go out of your way to help out around the house and what not. My wife had her gall bladder removed 6 weeks after a C-section, so the help around the house was especially important. |
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Try not to do too much research or self diagnose. You end up stressing yourself and her out and worrying about things that aren't even in the differential.
Some of the story doesn't sound right. What kind of Dr did she see? She had an EKG but didn't get a reading until then next day? That seems a little odd. Did the Dr order a chest xray? Do any blood work? How old is she? Does she have a history of high blood pressure, diabetes, a heart murmur, have a family history of heart disease, or is she a smoker? Is she short of breath? Cough? Fever? Is the pain worse when she takes a deep breath, or when she eats? How about when she exerts herself or does some exercise? Any recent travel or leg pain or swelling? LVH does not typically cause chest pain. Sometimes it is obvious on the EKG, sometimes it is "iffy". An Echo cardiogram (ultrsound of the heart) is the most common way to look at the size of the left ventricle. Some chest pain is OK to work up over a week or two, some needs to go to the ER and get a lot done in a short period of time. It sounds like her Dr has decided this is the former kind, so that is a good indicator of things. In my ER, I can get the EKG, chest xray, a set of enzymes and if necessary look for clot in the lung with a CT scan, all within an hour or two. During a weekday, I can get an ultrasound (ECHO) and usually a stress test done the same day as well, if indicated. If things get worse, or she gets more symptoms you can always go to the ER. |
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Try not to do too much research or self diagnose. You end up stressing yourself and her out and worrying about things that aren't even in the differential. Yep, I read the mayo clinic and that's all I'm going to do until I talk to the Dr. myself Some of the story doesn't sound right. What kind of Dr did she see? She had an EKG but didn't get a reading until then next day? That seems a little odd. General practitioner. Actually, we prefer the nurse practitioner who is in his office, so she saw her. I assume the EKG needed to be read by someone else? She wsan't seen until later in the afternoon, and the nurse called this morning. Did the Dr order a chest xray? Do any blood work? Nope How old is she? 37 Does she have a history of high blood pressure, diabetes, a heart murmur, have a family history of heart disease, or is she a smoker? No history that I'm aware of. BP is usually quite low. No smoking. Just recently started going to Jazzercise (6 months?) Is she short of breath? Cough? Fever? Nope Is the pain worse when she takes a deep breath, or when she eats? How about when she exerts herself or does some exercise? We're trying to find a correlation. A few hrs after she eats is when it hits. While its hitting, its worse if she bends over. No pain during exercise. Any recent travel or leg pain or swelling? Nope LVH does not typically cause chest pain. Sometimes it is obvious on the EKG, sometimes it is "iffy". An Echo cardiogram (ultrsound of the heart) is the most common way to look at the size of the left ventricle. We're calling the Dr. tomorrow to see what's up. When she took the call today she had two elementary classes in her room (she's a music teacher) was between classes. She didn't have the reaction time to think about asking questions. Some chest pain is OK to work up over a week or two, some needs to go to the ER and get a lot done in a short period of time. It sounds like her Dr has decided this is the former kind, so that is a good indicator of things. Hope so! In my ER, I can get the EKG, chest xray, a set of enzymes and if necessary look for clot in the lung with a CT scan, all within an hour or two. During a weekday, I can get an ultrasound (ECHO) and usually a stress test done the same day as well, if indicated. If things get worse, or she gets more symptoms you can always go to the ER. Thanks for the input! K |
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I don't mean to be a snob, but I am of the opinion that you shouldn't be doing an EKG unless you know how to read it. If it shows an ST elevation MI, and you call the patient the next day to let them know, you can just get out the checkbook to write the malpractice check.
That said: All of those answers are pretty reassuring. She is a fairly young woman without significant risk factors for cardiac disease. The fact that exertion does not trigger or worsen it makes cardiac problems even less likely. It also sounds like she doesn't have much in the way of risk factors for pulmonary embolis (blood clots), or aortic dissection (tearing of the major blood vessel coming off the heart). Doesn't sound like pneumonia. Is it for sure related to eating? Do greasy foods trigger worse episodes? When she is having pain, does it hurt if you push on her abdomen, under her ribs either in the middle or on the right side? Has she had many children? The timing is not quite right (two hours, not around one) after eating, but she may be having biliary colic: Biliary colic — Biliary colic is usually caused by the gallbladder contracting in response to hormonal or neural stimulation usually due to a fatty meal, forcing a stone (or possibly sludge or microlithiasis) against the gallbladder outlet or cystic duct opening, and leading to increased intragallbladder pressure and pain. The stones often fall back from the cystic duct as the gallbladder relaxes. As a result, the discomfort progresses in less than an hour to a steady plateau that ranges from moderate to excruciating and remains constant for more than an hour, then slowly subsides over several hours. In most patients the pain is not very severe which is why it takes several attacks before a patient seeks medical attention. The frequency of recurrent attacks is variable ranging from years to hours [1]. Despite the term "colic", the pain is usually constant and not colicky. The classic attack is described as an intense dull pressure-like discomfort in the right upper or mid abdomen or in the chest that may radiate to the back and the right shoulder blade [2,3]. The pain classically follows ingestion of a fatty meal (about one to two hours after) and usually does not occur during fasting. However, the pain may be unrelated to meals in a substantial proportion of patients [4]. One group suggested that the pain had a circadian pattern, peaking at 9:30 PM [4,5]. In most cases the pain has a characteristic pattern and timing for individual patients. Seeing the Dr is the right thing to do, and the ECHO is probably indicated if there really is LVH on the EKG. I would be willing to bet a fair amount that she does not have LVH, but that the computer in the ekg machine read it as such. I can not remember the last time I saw LVH in a 37 year old female without a history of hypertension or structural heart disease. ?Stress test? It is the Dr.s judgment. If all that looks ok, I would look toward the gall bladder. Her symptoms sound more like that, and at her age it would be the more likely diagnosis. An ulcer is also on the list, as is pancreatitis, athough pancreatitis is much less likely. Also, remember that this is not medical advice, just the ramblings of an unknown person on the internet. 
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juslearnin, thanks for the info!
I did learn after posting last night that her sister and mother have and are on medication for high blood pressure. However, hers is always low and she said that it wasn't high when she was at the Dr's office. She's on the phone now trying to get the Dr. I'll post up when I learn more. Thanks! K |
| My wife had very similar symptoms over the past few years. The doc's determined it was a gallstone, and were gonna "keep an eye on it". Well, back in August she doubled over in pain at work and the next day out came the Gallbladder with some big boulders in it, she has been doing great since then. My wife just turned 30. Her 27yo sister just had her gallbladder removed last month for the same reasons. If you don't mind me asking, is your wife on Yaz or similar variant of birth control?? There is a large class action suit against the manufacturer due to numerous people of unusually young age developing gallstones and other problems, numbness in the extremities, restless leg etc.... Good Luck, I hope all goes well, I'll say a prayer for you both on Sunday. |
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Juslearnin is right on the money IMHO. I'm in the ER as well, and the S/S are all there for GB issues. Would I still do a Cardiac work up? Sure, why not, it is only another couple of lab studies. The U/S of the aorta and the GB would be on the list too. , even before the stress test.
A GP put my dad in the hosp for an MI based on a self reading EKG, and while my own 12 lead skills are not the best, I can spot and elevated T wave or Q wave with the best of them. It took four days for the Cardio. guy to order the GB U/S which sent my dad to the OR that day to take out his (now very infected) GB. This happened in Germany, so medical practice was different than what I'm used to. (still, after four sets of negative cardiac enzymes and several negative EKG's, you would think they would start looking for something else.) I wish you and your wife the best of luck, and hope all works out well for you. Disclaimer: This is just an opinion and not a medical diagnosis, follow through with your PMD. stasiman |
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Random scenario?
Wife goes in with Gallbladder issue. One thing the automated 12-lead machine prints out is "LVH". Sent for reading. MD, possibly even cardiologist looks at it with no clinical correlation and writes "agree". Signs name. Provider says LVH? I've heard of this. We need a stress test and an echo. After expensive cardiology tests are negative, someone listens to or examines patient. HIDA scan/CT scan later, gallbladder comes out. Seen it too many times. Not thinking, covering your butt, poor communitcation, etc. Get her heart checked out. Don't mess with that. I'm just betting it's a red herring. |
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That is exactly correct, and is why I mentioned the pet peeve of people ordering an EKG they don't know how to read it. I can see the exact same EKG with two patients with different clinical scenarios and treat them completely differently. The history and exam dictate where you go, and ordering the wrong test (or a shotgun of tests) at the beginning can lead to a useless, time consuming, and expensive (and sometimes even dangerous) path of more and more invasive tests.
In residency, one of the attendings called it "iatrogenesis imperfecta" and he had the corollary: "The less indicated the procedure is, the more likely you are to have a complication". |
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What did the tests show? We're all hoping for the best here, hope all is well. Technicians who administered the test said she'd live. Cardiac doc's were going to review and get the results to the primary doc. We haven't heard back from her yet. Since this all started, she's not done her Jazzercise, and the pains have pretty much gone away. K |
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Nope, love the hell out of her. However, socialization from my dad and training as an engineer makes it easy for me to compartmentalize any emotion. She obviously doesn't like that! I recognize it as a fault, but in times of stress I know that I can get VERY non-emotional. Definately something that I need to work on! K Grass is always greener on the other side I guess. I'd almost like to be more like you. I'm a very passionate person and tend to go-off half-cocked. I haven't cultivated that Clint Eastwood coolness in the face of full-on emergencies. I'm into preparedness, so I tend to react with something and not just give-up. But the emotion gets the best of me at first. Anyways.... good luck with your wife's issue and yes... for her sake you'll want to be there for her emotionally. I've got an electrical engineer friend who's a lot like you. Women have a hard time understanding the lack of emotion shown in such circumstances. |
| Made me wonder about gallbladder. Engineers can get easily frustrated by medical matters, either as patients, or as a caring family member. They are frustrated by the "inexact" nature of medicine- or that's how they channel their fears or concerns at least, sometimes demanding "exact" answers, when that's often not immediately possible. It's not like physics or engineering lab- and you might find yourself having to deal with that. I've seen it many times. My best wishes to your wife and to you. |
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Letter came from the Doc today that the stress test was normal and the ultrasound showed that her heart is normal sized.
So now the open question is why does she have heart pain when she's on a normal exercise schedule? She's had very few episodes since this has started. One hit last night around 9pm, it was the first one in two days. K |
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Letter came from the Doc today that the stress test was normal and the ultrasound showed that her heart is normal sized. So now the open question is why does she have heart pain when she's on a normal exercise schedule? She's had very few episodes since this has started. One hit last night around 9pm, it was the first one in two days. K She is having chest pain, not heart pain as far as is known so far. Everything you have told us about the pain indicated that it was not from the heart, and now you have a normal stress test as well. As I said above the odds of the pain being from her heart were incredibly small, just like her odds of having LVH were incredibly small. Has she had an ultrasound of her gall bladder yet? Is it really related to exercise? or eating? If it does not occur during exercise, but after exercise it is certainly not indicative of heart pain. It could be chest wall pain, reflux, an ulcer, or, I think most likely gall bladder. |
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Letter came from the Doc today that the stress test was normal and the ultrasound showed that her heart is normal sized. So now the open question is why does she have heart pain when she's on a normal exercise schedule? She's had very few episodes since this has started. One hit last night around 9pm, it was the first one in two days. K She is having chest pain, not heart pain as far as is known so far. Everything you have told us about the pain indicated that it was not from the heart, and now you have a normal stress test as well. As I said above the odds of the pain being from her heart were incredibly small, just like her odds of having LVH were incredibly small. Has she had an ultrasound of her gall bladder yet? Is it really related to exercise? or eating? If it does not occur during exercise, but after exercise it is certainly not indicative of heart pain. It could be chest wall pain, reflux, an ulcer, or, I think most likely gall bladder. Huge distinction. Yes, chest pain, not heart pain. 
No ultrasound of the gall bladder that I'm aware of. We'll definately be calling the doc on Monday. K |