chest pain

By clj01 Latest Reply 2011-07-02 12:22:23 -0500
Started 2011-06-30 15:46:51 -0500

I just have a question today that hopefully someone out there can answer. I recently had a cath done. I was told by the doctor that there were no blockages, and no need for a stent. I have had episodes since then of chest pain with my worst occuring last night at work. To describe it is almost like reading the symptoms list for a heart attack, except milder. My question is if a cath report says that there are is no plaque buildup, can a person still have a heart attack?

2 replies

rentintin 2011-07-02 12:22:23 -0500 Report

Could you have heartburn? I've had both and they are difficult to tell apart. I was told by the dr to lie down and see if it went away and if not try my nitro, so far it has always gone away. But it is still kind of scary when I have it for a while.

HeartHawk 2011-07-02 09:06:58 -0500 Report


The short answer is, "Yes!" The real answer is a bit more complicated. It begins with a common misconception about heart attacks and what causes them. I'll give the short reply here.

Over 90% of heart attacks occur in arteries that do not restrict blood flow to the point that you would fail a stress test. That is why you can pass a stress test on Monday and have a heart attack on Tuesday. The old school of thought led people to believe a heart attack is part of a progressive narrowing. While this can happen it is the exception not the rule.

Most heart attacks occur because a relatively minor (non-obstructive) plaque in an artery wall ruptures. In the process of repairing the rupture a clot forms and cuts off blood flow. A cath may not pick this plaque up because of something called the "Glagov Effect." As plaque accumulates, arteries actually widen to accomodate that plaque (but not forever). The cath sees wide open blood flow but there may still be dangerous plaques lurking.

A heart attack is nothing more than an interruption of blood flow and there are many other contributing factors such as a spasm in an artery. Your constantly reocurring pain could be angina or any number of other non-cardiac conditions including anxiety attacks (non-life threatening but scary nonetheless).

When you say you have all the other symptoms does it include shortness of breath? I would discuss your symptoms with your doctor. If you get no satisfaction I would ask for a 24-hour or longer Holter Monitor to track your EKG for an extended period just to put your mind at ease. Another suggestion is to discuss taking nitrates during an attack with your doc. If nitrates resolve the pain this would indicate some sort of coronary artery problem.


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