Two weeks ago, I was on my way to work after a quick appointment in the morning, nothing special, mostly administrative. I got to work, parked the car in the lower underground lot, grabbed my bag from the trunk, and started off up the stairs. Four half-flights up the stairs, I’m on the lowest level of the building and I notice as I’m getting close to the elevator that my chest is hurting a bit.
I hesitated to call it chest pain, because it was more like indigestion, centred right on my sternum and unusual. I don’t normally have anything like that. Hmm…got up to my desk, sat down, did some stuff, it went away. I had been having some challenges with my back the previous few weeks, and I knew I had at least a rib or two out, so maybe it was just positional I thought. No big deal, I guess, it went away. And it wasn’t like it was really painful, maybe a 2 on a scale of 1-10. More than simply “there”, but not causing me great discomfort. And, like I said, it went away.
About 45 minutes later, I needed to talk to a few people, so I started wandering around the building. Ten minutes later, the pain was back. Steady. As long as I was moving, it was there. WTF?
My heart SHOULD have been fine
If you’ve read my blog in recent months, you know I tried to do a treadmill stress test back in September (#50by50ish #36 – A stress test with a side of manscaping) without much initial success, partly as I’m a slug, and partly because they didn’t tell me to stop my amlodipine (calcium-based drugs are bad apparently). I did a follow up test, an ultrasound stress test (aka a stress-echocardiogram) where they give you a drug to jack your heart rate while they take an ultrasound at rest and then again while you’re feeling like a jackrabbit.
Here’s the way it worked. I arrived at the hospital, got registered, wandered down to the unit, got settled in a bed, and they gave me an IV. To ensure they got good pics, they used a contrasting agent called Definity. This is a WEIRD feeling drug. I felt it go up through my arm, enter at the base of my skull and then in a one- to two-second timeline, cascade up the back of my head, over the top and around to the front. Picture putting a tight-fitting hoodie on, and have it lightly tickle your neck, back of your head, top of your head and then front lobes as it goes over top. It’s weird. Then they gave me a drug called dobutamine to make me heart beat faster and see if anything isn’t working somewhere (blockages, etc.). In addition to the imaging, they hooked me up to a monitor and measured heart rates all over my body (check, arms, ankles, etc.). When the dobutamine got going, my heart went up to something like 175 bpm. I felt like I was both vibrating and my entire body was twitching. Not the best of feelings, but it was okay. I couldn’t quite get to the desired level, so they added something like atropine to get me the rest of the way. I lay on my side, the ultrasound paparazzi did their thing, and then they killed the drug to bring me back to normal.
I was doing the test as a preventative to make sure everything was great before starting an active exercise routine, part of a long overdue physical and movement toward addressing my weight and diabetes. The result of the test? My heart was fine. No issues, go do whatever I wanted.
That was in November, this was only February. So why was I getting chest pains from basic exertion? Grrr…
Emergency room 101
After about 90 minutes from the first symptoms down in the parking lot, I decided I would head over to the emergency room at the hospital. Like the ads say, every second counts for protecting deteriorating heart muscle, and while the pain wasn’t acute, it was steady. Plus I have a family history, weight, recent diabetes diagnosis, sleep apnea, and blood pressure issues (albeit corrected to normal with medicine). A heart attack is not out of the realm of possibilities.
Did I mention I thought I might be having a heart attack once before? Yep, about 10 years back. My brother had one, which he initially thought was heartburn and then discovered the next morning that no, it was a heart attack. A few weeks later, I got really bad heartburn one night, unlike anything I had had before, and was thinking, “Wow, that’s a bit painful in my chest…hey, wait a minute”. Turned out mine was indeed just reflux, solved with meds.
Anyway, this didn’t feel the same so off I went to the hospital to be sure. I’d rather be safe than a cliché where people later say, “He thought it was just heartburn, so he didn’t go to the hospital…stupid twit, may he rest in peace.” I work in the same building with my wife, so I went to tell her I was going, and she came with me. Probably overkill but I was glad to have her along. I didn’t feel it was serious enough to call an ambulance. As I sat in the car on the way there, the feeling seemed to go away.
Arrived at the hospital, and chest pains opened the door to the Magic Kingdom pretty readily. One EKG later, plus some blood work, and I was all clear. No signs of a heart attack. They referred me to the Ottawa Heart Institute, the gold standard locally, and gave me a prescription for a baby aspirin a day. I picked up the prescription and started taking it.
I also squeezed in a chiro appointment the next day. Like I said, my back was out of alignment and separate from neck adjustments, he managed to do five full separate adjustments of my ribs and spine. Later that day, the pain was down to about a 1/10. Did the adjustment help? No idea, but it obviously didn’t hurt (no pun intended).
Time for a PET scan
So I’d had a CAT scan five years ago, and lots of LAB work, why not something with PETs? 🙂
The real name of the scan is Positron Emission Tomography (PET) Myocardial Perfusion Imaging. It is another form of picture taking of my heart, both at rest and with heart rate elevated, but a different imaging technique than the ultrasound.
The previous test was done while lying on a table with someone working a little hand held ultrasound over my heart. This one was a little more formal and elaborate.
First, you lie on a table with your hands above your head. I thought from one of the pictures they showed that there would be some sort of strap there to hold on to, but no, you just hold them there. They give you some blankets and pillows to help prop them in position, but you need to basically hold them there for 30-45 minutes.
Second, they raise the table and run it into a little tube about two feet deep. This is the camera, and unlike CAT scans or MRIs, it is only wide enough to basically take a picture of your upper torso. Your head and arms stick out the one side, your lower body out the other.
Third, they give you a “radioactive tracer” i.e. a drug that makes your blood radioactive so the camera can detect the radiation being released. In effect, it works like the contrast agent in the first test. Except the previous contrast agent made me feel wonky with the drug-induced hoody, this drug did nothing noticeable to me.
Fourth, after finishing the “at rest” images, they give me a drug to boost my heart. I assumed it was like the first time, the dobutamine, but no, this one is much less aggressive. Instead of taking my heart rate into the stratosphere, they gave me something called persantine / dipyridamole to take my heart rate up 20-30 bpm above normal. Hardly noticeable.
To be clear, the increased heart rate wasn’t noticeable; the drug certainly was though. They warned me, when it was going in, that it would need to be in my blood for about 4-6 minutes, and then they would give me the “antidote”. The fact that it required an antidote was a good indicator it wouldn’t be pleasant. You know that lovely medicine taste you sometimes get in your mouth with anesthetic? This was similar except I could taste it ALL THROUGH MY BODY and it made every square inch feel like it was nauseated. Like my toes were debating whether they should throw up. It is a CRAPPY, CRAPPY feeling. That lasts, as I said, about 4-6 minutes, then they give you the antidote called aminophylline to counteract it, and the nausea goes away. Not completely, you still feel as if you had been sick, and now you’re not sure you are completely done yet.
Fifth, once you’re back to resting heart rate, they take a few more pics, and you’re done.
Near the end, my right bicep was SCREAMING to MOVE, but, of course, you have to stay still. Then when we were done, they moved the bed back out of the scanner, I could put my shirt back on, and wait in the waiting room until my IV wound stopped bleeding. I’m not joking, the instructions for everyone were, “Sit over there until you stop bleeding.”
I stopped bleeding, but I didn’t leave immediately. I had been a bit slow to get up off the bed initially, a little light-headed, and I was still feeling a bit off while waiting for the IV wound to close. I was probably still looking a little pale as the tech wandering by stopped to see if I was okay. I was wondering about some food and how my body would react, partly as you can’t eat before the scan, so I hadn’t eaten anything in 14 hours or so, and partly because I was nauseated a bit. He told me to start with something with caffeine as it counteracts the drug really well (and the reason you can’t have anything with caffeine in the 24h before the scan too). One chocolate milk and about five minutes later, and I was right as rain.
Getting the results
The tech told me the results would be sent to my family doctor, kind of like a “see ya later” kiss-off. I had assumed I would see someone in the Heart Institute for follow up but apparently not, I was to follow up with my family doctor. I did a dance with the office nurse on the phone, he was trying to get permission from the doctor to tell me the results over the phone or to see if the doctor wanted to see me in person. In the meantime, the Heart Institute called. They DID want to see me (and the nurse said she wished the techs would stop telling people to just follow-up with the family doctor). Right, back to the Heart Institute.
I had the chest pains 14 days ago, did the test 10 days ago, and saw the cardiologist this morning, a Dr. H. They re-ran the EKG, no change, and the bottom-line was that my PET scan is normal. Or as he put it, “Why are you here?”.
I ran him through the incident that put me in emergency, and like all good heart specialists or GPs or anyone with an ounce of medical sense, he congratulated me for taking it seriously and going to emergency rather than sitting there thinking it is probably nothing. We also ran through other medical history, family history, blah blah blah, and bottom-line, it’s not my heart. My heart is working great.
His metaphor for the test is that of a faucet. Turn the faucet on half-way, that’s normal heart; turn it on full, that was the heart after exercising. Full blood flow pumping through all the openings. And my heart works the way it is supposed to, it pumps where it is supposed to, no signs of blockages, etc. Like the previous ultrasound test, all clear.
He asked me about how I had felt since that day. I mentioned the pain was intermittent, sometimes positional, different times of day, etc. I mentioned though that the day before I felt pretty good, and even that morning, I was running a bit late for the appointment (they like you there 15 minutes early, I was only going to be 10 minutes after a parking delay), so I had walked fairly briskly from the garage to the Heart Institute. No pain, it actually felt like a nice little jaunt in the cold morning air.
He said that was practically the definition of proof that it wasn’t the heart. If it had been exercise related heart problems, he said it would ALWAYS do it whenever I exercised. Replicability would be 100%, no exceptions. Of course, he already knew that the test had shown nothing, so easier to say too.
I then asked him about how the test linked to other things like circulation…what if I had a blocked artery somewhere? To go back to his metaphor, he pointed out that if there was a blocked pipe, the heart test would have shown that. If it was seriously narrowed, it likely would have shown too. But general narrowing? No. And he said he would guarantee there was SOME narrowing based on weight, diet, family history, etc.
A few other things were on my mind to see if there was any link, but there wasn’t. None of it heart or circulatory. So he doesn’t need to see me again, unless something happens, in which case I should go back to emergency.
In the meantime, I am to go back to my family doctor with three elements:
- He recommends I keep taking the baby aspirin, given the other variables at play, so long as my stomach tolerates it;
- He wants my doctor and I to keep a focused eye on my cholesterol levels just in case (I’ve never had issues); and,
- Explore the likelihood that it is “gut-related”, since it definitely isn’t heart.
This is good news, of course, as dropping from CARDIAC to GASTRO takes a lot of the scariness out of the equation for immediacy and overall risk. Not nothing, and I have to keep taking it seriously, but not OMG HE’S GOING TO DIE TOMORROW!
And the gastro side isn’t news. I take my Prevacid given a long time problem with reflux, plus I’m on Metformin which is notoriously hard on stomachs. I did take Gaviscon a couple of nights when I had recent pain but it didn’t seem to clear it.
In the end, I don’t know what is wrong with me, but I know one more thing that it isn’t.
On the positive side, the test did give me radioactive blood (I even have a letter to give to airport security officials in case I set off any detectors!). I haven’t seen any signs of super powers yet though. I do have the Spider-Man song in my head:
Is he strong? Listen, bud,
He’s got radioactive blood.
Can he swing from a thread?
Take a look overhead
There goes the Spider-Man.
I figure I’m one lightning strike from turning into the Flash, Hulk or Spider-Man. I don’t know if a Hulk tadpole is that great though. I can’t see anyone worrying about me turning into an enraged frog, saying “Poly angry, Poly smash” and then hopping up and down on things. Maybe a baby Avenger movie.
Physically, it’s not as serious as a heart attack. Which was originally the other name for this post — “not as serious as…”. But that is a bit dark even for me, particularly the number of heart attack events just in my immediate family history. Mentally, it’s kind of just throwing another log on the fire.
♫ Is he strong? Listen, bud…♫