David

Angina

Arrhythmia

How to obtain an accurate heart diagnosis

“It’s important to believe what your body tells you, and to challenge the view that everything is okay,” says David whose frequent visits to the doctor and hospital seemed to get him nowhere. This is his story in his words.

About three years ago, I found that I was forever going to the GP for blood pressure problems and other symptoms. I was already on medication to control my blood pressure, but with shift-work (as a part-time nurse at an aged care facility) and broken sleep, I was becoming more and more fatigued. 

Unfortunately, this impacted on my day-to-day life, and I found myself becoming more irritable and unable to concentrate on anything apart from minor tasks. This escalated to the extent that I was unable to walk any distance, and felt light-headed and strange. My wife and I are very keen on walking (not tramping) as we find this an ideal exercise to wind down from the day’s events, and a chance to talk without other distractions.

But soon enough my wife and I noticed that I was getting cramps in my chest, and strange feelings around my heart. I was rather apprehensive at this stage, and on the way home from an outing, one afternoon, we diverted to the hospital as I felt so unwell. They hooked me up to the machine, and took troponin-level blood tests. After a few hours, they did another series of tests to see if I had, in fact, had a heart attack. These turned out to be negative.

On my third visit (with similar symptoms) the tests were again negative, but the interesting thing was, when I was hooked up to the ECG machine, the alarm kept going off. I was looked at vaguely by the staff, and their response was to turn the alarm volume down. My wife and I both found this strange, as we would have expected them to investigate further. I was told to take three paracetamol and to go home. 

The alarm appeared to be triggered by my abnormally slow pulse, which was not followed up on in the hospital.

I went to ED about three times within about a month, with no heart attack symptoms being found. At one stage, the ambulance driver was going to call for back-up during a transfer, as he couldn’t find my pulse...

Back at the GP’s clinic, I was diagnosed with a classic case of angina, and prescribed a nitrolingual spray for when I felt an angina episode. During this time, I took the spray when I felt unwell, as the symptoms were a new experience to me. The net result was that my blood vessels dilated, and I ended up feeling more confused and unable to function.

Finally, I decided to see a cardiologist privately – a decision that was to change my prognosis and the outcome of my cardiac treatment. I had heard of a Holter monitor, and was told that I could go on a waiting list (several months) but we decided that we could pay for a Holter monitor, and give the results to the cardiologist at our private appointment. The whole Holter monitor hire and cardiologist appointment cost around $600 and was money very well spent.

The results of the holter monitor (24 hours of pulse tracking) was that I had sick sinus syndrome, and my heart was averaging 30-60 beats a minute. It would also stop beating for up to 2-3 seconds at a time. No wonder I felt rotten. The cardiologist implanted a pacemaker two weeks later.

I am still getting used to the pacemaker… it is very unnerving when you feel strange sensations that you haven’t felt before. I think that it is important to believe what your body tells you, and challenge the view that everything is ok. My new GP is very proactive, and has scheduled a pacemaker screening, as we have shifted to a new area.

We shifted from the South to the North Island. When I first had my pacemaker it was set on 60, so I had the “brakes” taken off and it now beats faster when I do exercise.

I joined the Heart Foundation for help (and to help) and I have found it invaluable to talk to other heart event people and to discuss and share their experiences. There is information and help out there. Don’t be afraid to ask!

Lessons from this are:

• If your symptoms continue and are not explained, then ask for a definitive diagnosis. In my case not angina, but a very slow heartbeat.
• If the nitrolingual spray makes you worse, not better, you may have heart arrhythmias that are causing the problem.
• Insist on (and pay for, if need be) a definitive diagnosis, otherwise you could well be being treated for the incorrect cardiac problem.
• If you feel unwell, get your symptoms checked, and enquire about fine-tuning medications. You do not have to live with the uncertainty, but your life does change when adapting to a machine-operated heartbeat.
• Remember that for me, and probably many others, a heart event is a series of new experiences, so you have nothing to compare it to. You may feel better, or worse, but if you have not had a heart event, better than what? Or, worse than what?

Written November 2016