He actually told my mother, “I don’t
think you have a heart problem. This has a GI flavor to it.” GERD often causes
chest pain.
The ER doctor prescribed Prilosec, an indigestion drug. Less than 48 hours later, my mother was undergoing quintuple bypass surgery.
The ER doctor prescribed Prilosec, an indigestion drug. Less than 48 hours later, my mother was undergoing quintuple bypass surgery.
Warning: A negative
troponin test only rules out that you just had a heart attack. It does not -- I
repeat -- it does not rule out imminent heart attack!
A negative troponin test only means you didn’t have a heart attack. It does not mean you won’t within the next 24 hours!
A negative troponin test only means you didn’t have a heart attack. It does not mean you won’t within the next 24 hours!
My sister is a medical doctor. She
flipped when I told her the ER doctor diagnosed my mother’s chest pain and shortness
of breath as GERD.
“This happens all the time!” fumed my sister. “Chest pain is so often misdiagnosed as GERD and patients are sent home and then have a heart attack!”
“This happens all the time!” fumed my sister. “Chest pain is so often misdiagnosed as GERD and patients are sent home and then have a heart attack!”
My mother didn’t have the heart attack.
Two days later she was back in the ER with chest pain, and this time, a different
ER doctor recommended she be admitted because her troponin level was elevated –
not enough to diagnose heart attack, but enough to concern the ER doctor. If
you come in with chest pain complaints, you’ll get the troponin test.
She was supposed to get a stress test
anyways, and realized that being admitted meant she’d get the stress test a lot
sooner than going through her primary care doctor.
There was no further chest pain during her evening and overnight hospital stay, and even next day, no chest pain.
There was no further chest pain during her evening and overnight hospital stay, and even next day, no chest pain.
An echocardiogram was performed first
(the next day) to see if it was safe to have a stress test. The echocardiogram
came back “abnormal,” and the cardiologist recommended the invasive catheter
angiogram.
“It’s unsafe to send you home,” the internal medicine doctor told her after she insisted she wanted to just go home.
“It’s unsafe to send you home,” the internal medicine doctor told her after she insisted she wanted to just go home.
All along, I had felt funny about that
first ER diagnosis of GERD. That first visit wasn’t just for chest pain and
shortness of breath, but my mother had vomited that morning; chest pain,
shortness of breath and vomiting can mean an imminent heart attack.
However, the first ER doctor was too
sure that the chest pain, shortness of breath and vomiting meant GERD.
In my layman’s, common-sense-based
opinion, he should have explained, “The
negative troponin means you did not have a heart attack. We did not give you a
diagnostic test for GERD, and this may very well be GERD, but we also did not
give you any tests to rule out severe heart disease, either. Though your
symptoms sound like GERD, they also sound like extensive coronary artery
blockage. I can’t send you home with a diagnosis of GERD. I am going to send
you home with a diagnosis that you did not have a heart attack. But I can’t say
that you won’t have a heart attack in the next 24 hours.”
The catheter angiogram revealed
extensive coronary artery blockage, and the bypass surgery was begun only a few
hours later; that’s how emergent the situation was.
Prior to surgery, I had asked the
cardiothoracic surgeon, cardiologist and internal medicine doctor, “You mean,
if my mother goes home without this surgery, she might have a fatal heart
attack within a week?” All three simultaneously said yes.
Warning: If you have chest
pain and the ER doctor diagnoses you with GERD, get a CT angiogram! A study by
the University of Pennsylvania School of Medicine showed that a CT angiogram is
an invaluable tool for screening for severe coronary artery disease.
Don’t just go home like my mother did
and think that chest pain that awakens you at 5 am (as with my mother) can be
explained by mere indigestion.
Source: sciencedaily.com
/releases/2009/05/090515104219.htm
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