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Dr. Singh
Dr. Singh, Doctor
Category: Health
Satisfied Customers: 6496
Experience:  MBBS. General Practitioner, experienced in hospital care and primary care.
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I was hospitalized on 2 days ago for chest pain, for testing

Resolved Question:

I was hospitalized on 2 days ago for chest pain, for testing and released late yesterday evening. The doctors and nurses did not tell me anything other than to schedule follow ups and that my synthroid for my hypothyroidism needed adjusting and they were adjusting my topomax because I had a seizure during the stress part when the injected the chemical to induce stress during my nuclear stress test for my heart. Luckily, the nurse who did my discharge makes it a habit to give her patients copies of every piece of paperwork from entrance to the ER to discharge, and reading over that packet, I found a few abnormal test results, but I don't know what they are or what they mean, and I'm hoping you can tell me and maybe can advise on what to ask my doctor when I go for my follow up on January 10th.
First, a little background, I have advanced, chronic Lyme disease, hypothyroidism, hypoglycemia, asthma, allergies, endometriosis (partial hysterectomy 2005), obesity (bariatric surgery 2003), disc and nerve problems in my spine, possibly b/c of Lyme disease timeline fits, etc., seizure disorder. Within the last six months, I started having dizziness and passed out, my blood pressure has been getting very low, the lowest recorded in the 60/40 range, then bouncing in the 140/90 range, my pulse is doing crazy stuff as well, going from the 50s to 130s while I am lying still, all within 10 or 15 minutes. Then the chest pain. crushing pain just to the left of sternum, with sharper pain going into my left shoulder and upper arm, then tingling pain and numbness down my arm up my neck with numbness in my left hand and cheek. That is what sent me to the ER on Dec. 29 about 2am. I am 36 years old and have never had a heart problem, always healthy blood pressure and resting heart rate, despite my weight. Before the Lyme disease caused problems with my spine and inactivity, I was very active and didn't have a weight problem after my bariatric surgery. I was at a very healthy weight and exercised A LOT. Okay, so now you have the background, I will list the tests as they are listed in the discharge paperwork and hopefully you can tell me what they mean and help me with what to ask of my doctor.

In the ER:

ECG:

Sinus Tachy

PLASMA:
NORMAL
Fibrin D-Dimer (HIGH) 475 (0-225.77) ng/ml

BLOOD:
NORMAL
RBC CNT ( LOW) 4.17 (4.2-5.4) x(10)6
HGB (LOW) 11.4 (12.2-16.4) G/DL
HCT (LOW) 35.2 (37.6-54.3) %
MCH (LOW) 27.3 (27.33-34.7) pg
MPV (LOW) 9.8 ( 10.3-13.3) FL

sinus tachycardia monitored by ICU via tele (some kind of remote device I was hooked up to the entire time because I was in a normal ward) but this is mentioned in the notes.

Nuclear stress test results: "possible mild reversible anterior and inferior wall ischemia await cardiology review"

I was released from the hospital with no mention of any abnormal test results an no mention of at home care/symptoms to watch for, so if you could possibly tell me that, I would appreciate it. My husband is driving himself nuts trying to figure out what to do for me, while we wait for my Jan. 10th follow up appt.

Thank you.

LeeXXXXX XXXXX
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Singh replied 2 years ago.

Dr. Singh :

Hi,

Customer:

Good afternoon.

Dr. Singh :

Your EKG result indicates that the rhythm of your heart is normal, but that your heart is beating faster than normal. This can be caused by a number of things such as pain, fever, thyroid abnormality (which might have been the case since they mentioned your thyroid medications needed to be readjusted). A D-dimer level of 475 is high and could be due to a blood clot, heart disease, trauma, recent surgery, etc. So it really is a non-specific test. Your other results RBC, HGB, HCT, MCV, MPV are all results regarding different blood cells their size and number, and though they state low, they are nothing worrisome or concerning. The stress test result may indicate an ischemic event in your heart and is the reason for the follow up. The cardiologist will most likely treat this medically with medications such as aspirin and cholesterol medications, but may decided to do a heart cath and this is a discussion that needs to be had when you follow up with them

Customer:

So does that mean that I might have had a small clot in my heart or a mild heart attack or something? A friend in the medical field who is now a mommy said it meant lack of blood or oxygen to that part of the heart? It just sounded scary and I couldn't understand why they didn't tell me at discharge, I had to find out in the notes. I didn't even get a cardiology referral, just a follow up with family medicine.

Customer:

what does an ischemic event actually mean?

Dr. Singh :

Yes it means that you may have had a mild heart attack. Ischemia is due to lack of oxygen to the tissues. But whatever it was, it appears from your report that it was mild in nature and considered reversible. So that is reassuring.

Dr. Singh :

I hope that clarifies it for you

Customer:

It does clarify, and thank you so very much. Basically, I need to clarify with my family medicine doctor what you have said, which is just a clarification of my discharge paperwork. Then find out what needs to be done to do the "reversing" to make sure my heart can go back to being healthy. In the meantime, for my husband's peace of mind, what should he and I be doing for my care? Because we were told literally nothing...

Dr. Singh :

Take the medications that were prescribed at discharge. Follow a heart healthy diet (low fat, low salt) and moderate exercise 3-5 times a week for 30-40 minutes. Do follow up with the cardiologist and your regular doctor as scheduled. If your symptoms return go to the ER.

Customer:

Ok, thank you. So if my pulse and blood pressure are weird that is probably just because my thyroid medicine will take a few weeks to work, but it probably led to the syncope episode a couply weeks ago. As for any chest pain, then I should return to the ER asap? Other than that, follow a healthy diet, rest, walking (its about all I can do right now) about 3-5 times a week? Is there any distance or time, or just basically build up from where I am and try to do a little more each day?

Dr. Singh :

Yes that can be due to your thyroid abnormality. Yes if you have chest pain again do return to the ER. In terms of exercise, start slow and work your way up to moderate exercise 30-40 minutes 4-5 times a week.

Customer:

Thank you. I appreciate your time. Is the test result an actual result or after the cardiologist sees it (it was read by PA in Cardiology in the hospital) could it be that the result would change and the "ischemic even" mild or otherwise would actual be changed? I'm just wondering if this is something that is a mistake, I don't want to tell concerned relatives and friends, "well, they think it was a mild heart attack" and then find out in a weak that I had the worst case of heartburn in modern history. I know it sounds silly, but I've had tons of folks asking, courtesy of my kids, lol.

Customer:

I will definitely follow your advice, because clearly this was a warning of some kind. The nice thing is I found out I had already lost some weight from the last time I had been to the doctor :)

Dr. Singh :

The result is usually confirmed by a cardiologist. So a report is never finalized until a cardiologist has read it and approved it. It will usually be indicated on the report itself in some manner as "final report" or "read by cardiologist Dr..." etc.

Dr. Singh :

That is good news. Weight loss will definitely help in your health.

Customer:

Ok, so the result is probably the actual real result, but it isn't the stand by, finalized in gold until the MD cardiologist signs it. Thank you again. Have a happy holiday!!

Dr. Singh :

Correct.

Dr. Singh :

Happy Holidays to you too!

Dr. Singh :

If you have any additional questions, please feel free to ask. If no further questions, then please click accept.

Dr. Singh :

Regards

Dr. Singh, Doctor
Category: Health
Satisfied Customers: 6496
Experience: MBBS. General Practitioner, experienced in hospital care and primary care.
Dr. Singh and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.
I forgot to ask what the "anterior" and "inferior" walls of the heart were and what ischemia is. From what I could learn, by definition it is lack of blood or oxygen to portion of the heart? Is that what a heart attack is, in essence? Do you think it would be okay to take aspirin until I see my doctor, since I didn't receive any instruction upon discharge? Thank you.
Expert:  Dr. Singh replied 2 years ago.
Anterior and inferior refers to the front and bottom part of your heart. Those are the areas that they were stating as seeing ischemia in. Ischemia is poor oxygenation to the heart tissue in this case. Yes, in other words heart attack. Yes I do recommend that you take a baby aspirin (81mg) every day unless you have bleeding issues.

Regards
Customer: replied 2 years ago.
Does it mean two heart attacks or one that did damage to two areas? I really appreciate your patience in answering my questions.
Expert:  Dr. Singh replied 2 years ago.
It is hard to say. It can be one or two. This test cannot tell the difference between though.

Regards
Customer: replied 2 years ago.
Is there a test that I can ask for or should as for, or does it not really matter?
Expert:  Dr. Singh replied 2 years ago.
When you visit with the cardiologist he/she will go over the options with you. They may mention a cardiac catherization to explore this further. But this is something that needs to be discussed with the cardiologist.

Regards
Customer: replied 2 years ago.
Alright. Thank you for your clear, concise answers that made all of this stuff understandable for me, and a little less scary. Kiss Happy New Year!!

LeeXXXXX XXXXX
Expert:  Dr. Singh replied 2 years ago.
You are very welcome.

Happy Holidays!
Customer: replied 2 years ago.
Oh, I'm sorry. One more quick question. Since I have advance, chronic Lyme disease, could that have harmed my heart, making me susceptible to this heart attack? Thanks again!

LeeAnn
Expert:  Dr. Singh replied 2 years ago.
Lyme disease can affect the heart. It can lead to arrhythmias and heart failure, these can certainly make one more susceptible to a heart attack. But whether it was the case for you, it cannot be said.

Regards
Customer: replied 2 years ago.
Thank you again for a thorough answer!
Expert:  Dr. Singh replied 2 years ago.
You are welcome.
Dr. Singh, Doctor
Category: Health
Satisfied Customers: 6496
Experience: MBBS. General Practitioner, experienced in hospital care and primary care.
Dr. Singh and 5 other Health Specialists are ready to help you

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