“I just knew something wasn't right”
“I want to thank you, Dr. Vainio. You saved my life.” Patti has always lived a very healthy and traditional lifestyle. She never wanted to be on any medicines and wanted to address her health in the most traditional ways possible. At age 52 she was really doing well and had been able to lose 30 pounds in the Diabetes Prevention Program.
About 6 months ago she started having pain in her neck and between her shoulder blades. Massage and seeing the Chiropractor helped somewhat, but when she started getting dizzy spells, “I just knew something wasn’t right.” Her exam was unremarkable, but her EKG (heart tracing) had changed from an earlier one. The changes were concerning for ischemia (not enough blood flow to the heart muscle) and she was referred to a Cardiologist.
Her stress test was abnormal, so an angiogram was done. This is a test that uses a thin catheter (tube) that goes into a blood vessel in the groin area and allows dye to be injected into the blood vessels of the heart. This showed multiple blockages and she was taken to surgery for a quadruple (4 vessel) coronary artery bypass operation.
She immediately felt better and did well in Cardiac Rehab. She completed the program as she was recovering from surgery and continued to do her exercises at home. She was able to go back to work and really felt she had a new lease on life.
But in the past month or so, she started to have chest pain and dizziness again. She was seen in the Emergency Room, where her EKG and cardiac labs were all normal. She was admitted to the hospital and the Cardiologist was consulted. She had a stress echocardiogram, which is a very good test for heart function and this came back normal. With her recent bypass surgery it was felt she most likely had GERD (gastroesophageal reflux disease) and she was put on a medicine for that and sent home. The esophagus (swallowing tube) goes right next to the heart and acid irritating the esophagus can often mimic heart pain. That’s where the term “heartburn” comes from.
The medicine didn’t help over the next week or so and she was sent for an EGD (esophagogastroduodenoscopy) to look at her esophagus and stomach. The EGD was totally normal, but she was kept on the reflux medicine as a preventative measure.
Her symptoms continued and included a bloating sensation after eating. Abdominal x-rays on an office visit showed lots of stool in her colon. Chronic constipation could easily account for her symptoms and we see it often. If stool gets backed up, it causes lots of cramping as the colon tries to contract. She was sent to the hospital to have an enema as an outpatient procedure.
The enema didn’t really help. She continued to have lower chest/upper left abdominal pain and it was thought this was possibly splenic flexure syndrome. This is a condition where gas gets trapped in the colon in the left upper abdomen and causes distension (swelling), pressure, bloating and pain. This was right in the area of her pain, but was not a totally satisfying explanation.
On a more careful history, her dizziness was accompanied by tingling in her fingers and around her mouth. These are classic symptoms of hyperventilation. I had her take 6 deep breaths in the office and it reproduced her symptoms. Hyperventilation is not fast like in cartoons and TV shows, but is slow, deep breaths that people are never aware of. Swallowed air can cause bloating and a pressure sensation in the abdomen. Hyperventilation causes the carbon dioxide level in the blood to get low and this can cause shortness of breath, dizziness, skipped heart beats (palpitations), tingling in the hands and numbness around the lips.
The treatment for hyperventilation is simple. I showed her how to breathe into a paper bag so she could bring her carbon dioxide levels back up to normal. Her symptoms continued. A few days later she was seen in the Emergency Room again and had a negative evaluation of her heart. She asked me if this could be anxiety causing her symptoms and I had to admit that it could, but we needed to make sure her heart was OK before we could say that for certain.
The Cardiologist was made aware of her workup and her symptoms and set her up for another angiogram. This is not a totally benign test and does have some risks associated with it. The risks are small, but include heart attack, stroke, damage to blood vessels or the heart and risks associated with the dye and radiation. In her case the benefits far outweighed the risks and this is usually the case when someone needs an angiogram.
The angiogram was done last week and showed that a blood vessel that had been 40% blocked on her first angiogram was now 90% blocked. The Cardiologist was able to do an angioplasty (use a balloon to push the vessel open) and put in a stent (a small metal tube to keep the vessel open). Her previously bypassed vessels were open and working fine.
Women are from Venus, men are from Mars. That’s true in personal interactions, but it’s also true when it comes to heart disease. Most heart disease studies have been done on men. Patti didn’t have the classic left arm pain, crushing chest pain, nausea and jaw pain that heralds heart disease in men. Women can often have atypical presentations, including neck and back discomfort, dizziness, abdominal discomfort and unusual fatigue. Heart disease kills more women over age 65 than all cancers combined and kills more women than men every year. Estrogen has a protective effect and risks go up after menopause, but younger women are still at risk. Diabetes, obesity, family history, smoking, high cholesterol, depression and high blood pressure are risk factors.
I saw Patti and her husband today. She’s doing great and is on more medicines than she ever wanted to be on, but she’s happy to be alive and taking them. She continues to use traditional medicines and ceremonies and understands all the diagnostic tests she had were reasonable. She knows without them she would not have had the second angiogram. Her presentation was complicated and it would have been easy to miss her final diagnosis.
She gave me credit for saving her life, but this was much more than me. Still, some days all of us feel underappreciated and it felt good to hear her say that.
I want to thank you, Patti. Today you made me love my job again.
Arne Vainio, M.D. is a Family Practice Physician at the Min-No-Aya-Win Human Services Clinic on the Fond du Lac Ojibwe Reservation in Northern Minnesota. He can be reached at email@example.com.