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Chest Pain - What's HCM and what's not?

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  • Chest Pain - What's HCM and what's not?

    Hi,

    In anticipation of going to see my cardiologist next week, I never know what to mention and what not to. Can I run a few things by you and see if it counts as being HCM based or not?!

    1. When I play football (which I know I shouldn't!), after about 2 minutes of running I get bad chest pain (middle of chest), which lasts until I stop playing. My wonder why it's HCM related or not is because I expected HCM chest pain to start after more time into the excercise?

    2. After playing sport sometimes I get chest pain which contnues after playing for a few hours and my uppper left arm hurts too.

    3. Sometimes for the next 2-3 days after playing sport my heart feels like it's trying really hard to beat - a bit like my heart's really tired? I can't describe it any better really, but i feel dreadful - but then improve after a couple of days!

    4. "Quick come - quick go" chest pain. For example sat in car and realise I've forgotten something from upstairs in the house so run in and upstairs and then back to the car... and then spend the next 2-5 minutes with central chest pain. But then goes fairly quickly.

    If anyone knows whether these are HCM or not that would be great! It would help me stop feeling like I'm making things up - I don't want things to sound more serious than they are.

    Thanks,

    Chris.
    In my 30's, Diag HCM Feb 08, ICD May 08, Myectomy June 30th 2011, Gene +ve, At the moment I'm taking... Verapamil 480mg (when I remember).

  • #2
    Re: Chest Pain - What's HCM and what's not?

    That all sounds like legit HCM related chest pain to me. I get chest pain from time to time, and changing my meds around has really helped out with it. Perhaps you should discuss that with your doctor.
    Daughter of Father with HCM
    Diagnosed with HCM 1999.
    Full term pregnancy - Son born 11/01
    ICD implanted 2/03; generator replaced 2/2005 and 2/2012
    Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

    Comment


    • #3
      Re: Chest Pain - What's HCM and what's not?

      Hi,

      Thanks for your feedback. I never know as I think that unless I'm on the floor rolling around in pain then it's never that bad! Like a typical man I have short term memory loss and usually forget about things as soon as they happen!

      And you never know if it's HCM or it's normal for normal people so to just get used to it!

      I did try a Calcium Channel Blocker but ended up worse so came off it. I have a Nitrate Spray but that doesn't seem to do anything.

      Thanks again,

      Chris.
      In my 30's, Diag HCM Feb 08, ICD May 08, Myectomy June 30th 2011, Gene +ve, At the moment I'm taking... Verapamil 480mg (when I remember).

      Comment


      • #4
        Re: Chest Pain - What's HCM and what's not?

        Yes I also would say it is HCM related, I get it on a regular bases and the doctor gave me a med called renexa to try they use it for people that has had a heart attack and have chest pain or angina pain it has helped me alot I think it is from the heart not getting enough oxigenated blood it needs and thr heart needs blood also it is a vital organ if it is really bothering you ask your doctor about Ranexa

        Shirley
        Diagnosed 2003
        Myectomy 2-23-2004
        Husband: Ken
        Son: John diagnosed 2004
        Daughter: Janet (free of HCM)

        Grandchildren: Drew 15,Aaron 13,Karen 9,Connor 9

        Comment


        • #5
          Re: Chest Pain - What's HCM and what's not?

          Oh, yeah. That is ALL HCM pain. Print out that post and show it to your doctor.

          Comment


          • #6
            Re: Chest Pain - What's HCM and what's not?

            Nitrates to treat angina aren't normally recommended for people with HCM so you might want to double-check with your cardiologist about using that spray.
            "Some days you're the dog... some days you're the hydrant."

            Comment


            • #7
              Re: Chest Pain - What's HCM and what's not?

              Chris, it is true that nitrates are NOT recommendeed to treat HCM. Do you see an HCM specialist? Since you are in the UK, you might want to contact the Cardiomyopathy Association - www.cardiomyopathy.org and see if they can help you get to an HCM expert nearby. It definitely sounds like you need some meds adjusted and that you could benefit from seeing a specialist. Not all cardiologists are up on what is good for HCM which often reacts differently than other heart ailments.
              Daughter of Father with HCM
              Diagnosed with HCM 1999.
              Full term pregnancy - Son born 11/01
              ICD implanted 2/03; generator replaced 2/2005 and 2/2012
              Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

              Comment


              • #8
                Re: Chest Pain - What's HCM and what's not?

                Why no nitrates for us, I take 1000mg twice daily
                Shirley
                Diagnosed 2003
                Myectomy 2-23-2004
                Husband: Ken
                Son: John diagnosed 2004
                Daughter: Janet (free of HCM)

                Grandchildren: Drew 15,Aaron 13,Karen 9,Connor 9

                Comment


                • #9
                  Re: Chest Pain - What's HCM and what's not?

                  They are vasodialators (they open up the veins) and if you have tiny veins, then they are good for you. If you have high blood pressure, they are good for you because they will cause your bp to drop--which is why they are usually not sued for HCM patients. Our bp is usually fine or low already.

                  Comment


                  • #10
                    Re: Chest Pain - What's HCM and what's not?

                    http://health.usnews.com/articles/he...omyopathy.html

                    This is a very interesting and enlightening description of what may be the issue for some HCM hearts and reasoning behind it.

                    Article Outline


                    • References
                    • Copyright
                    To the Editor:

                    We read with great interest the study by Chou et al1 in a recent issue of the Journal. The authors showed that patients with mitral valve prolapse syndrome (MVPS) have a higher frequency of angiotensin I–converting enzyme (ACE) insertion/insertion (I/I) genotype.

                    This study surprised and encouraged us because we reported that the I/I genotype of the ACE gene is a significant risk factor for atrial fibrillation2 and cardiovascular events3 in patients with hypertrophic cardiomyopathy (HCM).

                    The renin angiotensin system regulates sodium balance and intravascular volume and, in addition, interacts with other blood pressure control mechanisms including the sympathetic nervous system and baroreflexes.4 Because patients with HCM have small left ventricular cavity size because of hypertrophy, reduction of intravascular volume is related to hypotension. In addition, exercise hypotension due to inappropriate peripheral vasodilation is demonstrated in patients with HCM.5 Therefore, activating renin angiotensin system may be a protective means for maintaining intravascular volume and systemic circulation in these patients. In fact, ACE inhibition in patients with HCM is known to aggravate hemodynamics6 and lead to hypotension and excessive systolic emptying.7 Thomson et al8 suggested that hypotension during central volume unloading might provide an additional or alternative trigger for arrhythmia in some patients with HCM.

                    In patients with MVPS, the reduction of left ventricular volume, such as a reduced venous return, tachycardia, or an augmentation of myocardial contractility, results in earlier occurrences of prolapse during systole. In addition, dehydration and administration of nitroglycerin deteriorate systemic circulation in patients with MVPS, which are similar to HCM.

                    Plasma ACE activity is significantly higher in individuals with the D allele than in individuals with the I allele. Patients with the ACE I/I genotype can be thought to be in a circulatory ACE inhibitory state and have unstable systemic circulation because of comparatively reduced intravascular volume than the other patients. Although many studies have suggested that the D allele is a risk factor for many types of cardiovascular disease, there are few reports that the ACE I/I genotype is a risk factor for cardiovascular disease. In general, excessive volume overload is harmful in most types of cardiovascular disease. On the contrary, however, it may actually be beneficial to patients with MVPS and HCM. Therefore, it may be acceptable that patients with MVPS have a higher frequency of the ACE I/I genotype as a genetic risk factor. Orthostatic hypotension and neurally mediated syncope should be investigated about the association with ACE gene polymorphism.

                    References
                    1. Chou HT, Chen YT, Shi YR, et al. Association between angiotensin I–converting enzyme gene insertion/deletion polymorphism and mitral valve prolapse syndrome. Am Heart J. 2003;145:169–173. Abstract | Full-Text PDF (78 KB) | CrossRef

                    2. Ogimoto A, Hamada M, Nakura J, et al. Relation between angiotensin-converting enzyme II genotype and atrial fibrillation in Japanese patients with hypertrophic cardiomyopathy. J Hum Genet. 2002;47:184–189. MEDLINE

                    3. Ogimoto A, Hamada M, Nakura J, et al. Relation between angiotensin-converting enzyme II genotype and cardiovascular events in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2003;41(Suppl. A):146A.

                    4. Reid IA. Interactions between ANG II, sympathetic nervous system and baroreceptor reflexes in regulation of blood pressure. Am J Physiol. 1992;262:E763–E778. MEDLINE

                    5. Frenneaux MP, Counihan PJ, Caforio ALP, et al. Abnormal blood pressure response during exercise in hypertrophic cardiomyopathy. Circulation. 1990;82:1995–2002. MEDLINE

                    6. Kyriakidis M, Triposkiadis F, Dernellis J, et al. Effects of cardiac versus circulatory angiotensin-converting enzyme inhibition on left ventricular diastolic function and coronary blood flow in hypertrophic obstructive cardiomyopathy. Circulation. 1998;97:1342–1347. MEDLINE

                    7. Topol EJ, Traill TA, Fortuin NJ. Hypertensive hypertrophic cardiomyopathy of the elderly. N Engl J Med. 1985;312:277–283. MEDLINE

                    8. Thomson HL, Morris-Thurgood J, Atherton J, et al. Reduced cardiopulmonary baroreflex sensitivity in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1998;31:1377–1382. Abstract | Full Text | Full-Text PDF (96 KB) | MEDLINE | CrossRef
                    Dx @ 47 with HOCM & HF:11/00
                    Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
                    Lead failure,replaced 12/06.
                    SF lead recall:07,extracted leads and new device 2012
                    [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
                    Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
                    Genetic mutation 4/09, mother(d), brother, son, gene+
                    Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

                    Comment


                    • #11
                      Re: Chest Pain - What's HCM and what's not?

                      Hi All,

                      Thank you. I'll print out my list of pain symptoms and take it with me and see what happens. I just wanted to check so I didn't seem to be complaining about things that were "normal" anyway! My consultant seems pretty good and I trust his judgement. He seems to have a few different views to some things that I read, but then I probably tend to play down how things are as I don't want to cause a fuss (and I'm new to all this HCM stuff).


                      Can I also ask another question??? As me and my family are new to all this chest pain thing... when's the right time to go to the ER when you have chest pain or just plain feel awful in a "heart related" way? My wife is always jumpy and wants me to go as soon as I say i hurt - and I never want to go whatever as I don't think there is much they would do anyway?! What would you suggest?

                      Thanks,

                      Chris.
                      Last edited by Chris_in_shed; 11-16-2008, 11:18 AM.
                      In my 30's, Diag HCM Feb 08, ICD May 08, Myectomy June 30th 2011, Gene +ve, At the moment I'm taking... Verapamil 480mg (when I remember).

                      Comment


                      • #12
                        Re: Chest Pain - What's HCM and what's not?

                        Chris

                        There is quite a bit they can do if you are having a heart attack or a stroke (and obviously if you have a cardiac arrest, someone is calling 911/999 and you need to be defibrillated immediately). Do NOT avoid going to the ER just because they can't reverse HCM. They can do lots of things to calm your heart down and prevent more damage. Chest pain means that part of your heart is without oxygen and the muscle tissue is dying. The more of your heart that consists of dead tissue, the less it is able to function.

                        From http://www.emedicinehealth.com/chest...article_em.htm (good article about all kinds of chest pain):
                        If you are having severe pain, crushing, squeezing, or pressure in your chest that lasts more than a few minutes, or if the pain moves into your neck, left shoulder, arm, or jaw, go immediately to a hospital emergency department. Do not drive yourself. Call 911 for emergency transport.

                        Chest pain is one of the most frightening symptoms a person can have. It is sometimes difficult even for a doctor or other medical professional to tell what is causing chest pain and whether it is life-threatening.
                        * Any part of the chest can be the cause of the pain including the heart, lungs, esophagus, muscle, bone, and skin.
                        * Because of the complex nerve distribution in the body, chest pain may actually originate from another part of the body.
                        * The stomach or other organs in the belly (abdomen), for example, can cause chest pain.


                        When to go to the ER:

                        From the Mayo Clinic:
                        If you experience unexplained and persistent chest pain or a feeling of pressure or tightness in your chest — particularly if it's accompanied by other signs and symptoms, such as shortness of breath, sweating, nausea, dizziness or pain that radiates beyond your chest to one or both of your arms or your neck — seek emergency medical care immediately. If you are having a heart attack, rapid treatment can dramatically reduce the amount of damage to your heart muscle and prevent long-term complications.
                        http://www.mayoclinic.com/health/che...medical-advice

                        American Heart Association:
                        *Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
                        * Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
                        * Shortness of breath with or without chest discomfort.
                        * Other signs may include breaking out in a cold sweat, nausea or lightheadedness
                        http://www.americanheart.org/present...3#Heart_Attack (rather longer explanation)

                        Heart attack and cardiac arrest are different. Here's cardiac arrest:
                        Cardiac arrest strikes immediately and without warning. Here are the signs:
                        * Sudden loss of responsiveness (no response to tapping on shoulders).
                        * No normal breathing (the victim does not take a normal breath when you tilt the head up and check for at least five seconds).

                        Stroke:
                        * Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
                        * Sudden confusion, trouble speaking or understanding
                        * Sudden trouble seeing in one or both eyes
                        * Sudden trouble walking, dizziness, loss of balance or coordination
                        * Sudden, severe headache with no known cause
                        Severe headache and nausea with dizziness


                        Sarah's personal rules based on the guidelines my insurance company gave me (and can't find at the moment): low grade pain that last more than 4 hours w/o other symptoms OR extreme, crushing pain lasting over 15 min w/o other symptoms OR the above situation.

                        I get panic attacks, so I will often take a small (.5mg) amount of Ativan under my tongue (faster delivery) at the onset of symptoms and if they go away after 15 minutes then I don't go to the ER. If they do NOT go away, then I go to the ER.
                        Last edited by Sarah; 11-16-2008, 01:41 PM.

                        Comment


                        • #13
                          Re: Chest Pain - What's HCM and what's not?

                          Chris - Have you had an angio? you had mentioned pain radiating to your left arm & this may involve a vascular issue (but not always). Please discuss ALL your symptoms with your doc (the print out is a great idea).
                          Also, perhaps a frank discussion on your limitations, Sometimes a reminder can put things in perspective (though its not fun!)
                          Marc
                          Diagnosed @ 48
                          Saw Dr. Michael Debakey @ age 5 - "He's fine, just a little noisy"
                          Father to 3 boys 22, 25, 29 (all currently clear - pending genetics)
                          AICD - Valentines Day '08, Spark Plug replaced 11/14
                          After much research, I had a Myectomy @ Mayo for my 50th Birthday '08
                          Quietly going insane . . .

                          Comment


                          • #14
                            Re: Chest Pain - What's HCM and what's not?

                            Hi mbcube,

                            No, not had an angiogram. Although the consultant mentioned maybe having one soon if the chest pain continues. Although I'm only 34 so don't want to get into thinking it's anything other than my HCM.

                            Yeah, I know I need that frank discussion ALL my symptoms and any needed limitations with my doc - I've been trying to avoid that but maybe that time has come. After spending most of the weekend with chest/arm pain and feeling lightheaded, hot etc (which is not usual for me) maybe I do need to cut back what I do.

                            In the past i've been relectant to discuss things because I just don't want to make a fuss or make this seem worse than it is. (but then in my head I don't think there's anything wrong with me still!).

                            Chris.
                            In my 30's, Diag HCM Feb 08, ICD May 08, Myectomy June 30th 2011, Gene +ve, At the moment I'm taking... Verapamil 480mg (when I remember).

                            Comment


                            • #15
                              Re: Chest Pain - What's HCM and what's not?

                              Chris,

                              Sadly, no one is every "too young" for serious health issues. You really need to call your doctor asap about your weekend of pain and other symptoms--it is definitely attention-worthy.

                              I know what you mean about not thinking anything is wrong with yourself. My mom was semi-paralyzed from a stroke over 12 years ago and she still walks backwards or tries to pivot or lift things that she just simply can't. Of course, she falls (and often breaks something) every time she tries something fancy (like a revolving door).

                              It is hard to acknowledge our limitations, but HCM can be managed and you can live a full life span. However, ignoring the warning signs and pushing too hard will not help you. Be kind to yourself. Slow down a little. : ) Your family will thank you!!

                              S

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