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[sleeping cough]
Author: Bryan Lombardo (---.bos.east.verizon.net)
Date: 08-21-02 09:27
I was just wondering if in anyway HCM can have an effect on your sleeping? Out of a deep sleep I will just wake up and start coughing, and its actually hard to catch my breath. I really dont know how it comes on, (cause im sleeping ) but its annoying.
Also, What i really dont understand is the enzyme thing. Last 2 times I went to the Drs complaining of chest pain, I had the pains for a week before i would go,they did bloodwork and said my enzyme levels were elevated. They said they could just be elevated because of my HCM but the still kept me for overnight for 1 night one time and for 5 nights another time. I just think its strange that they say it could be high because of the HCM but still decide to keep me over night. And they wouldnt let me go home until the levels decreased Does this sound odd?
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[Re: sleeping cough/enzyme]
Author: Dolly W (---.proxy.aol.com)
Date: 08-21-02 09:38
Interesting. I had a similar thing happen to me about a year ago. I had chest pain and fatigue (more than usual) for about a week. When I finally went to the hospital, my cardiac enzymes were "mildly" elevated. I was admitted and the usual tests were run, but no one could determine if I had experienced a heart attack.
Monday, I told this same story to a thoracic surgeon who said that sometimes a small vessel in the heart "pinches off" which causes enough enzyme to be released and will slightly raise the enzyme level. So, technically, it is a heart attack, but not of severity to cause damage to the major vessels. I'm not sure if all this makes sense, but it satisfied my questions.
Anyone else have input?
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[Re: sleeping cough/enzyme]
Author: Sarah B--Board Moderator (---.client.attbi.com)
Date: 08-21-02 12:28
Dear Bryan and Dolly,
The hospital can't let you leave if you have elevated enzyme levels because they are the standard indication that you are having a heart attack. They can't let people having heart attacks walk out the door or the hosptial would get their butt kicked.
However, this is one area where the "standard" hasn't really caught up to HCM reality. I, too, have experienced elevated troponin levels despite not having had a heart attack.
From my discussions with my local ER and my Mayo specialist, I have formed these conclusions: there are several cardiac enzymes and they measure all of them. Recently, though, they have focused more on troponin and will check people for heart attacks even if troponin is the only elevated enzyme. But my doctor at Mayo said that troponon is very sensitive and it doesn't mean that you've had a heart attack in the classical sense. Basically, HCM puts a lot of stress on the heart and if you are having a lot of chest pain or symptoms, it could cause the troponin to rise in response. It is important to note that it was probably ONLY troponin that was elevated and not any of the other cardiac enzymes, which could indicate more extensive damage or a classic heart attack.
I would love to know if my take is correct on this (Paging Dr. M, paging Dr. M...)
Sarah
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[Re: sleeping cough/enzyme]
Author: Lisa Salberg (---.dyn.optonline.net)
Date: 08-21-02 12:32
Dr. M is busy this week taking his boards...so we have to let him alone
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[Re: sleeping cough/enzyme]
Author: Bryan Lombardo (---.bos.east.verizon.net)
Date: 08-21-02 15:05
Sarah,
I dont believe it was my tropinin level. IM actually about 85-90% sure it wasnt my tropinin level.(I will be able to be 100% sure tomorrow seeing my medical records where "mailed" out on Tues.) Im almost positive one was my CK-MB, but im not sure what the other might be. When, and if my stuff gets here tomorrow ill look and over and let you know..
Bryan
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: sleeping cough/enzyme]
Author: Bryan Lombardo (---.bos.east.verizon.net)
Date: 08-22-02 16:16
It was my CK-MB and my CKMD index. Do these ring a bell to anyone?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: sleeping cough/enzyme]
Author: Sarah B--Board Moderator (---.client.attbi.com)
Date: 08-22-02 17:48
Dear Bryan
I'm not familiar with these enyzmes specifically. As for the sleeping thing, decreased cardiac function can cause the lungs to fill with fluid faster, which makes you cough more. I call it my "cardiac insufficiency cough."
Are you seeing a specialist yet? It sounds like you need a higher level of care than you are getting.
S
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: sleeping cough/enzyme]
Author: AlecW (---.eisai.com)
Date: 09-12-02 12:43
Dear Bryan,
By any chance are you taking an ACE inhibitor like enalapril? Cough is a common adverse event in people receiving ACE inhibitors, though I am unaware of any tendency for the cough to occur more frequently at night.
Chest pain is a symptom of inadequate oxygen getting to your heart muscle. In most cases, this symptom is associated with coronary artery disease, where a large blood vessel supplying the heart muscle is partially blocked, preventing adequate blood flow to part of the heart. This shortage of oxygen can damage the heart muscle cells, which release chemicals called cardiac enzymes into the blood.
In HCM, the mechanisms responsible for chest pain are not completely understood. The most simplistic explanation is that the affected heart muscle has outgrown its blood supply, and when demand is great, as during exercise, stair climbing, etc, the muscle cells can become deprived of oxygen. In addition, there are apparently changes in the structure of the microscopic blood vessels penetrating into the heart muscle, which affect the volume and rate of blood flow through these vessels. In either HCM scenario, the outcome is similar: the muscle cells are deprived of oxygen, and one way they respond would be by release of cardiac enzymes.
In most cases, the oxygen deficit resolves when you stop doing whatever it is that is putting the extra demand on your heart, so the amount of cardiac enzymes that get into your bloodstream is negligible. If you were experiencing sustained chest pain, then you may have released enough cardiac enzymes to bring your blood levels above the normal range.
If sustained chest pain is atypical for you, and your cardiac enzymes were elevated, it was prudent of the ER staff to keep you for observation. Just because someone has HCM doesn't mean they can't suffer a heart attack too!
AlecW
Not an HCM doctor, just a doctor with HCM
Author: Bryan Lombardo (---.bos.east.verizon.net)
Date: 08-21-02 09:27
I was just wondering if in anyway HCM can have an effect on your sleeping? Out of a deep sleep I will just wake up and start coughing, and its actually hard to catch my breath. I really dont know how it comes on, (cause im sleeping ) but its annoying.
Also, What i really dont understand is the enzyme thing. Last 2 times I went to the Drs complaining of chest pain, I had the pains for a week before i would go,they did bloodwork and said my enzyme levels were elevated. They said they could just be elevated because of my HCM but the still kept me for overnight for 1 night one time and for 5 nights another time. I just think its strange that they say it could be high because of the HCM but still decide to keep me over night. And they wouldnt let me go home until the levels decreased Does this sound odd?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: sleeping cough/enzyme]
Author: Dolly W (---.proxy.aol.com)
Date: 08-21-02 09:38
Interesting. I had a similar thing happen to me about a year ago. I had chest pain and fatigue (more than usual) for about a week. When I finally went to the hospital, my cardiac enzymes were "mildly" elevated. I was admitted and the usual tests were run, but no one could determine if I had experienced a heart attack.
Monday, I told this same story to a thoracic surgeon who said that sometimes a small vessel in the heart "pinches off" which causes enough enzyme to be released and will slightly raise the enzyme level. So, technically, it is a heart attack, but not of severity to cause damage to the major vessels. I'm not sure if all this makes sense, but it satisfied my questions.
Anyone else have input?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: sleeping cough/enzyme]
Author: Sarah B--Board Moderator (---.client.attbi.com)
Date: 08-21-02 12:28
Dear Bryan and Dolly,
The hospital can't let you leave if you have elevated enzyme levels because they are the standard indication that you are having a heart attack. They can't let people having heart attacks walk out the door or the hosptial would get their butt kicked.
However, this is one area where the "standard" hasn't really caught up to HCM reality. I, too, have experienced elevated troponin levels despite not having had a heart attack.
From my discussions with my local ER and my Mayo specialist, I have formed these conclusions: there are several cardiac enzymes and they measure all of them. Recently, though, they have focused more on troponin and will check people for heart attacks even if troponin is the only elevated enzyme. But my doctor at Mayo said that troponon is very sensitive and it doesn't mean that you've had a heart attack in the classical sense. Basically, HCM puts a lot of stress on the heart and if you are having a lot of chest pain or symptoms, it could cause the troponin to rise in response. It is important to note that it was probably ONLY troponin that was elevated and not any of the other cardiac enzymes, which could indicate more extensive damage or a classic heart attack.
I would love to know if my take is correct on this (Paging Dr. M, paging Dr. M...)
Sarah
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: sleeping cough/enzyme]
Author: Lisa Salberg (---.dyn.optonline.net)
Date: 08-21-02 12:32
Dr. M is busy this week taking his boards...so we have to let him alone
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: sleeping cough/enzyme]
Author: Bryan Lombardo (---.bos.east.verizon.net)
Date: 08-21-02 15:05
Sarah,
I dont believe it was my tropinin level. IM actually about 85-90% sure it wasnt my tropinin level.(I will be able to be 100% sure tomorrow seeing my medical records where "mailed" out on Tues.) Im almost positive one was my CK-MB, but im not sure what the other might be. When, and if my stuff gets here tomorrow ill look and over and let you know..
Bryan
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: sleeping cough/enzyme]
Author: Bryan Lombardo (---.bos.east.verizon.net)
Date: 08-22-02 16:16
It was my CK-MB and my CKMD index. Do these ring a bell to anyone?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: sleeping cough/enzyme]
Author: Sarah B--Board Moderator (---.client.attbi.com)
Date: 08-22-02 17:48
Dear Bryan
I'm not familiar with these enyzmes specifically. As for the sleeping thing, decreased cardiac function can cause the lungs to fill with fluid faster, which makes you cough more. I call it my "cardiac insufficiency cough."
Are you seeing a specialist yet? It sounds like you need a higher level of care than you are getting.
S
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[Re: sleeping cough/enzyme]
Author: AlecW (---.eisai.com)
Date: 09-12-02 12:43
Dear Bryan,
By any chance are you taking an ACE inhibitor like enalapril? Cough is a common adverse event in people receiving ACE inhibitors, though I am unaware of any tendency for the cough to occur more frequently at night.
Chest pain is a symptom of inadequate oxygen getting to your heart muscle. In most cases, this symptom is associated with coronary artery disease, where a large blood vessel supplying the heart muscle is partially blocked, preventing adequate blood flow to part of the heart. This shortage of oxygen can damage the heart muscle cells, which release chemicals called cardiac enzymes into the blood.
In HCM, the mechanisms responsible for chest pain are not completely understood. The most simplistic explanation is that the affected heart muscle has outgrown its blood supply, and when demand is great, as during exercise, stair climbing, etc, the muscle cells can become deprived of oxygen. In addition, there are apparently changes in the structure of the microscopic blood vessels penetrating into the heart muscle, which affect the volume and rate of blood flow through these vessels. In either HCM scenario, the outcome is similar: the muscle cells are deprived of oxygen, and one way they respond would be by release of cardiac enzymes.
In most cases, the oxygen deficit resolves when you stop doing whatever it is that is putting the extra demand on your heart, so the amount of cardiac enzymes that get into your bloodstream is negligible. If you were experiencing sustained chest pain, then you may have released enough cardiac enzymes to bring your blood levels above the normal range.
If sustained chest pain is atypical for you, and your cardiac enzymes were elevated, it was prudent of the ER staff to keep you for observation. Just because someone has HCM doesn't mean they can't suffer a heart attack too!
AlecW
Not an HCM doctor, just a doctor with HCM