Chronic angina?

[MonkeyFunk]

Hi all, first post here.

I looked through the first few pages and didn't see much, if anything, about heart disease.

I had a stent put in at 41, another angiogram at 43, and now I'm almost at 46, and spent last night in the ER with severe chest pain.

They wanted to keep me 'til the morning to meet with the cardiologist (whom I hate) and I said no - I have no insurance, I can't afford another angiogram/angioplasty (much less a bypass) and the LAST time I presented with such pain, my heart enzymes were much worse than this time, and the last time, they did nothing.

Plus, I've read recent reports that stent-placement isn't any more successful than other, non-surgical, treatments. He said he was aware of such studies, and thought there might be something to them. But here's the kick...

I told the ER doc that I wouldn't get another angiogram/plasty until we tried an aggressive drug regimen first, and he got all pissy. He sent an RN in (and stood behind him) while the RN explained that I would have to sign myself out against Dr.'s orders and blah blah. And I said I understood, thinking that I would at least get the statins and thinner meds that have been shown to be superior, but no. He made me sign myself out with just one small bottle of nitro-glycerin, pretty much insuring that I'll end up coming back for a surgical treatment.

Grrr....

[Warpy]

1. I don't know of any ER doc who will take over a cardiac patient

They'll diagnose the problem, read the EKG, set up the right drips, and then call in the cath lab team and cardiologist on call if necessary.

What you should have done is wait for the cardiologist, explain your insurance situation, and request a trial of aggressive chemical therapy.

The problem with the drugs is that they'll cost a bundle over time, too. People without insurance can often afford generics and forestall surgery for some time.

Try to get in to see the cardiologist. You don't have to like him. You need his skill, not his personality.

He is the one who needs to review your EKG and labs and determine which drugs you'll need to be on.

[MonkeyFunk]

2. Thanks

but they wanted to keep me for another hour or two, as well as run another blood test, and I couldn't afford it.

I presented with very high blood pressure. Why would he not at least give me bp meds?

[Warpy]

3. Becaue he didn't KNOW you!

He didn't do the in depth history and examination. That's the job of your cardiologist. The ER doc is to get you stable enough to wait until the cardiologist comes in. Basically, it WASN'T HIS JOB.

The nitro tabs will drop your blood pressure as well as give you a massive headache.

Again, you really need to see your cardiologist. This is nothing to play with and he's the only dude who can properly prescribe the meds you need.

[mopinko]

4. er docs

ya know, i just had another experience of er guys who basically discounted a possible fatal condition, then washed their hands. my daughter was sent in with pain that her pcp thought looked like appendicitis. they did the full lab yaya, and a ct. said, no appendix is fine. here is a pain shot, goodbye. next 2 days pcp frantically calling to get a hold of her to tell her that she had a kidney infection.
before that, hubby had the full treatment for possible heart attack, ride in the ambulance, overnight, blood tests, imaging stress tests, whole nine yards. no heart attack. didn't bother to find out that he had gallstones. pretty bad gallstones.
the philosophy seems to be- if it isn't gonna kill you right now, it is not my job. i am getting to be more and more agressive with these folks the more this shit happens. i will not let anyone go to the hospital without me.
what is with these people?

[Warpy]

5. Yes, it's EMERGENCY medicine

and that means heart attacks, accidents, assaults, overwhelming allergic reactions, life threatening infections, and folks who get shot real bad.

The ER doc will refer you to your PCP to follow up if a heart attack is ruled out. Gallstones are not life threatening unless the common bile duct has been blocked. Apparently that wasn't borne out by lab work.

Likewise, the ER doc will refer you to your PCP to follow up if abdominal pain continues but appendicitis has been ruled out.

[mopinko]

6. i understand the E part, but

but they had all the labs pointing to kidney infection. ua, cbc, all that shit. the pcp didn't need to do anything but talk to her. why would any doc have abnormal labs on someone, and not tell them? i am kicking myself, because i did not ask to see the test results, and them, because they did not show them. to say nothing of the fact that they had those results long before they did a totally unnecessary ct. thank god for insurance. maybe they were saying the same thing.
this kid and i have a bad relationships, so just spending those hours in the er, with boyfriend (who i do not like) and best buddy was torture. i kept waiting for her to get pissed at me, and start a scene. so i wasn't my usual nosy and assertive self.
and i wasn't around for the hubby thing. i was out of town. but he ended up having 2 more attacks before his surgery. when he described them to the pcp, he knew right away what it was. surely these docs must have had a hunch. they told him after the first round of blood work that it was not his heart. but they kept him all night, did another few thousand dollars worth of tests, and cut him loose without a clue. they could have just as easily done an ultrasound as a stress test.
frustrating.